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Thougaard J, Pedersen L, Walsted E. Feasibility of Constant Work Rate Testing to Detect Exercise-Induced Laryngeal Obstruction. Med Sci Sports Exerc 2024; 56:427-434. [PMID: 38356163 DOI: 10.1249/mss.0000000000003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Exercise-induced laryngeal obstruction (EILO) is a condition in which laryngeal structures inappropriately obstruct the upper airway during exercise. The standard diagnostic test for EILO is the continuous laryngoscopy during exercise (CLE) test, usually performed with an incremental work rate protocol regardless of the nature of the triggering event. Typically, laryngeal obstruction occurs only briefly at the end of an incremental test, near peak work capacity. We aimed to investigate constant work rate (CWR) protocols for CLE testing to expand diagnostic test modalities and improve the understanding of EILO. METHODS In this prospective, self-controlled feasibility study, 10 patients with EILO performed both an incremental and a CWR CLE test at 70%, 80%, and 90% of maximal exercise capacity. Laryngoscopic video data were recorded and compared, and we evaluated the ability of CWR to reproduce the symptoms and laryngeal obstruction seen in incremental testing. RESULTS In 70%-90% of cases, CWR testing induced at least the same severity of obstruction as incremental testing and CLE scores remained comparable across test modalities. CWR at 70% allowed observation of laryngeal obstruction for a significantly longer duration than in incremental testing (158 s; 95% confidence interval, 25-291 s; P = 0.027). Dyspnea intensity appeared higher during CWR testing compared with incremental testing. CONCLUSIONS Submaximal CWR CLE testing is feasible and able to induce EILO equivalent to the standard incremental CLE test. This is the first step toward tailored CLE exercise protocols, and further studies are now needed to establish the utility of CWR in clinical and research settings.
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Affiliation(s)
- Jens Thougaard
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, DENMARK
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Glasson N, Diserens L, Besson C, Raemy A, Rochat Guignard I, Todic J. [Exercise-induced laryngeal obstruction : diagnosis and management]. Rev Med Suisse 2024; 20:453-457. [PMID: 38415733 DOI: 10.53738/revmed.2024.20.863.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Exercise-induced laryngeal obstruction (EILO) is a condition characterized by temporary narrowing or closure of the larynx during physical activity, in particular during intense physical exertion. It generally affects teenagers and young adults and is often misdiagnosed as exercise-induced asthma. Symptoms include dyspnea, wheezing and a feeling of throat tightness during exercise. The aim of this article is to review this often underrecognized condition, its diagnosis and its management.
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Affiliation(s)
- Nicolas Glasson
- Service d'otorhinolaryngologie de chirurgie cervico-faciale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Léonard Diserens
- Service de médecine du sport, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Cyril Besson
- Service de médecine du sport, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Anton Raemy
- Service d'otorhinolaryngologie de chirurgie cervico-faciale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | | | - Jelena Todic
- Service d'otorhinolaryngologie de chirurgie cervico-faciale, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports 2024; 34:e14358. [PMID: 36965010 DOI: 10.1111/sms.14358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.
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Affiliation(s)
- Morten Hostrup
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erik S H Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Søren Jessen
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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4
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He T, Song T. Exercise-induced bronchoconstriction in elite athletes: a narrative review. PHYSICIAN SPORTSMED 2023; 51:549-557. [PMID: 36373406 DOI: 10.1080/00913847.2022.2148137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is the most common chronic disease among elite athletes and when left untreated, can impact both respiratory health and sports performance. In recent years, there has been an increase in the awareness and detection of EIB in elite athletes. This narrative review aims to evaluate the risk, prevention, diagnosis, medication, and anti-doping policies of EIB in elite athletes, and to provide more references for athletes with EIB. The results showed that athletes of endurance, winter, and water sports generally have a higher prevalence of EIB than athletes of other sports. Adaptive warm-up before formal exercise and using heat exchange masks at low temperatures are effective ways for athletes to prevent EIB. For physicians, the exercise challenge test and eucapnic voluntary hyperpnea are the recommended diagnostic methods for EIB in athletes. The treatment of athletes with EIB is medication-based, such as inhaled corticosteroids and beta-2 agonists, but current anti-doping policies should be considered when used.
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Affiliation(s)
- Tianchang He
- Department of research, Shenyang Sport University, Shenyang, Liaoning, China
| | - Tienan Song
- Department of research, Shenyang Sport University, Shenyang, Liaoning, China
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Wang L, Wu S, He B, Liu S, Liang S, Luo Y. Exercise-induced bronchoconstriction assessed by a ratio of surface diaphragm EMG to tidal volume. Physiol Rep 2023; 11:e15860. [PMID: 37960999 PMCID: PMC10643992 DOI: 10.14814/phy2.15860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is usually assessed by changes in forced expiratory volume in 1 s (FEV1 ) which is effort dependent. The purpose of this study was to determine whether the diaphragm electromyogram (EMGdi ) recorded from chest wall surface electrodes could be used to reflect changes in airway resistance during an exercise challenge test and to distinguish patients with EIB from those without EIB. Ninety participants with or without asthma history were included in the study. FEV1 was recorded before and 5, 10, 15, and 20 min after exercise. EIB was defined as an FEV1 decline greater than 10% after exercise. A ratio of root mean square of EMGdi to tidal volume (EMGdi /VT ) was used to assess changes in airway resistance. Based on changes in FEV1 , 25 of 90 participants exhibited EIB; the remainder were defined as non-EIB participants. EMGdi /VT in EIB increased by 124% (19%-478%) which was significantly higher than that of 21% (-39% to 134%) in non-EIB participants (p < 0.001). At the optimal cutoff point (54% in EMGdi /VT ), the area under the ROC curve (AUC) for detection of a positive test was 0.92 (p < 0.001) with sensitivity 92% and specificity 88%. EMGdi /VT can be used to assess changes in airway resistance after exercise and could be used to distinguish participants with EIB from those without EIB.
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Affiliation(s)
- Lishuang Wang
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Senrui Wu
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Baiting He
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Simin Liu
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Shanfeng Liang
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
| | - Yuanming Luo
- State Key Laboratory of Respiratory DiseaseGuangzhou Medical UniversityGuangzhouChina
- Division of Sleep and Circadian DisordersBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- College of Medicine and Public Health, Adelaide Institute for Sleep HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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Gaylord JN, Schaaf S, Frederick E. Exercise-Induced Dyspnea in Collegiate Athletes: Are We Missing the Diagnosis? J Voice 2023; 37:722-728. [PMID: 34162495 DOI: 10.1016/j.jvoice.2021.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Exercise-induced dyspnea (EID) can disrupt an athlete's participation and performance in their given sport. Differential diagnosis of EID is often completed using subjective report and may be inaccurate, therefore increasing the frustration and stress of the athlete. This nonexperimental research study was used to determine prevalence of EID and related respiratory symptoms in athletes at a small, Division I university. METHODS An anonymous survey was provided to athletes at Murray State University as they registered for participation in sports for the 2020-2021 school year. Data from this survey was analyzed as to reported physician-given diagnosis of a respiratory disorder as well as reported symptoms of EID. RESULTS Results showed that athletes with a physician-given diagnosis often did not report symptoms or responses to medications that support that diagnosis. Additionally, athletes frequently reported symptoms of EID without a formal diagnosis of a respiratory disorder. CONCLUSIONS These findings provide preliminary insight and pilot data that may be used to understand the prevalence of EID in collegiate athletes and the need for improved methods of diagnosis for etiologies of EID.
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Affiliation(s)
- J Nikki Gaylord
- Murray State University, Center for Communication Disorders, Murray, KY.
| | - Stephanie Schaaf
- Murray State University, Center for Communication Disorders, Murray, KY
| | - Eric Frederick
- Murray State University, Athletics Department, Murray, KY
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Spivak I, Gut G, Hanna M, Gur M, Shallufi G, Ben-David Y, Nir V, Hakim F, Bentur L, Bar-Yoseph R. The effect of nose clip on exercise-induced bronchoconstriction in adolescents. Pediatr Pulmonol 2023; 58:2647-2655. [PMID: 37378471 DOI: 10.1002/ppul.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Oral breathing is considered to increase hyper-responsiveness of the airways. Data on the need for nose clip (NC) during exercise challenge test (ECT) in children and adolescents is scarce. Ouraim was to evaluate the role of NC during ECT in children and adolescents. METHODS A prospective, cohort study; children referred for ECT were evaluated on two separate visits, with and without a NC. Demographic, clinical data and measurements of lung functions were recorded. Allergy and asthma control were evaluated by Total Nasal Symptoms Score (TNSS) and Asthma Control Test (ACT) questionnaires. RESULTS Sixty children and adolescents (mean age 16.7 ± 1.1 years, 38% Female,) performed ECT with NC and 48 (80%) completed visit 2 (ECT without NC), 8.7 ± 7.9 days after visit 1. Following exercise, 29/48 patients (60.4%) with NC had a decline of ≥12% in forced expiratory volume in the first second (FEV1 ) (positive ECT) compared to only 16/48 (33.3%) positive tests without NC (p = 0.0008). Test result was changed in 14 patients from positive ECT (with NC) to negative ECT (no NC) and in only one patient from negative to positive. The use of NC resulted in greater FEV1 decline (median 16.3% predicted, IQR 6.0-19.1% predicted vs. median 4.5% predicted, IQR 1.6-18.4% predicted, p = 0.0001), and better FEV1 increase after bronchodil at or inhalation compared to ECT without NC. Higher TNSS scores did not predict higher probability to positive ECT. CONCLUSIONS The use of NC during ECT increases detection rate of exercise induced bronchoconstriction during ECT in the pediatric population. These findings strengthen the recommendation of nasal blockage during ECT in children and adolescents.
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Affiliation(s)
- Ilia Spivak
- Department of Pediatrics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hull JH. Persistent symptoms in athletes following COVID-19: time to take a breath in the search for answers? Br J Sports Med 2022; 56:952-953. [PMID: 35640940 DOI: 10.1136/bjsports-2022-105889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
Affiliation(s)
- James H Hull
- Respiratory Medicine, Royal Brompton Hospital, London, UK
- Institute of Sport, Exercise and Health, University College London, London, UK
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Kang N, Koh E, Lee JY, Song WJ, Choi DC, Lee BJ. Cut-off value for exercise-induced bronchoconstriction based on the features of the airway obstruction. PLoS One 2022; 17:e0268969. [PMID: 35617173 PMCID: PMC9135203 DOI: 10.1371/journal.pone.0268969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
The current cut-off value for diagnosing exercise-induced bronchoconstriction (EIB) in adults—percent fall in FEV1 (ΔFEV1) ≥ 10% after exercise challenge test (ECT)—has low specificity and weak evidences. Therefore, this study aimed to identify the cut-off value for EIB that provides the highest diagnostic sensitivity and specificity. Participants who underwent the ECT between 2007 and 2018 were categorized according to ΔFEV1: definite EIB (ΔFEV1 ≥ 15%), borderline (10% ≤ ΔFEV1 < 15%), and normal (ΔFEV1 < 10%). Distinct characteristics of the definite EIB group were identified and explored in the borderline EIB group. A receiver operating characteristic curve was plotted to determine the optimal cut-off value. Of 128 patients, 60 were grouped as the definite EIB group, 23 as the borderline group, and 45 as the normal group. All participants were men, with a median age of 20 years (interquartile range [IQR:] 19–23 years). The definite EIB group exhibited wheezing on auscultation (P < 0.001), ΔFEV1/FVC ≥ 10% (P < 0.001), and ΔFEF25–75% ≥ 25% (P < 0.001) compared to other groups. Eight (8/23, 34.8%) patients in the borderline group had at least one of these features, but the trend was more similar to that of the normal group than the definite EIB group. A cut-off value of ΔFEV1 ≥ 13.5% had a sensitivity of 98.5% and specificity of 93.5% for EIB. Wheezing on auscultation, ΔFEV1/FVC ≥ 10%, and ΔFEF25–75% ≥ 25% after ECT may be useful for the diagnosis of EIB, particularly in individuals with a ΔFEV1 of 10–15%. For EIB, a higher cut-off value, possibly ΔFEV1 ≥ 13.5%, should be considered as the diagnostic criterion.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunsil Koh
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Burman J, Elenius V, Lukkarinen H, Kuusela T, Mäkelä MJ, Kesti O, Väätäinen K, Maunula M, Remes S, Jartti T. Cut-off values to evaluate exercise-induced asthma in eucapnic voluntary hyperventilation test for children. Clin Physiol Funct Imaging 2020; 40:343-350. [PMID: 32491255 PMCID: PMC7496314 DOI: 10.1111/cpf.12647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 05/25/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM The eucapnic voluntary hyperventilation (EVH) testing is a diagnostic tool for diagnostics of exercise-induced bronchoconstriction; while the testing has become more common among children, data on the test's feasibility among children remain limited. Our aim was to investigate EVH testing feasibility among children, diagnostic testing cut-off values, and which factors affect testing outcomes. METHODS We recruited 134 patients aged 10-16 years with a history of exercise-induced dyspnoea and 100 healthy control children to undergo 6-min EVH testing. Testing feasibility was assessed by the children's ability to achieve ≥70% of the target minute ventilation of 30 times forced expiratory volume in 1 s (FEV1). Bronchoconstriction was assessed as a minimum of 8%, 10%, 12%, 15% or 20% fall in FEV1. Patient characteristics were correlated with EVH outcomes. RESULTS Overall, 98% of the children reached ≥70%, 88% reached ≥80%, 79% reached ≥90% and 62% reached ≥100% of target ventilation in EVH testing; of children with a history of exercise-induced dyspnoea, the decline percentages were as follows: 24% (≥8% fall), 17% (≥10% fall), 10% (≥12% fall), 6% (≥15% fall) and 5% (≥20% fall) in FEV1, compared to 11%, 4%, 3%, 1% and 0% among the healthy controls, respectively. Healthy controls and boys performed testing at higher ventilation rates (p < .05). CONCLUSION Eucapnic voluntary hyperventilation testing is feasible among children aged 10-16 years and has diagnostic value in evaluating exercise-induced dyspnoea among children. A minimum 10% fall in FEV1 is a good diagnostic cut-off value. Disease status appears to be important covariates.
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Affiliation(s)
- Janne Burman
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Varpu Elenius
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Heikki Lukkarinen
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Tom Kuusela
- Department of Physics and AstronomyUniversity of TurkuTurkuFinland
| | - Mika J. Mäkelä
- Skin and Allergy HospitalHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Olli Kesti
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Katri Väätäinen
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Maria Maunula
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
| | - Sami Remes
- Department of PediatricsKuopio University HospitalKuopioFinland
| | - Tuomas Jartti
- Department of Pediatrics and Adolescent MedicineTurku University Hospital and University of TurkuTurkuFinland
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Del Giacco S, Couto M, Firinu D, Garcia-Larsen V. Management of Intermittent and Persistent Asthma in Adolescent and High School Athletes. J Allergy Clin Immunol Pract 2020. [PMID: 32620431 DOI: 10.1016/j.jaip.2020.05.003.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Asthma is the most common chronic condition during childhood and adolescence, affecting an estimated 8% of children and youngsters below 18 years in the United States and the United Kingdom. In adolescent athletes, asthma-like symptoms may represent a common consequence of regular sport practice. Asthma in young athletes poses several challenges, including the ambiguity of definitions and diagnosis of asthma resulting from exercise-induced symptoms, the best pharmacological treatments, and the nonpharmacological options for the management of disease and the challenges inherent to this age group. At a time when the regular practice of sports is increasingly being recommended for a healthy living, the support network around the young athletes is crucial to reduce the impact of asthma on their physical and emotional well-being. In this review, we examine the main issues around the definitions and clinical differentiations of asthma in young sport athletes. We discuss best practice approaches to improve the adherence to the clinical management, including nonpharmacological strategies directed at the family and trainers of athlete adolescents.
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Affiliation(s)
- Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Mariana Couto
- Immunoallergology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vanessa Garcia-Larsen
- Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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Kennedy MD, Steele AR, Parent EC, Steinback CD. Cold air exercise screening for exercise induced bronchoconstriction in cold weather athletes. Respir Physiol Neurobiol 2019; 269:103262. [PMID: 31369875 DOI: 10.1016/j.resp.2019.103262] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/10/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Exercise Induced Bronchoconstriction (EIB) prevalence in cold weather athletes is high. Currently, no standardized cold air exercise provocation test exists. Thus we aimed to determine EIB prevalence using a Cold Air Test (CAT; 5 km outdoor running; -15 °C) compared to the most common EIB screen the Eucapnic Voluntary Hyperpnea (EVH) test in cold weather athletes. Sixteen (9 male; 20-35 years old) cold weather athletes completed EVH 72 h before CAT. Spirometry, Fractional Expired Nitric Oxide (FENO), respiratory symptoms were measured and atopy status was determined. Five and 7 participants were EIB + on the EVH and CAT, respectively. Level of agreement was 50% between tests. FEV1 recovery was significantly prolonged and Peak Expiratory Flow was decreased after CAT compared to EVH. Predictive characteristics of EIB + included FENO >12 ppb, FEV1/FVC ratio (<0.75) and BMI < 20. EVH does not always reflect EIB triggered by cold weather exercise. More research is required to understand the best EIB screens for cold weather athletes.
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Affiliation(s)
- Michael D Kennedy
- Athlete Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Andrew R Steele
- Neurovascular Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Eric C Parent
- Clinical Spinal Research Lab, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D Steinback
- Neurovascular Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Geller M. Sexual intercourse as a trigger of inducible urticaria. Ann Allergy Asthma Immunol 2019; 122:659-660. [PMID: 30904579 DOI: 10.1016/j.anai.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 01/04/2023]
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Abstract
Exercise-induced dyspnea in children and adolescents can occur for many reasons. Although asthma is the common cause, failure to prevent exercise-induced asthma by pretreatment with a bronchodilator, such as albuterol, indicates that other etiologies should be considered. Other causes of exercise-induced dyspnea include exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, chest wall restrictive abnormalities, cardiac causes, and normal physiologic limitation. When exercise-induced dyspnea is not from asthma, cardiopulmonary exercise testing with reproduction of the patient's dyspnea is the means to identify the other causes. Cardiopulmonary exercise testing monitors oxygen use, carbon-dioxide production, end-tidal pCO2 (partial pressure of carbon dioxide), and electrocardiogram. Additional components to testing are measurement of blood pH and pCO2 when symptoms are reproduced, and selective flexible laryngoscopy when upper airway obstruction is observed to specifically identify vocal cord dysfunction or laryngomalacia. This approach is a highly effective means to identify exercise-induced dyspnea that is not caused by asthma. [Pediatr Ann. 2019;48(3):e121-e127.].
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Izadi N, Rabinovitch N. Food-dependent exercise-induced anaphylaxis to soybean. J Allergy Clin Immunol Pract 2019; 7:303-304. [PMID: 29802905 DOI: 10.1016/j.jaip.2018.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/10/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Neema Izadi
- Division of Pediatric Allergy & Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colo.
| | - Nathan Rabinovitch
- Division of Pediatric Allergy & Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colo
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David MMC, Gomes ELDFD, Mello MC, Costa D. Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial. Ther Adv Respir Dis 2018; 12:1753466618777723. [PMID: 29865929 PMCID: PMC5990882 DOI: 10.1177/1753466618777723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/27/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test. METHODS A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ ClinicalTrials.gov identifier: NCT02939625]. RESULTS A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height ( z score: -2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group. CONCLUSION Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.
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Affiliation(s)
| | | | - Maryjose Carvalho Mello
- Nove de Julho University, Rua Vergueiro, 235/249 - Liberdade, São Paulo - SP, Brazil 01504-000
| | - Dirceu Costa
- Nove de Julho University, Rua Vergueiro, 235/249 - Liberdade, São Paulo - SP, Brazil 01504-000
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Hunt EB, Murphy B, Murphy C, Crowley T, Cronin O, Hay S, Stack M, Bowen B, Ronan NJ, Greene E, Eustace JA, Plant BJ, Murphy DM. A Study To Assess The Prevalence Of Exercise-Induced Bronchoconstriction In Inter-County Hurling. Ir Med J 2017; 110:655. [PMID: 29465845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Exercise-Induced Bronchoconstriction (EIB) is an acute, transient airway narrowing occurring after exercise which may impact athletic performance. Studies report 10% of the general population and up to 90% of asthmatics experience EIB. Ninety-two players from three elite hurling squads underwent a spirometric field-based provocation test with real-time heart rate monitoring and lactate measurements to ensure adequate exertion. Players with a new diagnosis of EIB and those with a negative field-test but with a previous label of EIB or asthma underwent further reversibility testing and if negative, methacholine challenge. Eight (8.7%) of players had EIB, with one further athlete having asthma with a negative field test. Interestingly, only three out of 12 players who had previously been physician-labelled with EIB or asthma had their diagnosis objectively confirmed. Our study highlights the role of objective testing in EIB.
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Affiliation(s)
- E B Hunt
- Department of Respiratory Medicine, Cork University Hospital
- Health Research Board Clinical Research Facility, University College Cork, Cork
| | | | | | | | - O Cronin
- Department of Respiratory Medicine, Cork University Hospital
| | - S Hay
- Department of Respiratory Medicine, Cork University Hospital
| | - M Stack
- Department of Respiratory Medicine, Cork University Hospital
| | - B Bowen
- Department of Respiratory Medicine, Cork University Hospital
| | - N J Ronan
- Department of Respiratory Medicine, Cork University Hospital
| | - E Greene
- Department of Respiratory Medicine, Cork University Hospital
| | - J A Eustace
- Health Research Board Clinical Research Facility, University College Cork, Cork
| | - B J Plant
- Department of Respiratory Medicine, Cork University Hospital
- Health Research Board Clinical Research Facility, University College Cork, Cork
| | - D M Murphy
- Department of Respiratory Medicine, Cork University Hospital
- Health Research Board Clinical Research Facility, University College Cork, Cork
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19
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Reinhard-Groebli F, Nicod LP. [Exercise-induced bronchoconstriction: epidemiology, physiopathology and management]. Rev Med Suisse 2017; 13:1985-1989. [PMID: 29143502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Exercise-induced bronchoconstriction, associated or not with asthma, describes a transient limitation of airflow in the airways occurring during or after physical activity, regardless of age or training. Bronchoconstriction on exertion is principally induced by thermal and fluid losses of the bronchial mucosa by hyperventilation of large air volumes. Respiratory symptoms are variable and not specific. Among bronchial provocation test, eucapnic voluntary hyperventilation owns the best sensitivity and specificity in the diagnosis of exercise-induced bronchoconstriction. Therapeutic management consists in an adjustment of the environment and training, as well as bronchodilators.
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Affiliation(s)
| | - Laurent P Nicod
- Service de pneumologie, Département de médecine interne, CHUV, 1011 Lausanne
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20
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Abstract
BACKGROUND Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed. METHODS This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process. RESULTS Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes. CONCLUSIONS The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
| | - Julie Turmel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada
| | - Richard S Irwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA
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Weiler JM, Brannan JD, Randolph CC, Hallstrand TS, Parsons J, Silvers W, Storms W, Zeiger J, Bernstein DI, Blessing-Moore J, Greenhawt M, Khan D, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Tilles SA, Wallace D. Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol 2016; 138:1292-1295.e36. [PMID: 27665489 DOI: 10.1016/j.jaci.2016.05.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 12/26/2022]
Abstract
The first practice parameter on exercise-induced bronchoconstriction (EIB) was published in 2010. This updated practice parameter was prepared 5 years later. In the ensuing years, there has been increased understanding of the pathogenesis of EIB and improved diagnosis of this disorder by using objective testing. At the time of this publication, observations included the following: dry powder mannitol for inhalation as a bronchial provocation test is FDA approved however not currently available in the United States; if baseline pulmonary function test results are normal to near normal (before and after bronchodilator) in a person with suspected EIB, then further testing should be performed by using standardized exercise challenge or eucapnic voluntary hyperpnea (EVH); and the efficacy of nonpharmaceutical interventions (omega-3 fatty acids) has been challenged. The workgroup preparing this practice parameter updated contemporary practice guidelines based on a current systematic literature review. The group obtained supplementary literature and consensus expert opinions when the published literature was insufficient. A search of the medical literature on PubMed was conducted, and search terms included pathogenesis, diagnosis, differential diagnosis, and therapy (both pharmaceutical and nonpharmaceutical) of exercise-induced bronchoconstriction or exercise-induced asthma (which is no longer a preferred term); asthma; and exercise and asthma. References assessed as relevant to the topic were evaluated to search for additional relevant references. Published clinical studies were appraised by category of evidence and used to document the strength of the recommendation. The parameter was then evaluated by Joint Task Force reviewers and then by reviewers assigned by the parent organizations, as well as the general membership. Based on this process, the parameter can be characterized as an evidence- and consensus-based document.
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Stelmach I, Zaczeniuk M, Sztafińska A, Majak P, Jerzyńska J, Kuklinska-Pijanka A, Stelmach W. Serum tryptase level and inflammatory markers in exhaled breath condensate of children with exercise-induced symptoms. Allergy Asthma Proc 2016; 37:84-92. [PMID: 27657515 DOI: 10.2500/aap.2016.37.3974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathogenesis of exercise-induced bronchoconstriction (EIB) is poorly understood. OBJECTIVE To evaluate the biomarkers concentration in exhaled breath condensate (EBC) in schoolchildren with postexercise symptoms. We also evaluated changes in fractional exhaled nitric oxide (FeNO) value and the serum tryptase level after exercise. METHODS One hundred children with postexercise symptoms were included. Methacholine challenge testing (MCT) was performed at visit 2, and exercise challenge testing (ECT) was performed at visit 3. Before and after ECT serum tryptase levels and FeNO values were measured. EBC was collected after ECT from 10 randomly selected children from each group. The children were assigned to the following groups: ECT(+) MCT(+), ECT(+) MCT(-), ECT(-) MCT(+), ECT(-) MC(-). We measured the following molecules: eotaxin, interleukin (IL) 8, IL-1ra, IL-1 beta, IL-6, IL-1 alpha, IL-12(p40), IL-5, granulocyte-macrophage colony-stimulating factor, IL-7, IL-15, IL-4, IL-2, IL-10, tumor necrosis factor alpha, interferon gamma, IL-13, tumor necrosis factor beta, monocyte chemoattractant protein-1, IL-17A, macrophage inflammatory proteins-1 alpha, macrophage inflammatory proteins-1 beta, IL-12(p70), and regulated on activation, normal T-cell expressed and secreted by using a multiplex immunoassay. Prostaglandin E2 (PGE2), leukotriene B4, and cysteinyl leukotriene were analyzed by using separate enzyme-linked immunosorbent assay kits. RESULTS In the MCT(+) group, a detectable level of IL4 in EBC and detectible levels of eicosanoids were seen in the ECT(+) group. We observed the opposite direction of ECT-induced changes in FeNO and serum tryptase concentrations in patients with detectable compared with patients without detectable levels of cytokines in EBC. We showed ECT-induced reduction in the tryptase level in patients with a nondetectable PGE2 level in EBC and an increase in tryptase levels in patients who had detectable levels of PGE2 in EBC. CONCLUSIONS EBC was a useful method to estimate inflammation but only in children with symptoms and with EIB shown by a positive ECT. Children with a positive ECT had detectable levels of eicosanoids in EBC; the opposite direction of ECT-induced changes in FeNO and serum tryptase concentrations was observed. The results of above study confirm the role of mast cells and eicosanoids in the pathogenesis of EIB in children.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
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Tahan F, Eke GH, Bicici E, Saraymen B. Increased Postexercise Lipoxin A4 Levels in Exhaled Breath Condensate in Asthmatic Children With Exercise-Induced Bronchoconstriction. J Investig Allergol Clin Immunol 2016; 26:19-24. [PMID: 27012012 DOI: 10.18176/jiaci.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lipoxins could be potential modulators of inflammation in the lungs. To our knowledge, the role of exhaled breath condensate (EBC) lipoxin A4 (LXA4) in asthmatic children with exercise-induced bronchoconstriction (EIB) has not been investigated. OBJECTIVE The aim of our study was to determine the involvement of EBC LXA4 in EIB. METHODS Forty-five patients aged between 5 and 17 years were included in the study. Patients were divided into 2 groups: asthmatic children with a positive response to exercise (n = 17) and asthmatic children with a negative response to exercise (n = 28). Levels of LXA4 were determined in EBC before and immediately after the exercise challenge using ELISA. RESULTS EBC LXA4 levels were significantly increased immediately after exercise in asthmatic children with a positive response to the exercise challenge (P = .05). No significant differences were observed in children with a negative response to exercise (P > .05). There was an inverse correlation between LXA4 levels and the percent degree of reduction in forced expiratory volume in the first second (FEV1%) postexercise in children with a positive exercise challenge (P = .05, r = -0.50). No significant differences were observed in LXA4 levels between atopic and nonatopic asthmatics (P > .05, Mann-Whitney U test). CONCLUSIONS Levels of EBC LXA4 increased immediately after exercise in asthmatic children with a positive exercise challenge response. We hypothesize that airway LXA4 levels increase to compensate bronchoconstriction and suppress acute inflammation, and that spontaneous bronchodilatation after EIB may be due to LXA4.
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Couto M, Moreira A. The athlete "out of breath". Eur Ann Allergy Clin Immunol 2016; 48:36-45. [PMID: 26934737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Athletes often complain about breathing problems. This is a crucial issue due to potential implications not only on their general health, but also on their competing performance. Asthma and exercise-induced bronchoconstriction are prevalent conditions in elite athletes, which leads doctors to rely most of the times on asthma medication to treat athletes feeling "out of breath". However, there are several other conditions that may mimic asthma and cause dyspnea in athletes. Effective treatment of dyspnea requires appropriate identification and treatment of all disorders. Proper knowledge and accurate diagnosis of such entities is mandatory, since asthma medication is not effective in those conditions. Herein we review the most common differential diagnosis of dyspnea in athletes, and describe the diagnostic strategies in order to increase awareness and to improve doctor's confidence on dealing with these patients.
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Affiliation(s)
- M Couto
- Instituto & Hospital CUF Porto, Allergy Unit, Portugal. E-mail: Phone: +35 1 2200 39 000 Fax: +35 1 2255 13 601. Centre for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | - A Moreira
- Centre for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal. Immunoallergology Department, Centro Hospitalar São João E.P.E., Porto, Portugal. Immunology Department, Faculty of Medicine, University of Porto, Porto, Portugal
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Tahan F, Akar HH, Saraymen B. Exhaled breath condensate annexin A5 levels in exercise-induced bronchoconstriction in asthma: A preliminary study. Allergol Immunopathol (Madr) 2015; 43:538-42. [PMID: 25796304 DOI: 10.1016/j.aller.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/19/2014] [Accepted: 10/24/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The pathogenesis of exercise-induced bronchoconstriction (EIB) in asthma is incompletely understood. The role of exhaled breath condensate (EBC) annexin A5, which is an anti-inflammatory mediator, has not been investigated. The purpose of this study is to evaluate EBC annexin A5 levels in EIB in asthmatic children. METHODS Two groups of children were enrolled in this study: asthmatic children with positive (n=11) and negative (n=7) responses to exercise. The levels of pre- and post-exercise EBC annexin A5 were determined with using enzyme-linked immunosorbent assay (ELISA). RESULTS We observed significant higher pre-exercise EBC annexin A5 levels in the challenge test negative children than in the challenge test positive children (p<0.05). No significant difference was observed in the post-exercise EBC annexin A5 levels between the groups (p>0.05). Also, no significant difference was observed between pre- and post-exercise EBC annexin A5 levels within each group (p>0.05). There was an inverse correlation between annexin A5 levels and a reduction in forced expiratory volume at one second percent (FEV1%) (p=0.009, r=-0.598). CONCLUSIONS Our preliminary study showed that EBC annexin A5 may have a possible preventive role in EIB in asthma. Annexin A5 and related compounds may provide novel therapeutic approaches to the treatment of EIB in asthma.
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Affiliation(s)
- F Tahan
- Erciyes University School of Medicine, Department of Pediatric Allergy and Asthma, Kayseri, Turkey.
| | - H H Akar
- Erciyes University School of Medicine, Department of Pediatric Allergy and Asthma, Kayseri, Turkey
| | - B Saraymen
- Erciyes University School of Medicine, Department of Biochemistry, Kayseri, Turkey
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Vuljanko IM, Plavec D. [Exercise-induced asthma in athletes--a review]. Lijec Vjesn 2014; 136:339-345. [PMID: 25647995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Elite athletes are often subjected to endurance training in the environment in which they are chronically exposed to pollutants/irritants, allergens or cold air. These factors lead to an increased risk of upper and lower respiratory tract dysfunction. The diagnosis of asthma is crucial in elite athletes because of potential implications on athlete's general well-being as well as their competitive ability. Symptoms of asthma in elite athletes are not necessarily associated with the classic features of asthma seen in general population. Other clinical entities can create symptoms similar to those of asthma and therefore can lead to an incorrect diagnosis and ineffective treatment. The diagnosis requires a combination of symptoms and positive laboratory tests. Currently, there is no evidence that the treatment of asthma in athletes should be different from the treatment of asthma in non-athletes. However, some specific issues need to be considered in the elite athletes, such as compliance with the rules of World Anti-Doping Agency and International Olympic Committee.
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Mahut B, Fuchs-Climent D, Plantier L, Karila C, Refabert L, Chevalier-Bidaud B, Beydon N, Peiffer C, Delclaux C. Cross-sectional assessment of exertional dyspnea in otherwise healthy children. Pediatr Pulmonol 2014; 49:772-81. [PMID: 24155055 DOI: 10.1002/ppul.22905] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 07/10/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Exertional dyspnea during sport at school in children with asthma or in otherwise healthy children is commonly attributed to exercise-induced asthma (EIA), but when a short-acting beta agonist (SABA) trial fails to improve symptoms the physician is often at a loose end. DESIGN The aims were to prospectively assess the causes of exertional dyspnea in children/adolescents with or without asthma using a cardiopulmonary exercise test while receiving a SABA and to assess the effects of standardized breathing/reassurance therapy. RESULTS Seventy-nine patients (12.2 ± 2.3 years, 41 girls, 49 with previously diagnosed asthma) with dyspnea unresponsive to SABA were prospectively included. Exercise test outcomes depicted normal or subnormal performance with normal ventilatory demand and capacity in 53/79 children (67%) defining a physiological response. The remaining 26 children had altered capacity (resistant EIA [n = 17, 9 with previous asthma diagnosis], vocal cord dysfunction [n = 2]) and/or increased demand (alveolar hyperventilation [n = 3], poor conditioning [n = 7]). Forty-two children who had similar characteristics than the remaining 37 children underwent the two sessions of standardized reassurance therapy. They all demonstrated an improvement that was rated "large." The degree of improvement correlated with % predicted peak V'O2 (r = -0.37, P = 0.015) and peak oxygen pulse (r = -0.45, P = 0.003), whatever the underlying dyspnea cause. It suggested a higher benefit in those with poorer conditioning condition. CONCLUSIONS The most frequent finding in children/adolescents with mild exertional dyspnea unresponsive to preventive SABA is a physiological response to exercise, and standardized reassurance afforded early clinical improvement, irrespective of the dyspnea cause.
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Affiliation(s)
- Bruno Mahut
- AP-HP, Hôpital Européen Georges Pompidou, Service de Physiologie-Clinique de la Dyspnée, Paris, France; Cabinet La Berma, Antony, France
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Murakami Y, Honjo S, Odajima H, Adachi Y, Yoshida K, Ohya Y, Akasawa A. Exercise-induced wheezing among Japanese pre-school children and pupils. Allergol Int 2014; 63:251-9. [PMID: 24759555 DOI: 10.2332/allergolint.13-oa-0644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/24/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Exercise-induced wheezing (EIW) may be a symptom of asthma and is a predictor of exercise-induced bronchoconstriction, transient narrowing of the lower airway following exercise in the presence or absence of diagnosed asthma. Population-based studies with a large sample of EIW in relation to age, sex, current asthma severity and medication usage have been sparse. METHODS International Study of Asthma and Allergies in Childhood questionnaires were distributed at 885 nurseries, 535 primary schools, 321 junior high schools and 190 high schools, respectively, across Japan, and the corresponding data on 46,597, 41,216, 45,960 and 51,104 children were analyzed. RESULTS Prevalence of EIW was 4.8, 4.7, 17.9 and 15.4% for each of the four educational facility types, respectively. Among 24,103 current asthmatics, 20.9, 28.7, 76.1 and 73.6% of subjects for the 4 educational facility groups reported to have experienced EIW, respectively. Severity of current asthma was associated with the risk of EIW; odds ratio (95% confidence interval) of children with asthma attack every day for having EIW once a week or more, using intermittent asthmatics as reference group, were 24.48 (19.33 to 31.01) adjusted for other covariates. Among current asthmatic kindergartners, increase in risk for EIW due to ascending severity of current asthma was mitigated by daily use of leukotriene receptor antagonist (p for interaction = 0.071). CONCLUSIONS EIW was not rare among current asthmatic children. An increased risk for EIW was in accordance with increasing severity of current asthma and this relation was mitigated with leukotriene receptor antagonist daily use among kindergartners.
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Affiliation(s)
- Yoko Murakami
- Department of Paediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Paediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Hiroshi Odajima
- Department of Paediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Yuichi Adachi
- Department of Paediatrics, Faculty of Medicine, Graduate School of Medicine and Pharmaceutical Science for Education, Toyama University, Toyama, Japan
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Centre, Tokyo, Japan
| | - Yukihiro Ohya
- Division of Allergy, National Centre for Child Health and Development, Tokyo, Japan
| | - Akira Akasawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Centre, Tokyo, Japan
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30
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Pastorello EA, Farioli L, Stafylaraki C, Scibilia J, Mirone C, Pravettoni V, Ottolenghi AI, Conio S, Mascheri A, Losappio L, Capocchi A, Fontanini D, De Giacomo C. Wheat-dependent exercise-induced anaphylaxis caused by a lipid transfer protein and not by ω-5 gliadin. Ann Allergy Asthma Immunol 2014; 112:386-7.e1. [PMID: 24507829 DOI: 10.1016/j.anai.2014.01.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 01/04/2023]
Affiliation(s)
- Elide Anna Pastorello
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy; Department of Clinical Sciences and Community Health, Pisa, Italy, Universitá degli Studi of Milan, Milan, Italy
| | - Laura Farioli
- Department of Laboratory Medicine, Niguarda Ca' Granda Hospital
| | - Chrysi Stafylaraki
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Joseph Scibilia
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Corrado Mirone
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Cá Granda Ospedale Maggiore Policlinico
| | | | | | - Ambra Mascheri
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Laura Losappio
- Allergology and Immunology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
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Gaffin JM, Bouzaher A, McCown M, Larabee Tuttle K, Israel E, Phipatanakul W. Rethinking the prevalence of exercise-induced bronchoconstriction in patients with asthma. Ann Allergy Asthma Immunol 2013; 111:567-8. [PMID: 24267370 DOI: 10.1016/j.anai.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 09/27/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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32
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Kaneko M, Yagi H, Koyama H, Nakajima N, Muramatu R, Takizawa T, Arakawa H. [A case of apple allergy with initial symptoms like food-dependent exercise-induced anaphylaxis]. Arerugi 2013; 62:698-703. [PMID: 23969882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/30/2013] [Indexed: 06/02/2023]
Abstract
A 13-year-old boy with two episodes of anaphylaxis after exercise was suspected as food-dependent exercise-induced anaphylaxis (FEIAn). The exercise challenge test after ingestion of an apple was performed, because apple was commonly contained in meals before the both episodes and a prick test for apple was positive. The exercise test was positive accompanied with nasal discharge, sneezing, throat discomfort, swelling of the uvula. The patient was instructed to refrain from exercise for 4 hours after ingestion of apple. In five months, he developed allergic symptoms only by an intake of foods containing heated apple without exercise and showed a slight increase in apple-specific IgE from negative to 0.51 IU/ml. The prognosis of FEIAn has not been well described. Cases with FEIAn to apples like this case require a close follow-up in consideration of development of allergic reactions without exercise.
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Affiliation(s)
- Mari Kaneko
- Department of Pediatrics, Gunma University, Graduate School of Medicine
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33
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Suppli Ulrik C. Elite athletes with asthma: is the management goal total control? Expert Rev Respir Med 2013; 6:473-5. [PMID: 23134239 DOI: 10.1586/ers.12.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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van Leeuwen JC, Driessen JMM, de Jongh FHC, Anderson SD, Thio BJ. Measuring breakthrough exercise-induced bronchoconstriction in young asthmatic children using a jumping castle. J Allergy Clin Immunol 2012. [PMID: 23199614 DOI: 10.1016/j.jaci.2012.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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35
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Chinuki Y, Kaneko S, Dekio I, Takahashi H, Tokuda R, Nagao M, Fujisawa T, Morita E. CD203c expression-based basophil activation test for diagnosis of wheat-dependent exercise-induced anaphylaxis. J Allergy Clin Immunol 2012; 129:1404-6. [PMID: 22464646 DOI: 10.1016/j.jaci.2012.02.049] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/24/2012] [Accepted: 02/28/2012] [Indexed: 01/02/2023]
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36
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Chen X, Zeng MY, Li Y, Xu J, Lin JT. [A study on the correlation between exercise-induced bronchoconstriction and atopy]. Zhonghua Jie He He Hu Xi Za Zhi 2012; 35:167-170. [PMID: 22781146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the correlation between exercise-induced bronchoconstriction and atopy. METHODS Exercise-induced bronchoconstriction (EIB) was defined by free running asthma screening test. Atopy was defined by serum total IgE level and skin allergen test. Airway hyperreactivity was determined by bronchial provocation test. For a matched pair study, all EIB and some non-EIB students received serum total IgE measurements, skin allergen test and bronchial provocation test. All data were calculated by correlation analysis to investigate the correlation between EIB and atopy. RESULTS Totally 773 students participated in the free running screening test, and 89 students (11.5%) were diagnosed as having EIB. The serum total IgE level exceeded the normal range in 16 among the 89 EIB students, but in 10 among the 70 non-EIB students. Statistical analysis (χ(2) test) did not support the correlation between atopy and EIB. Fifty EIB students received bronchial provocation test, but only 1 showed airway hyperreactivity. CONCLUSION There was no correlation between atopy and EIB, and airway hyperreactivity was absent in most of the EIB students.
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Affiliation(s)
- Xin Chen
- Department of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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37
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Agodokpessi G, Ade G, Ahounou FJ, Gbenou DJ, Dansou HP, Gninafon M. [Bronchoconstriction induced by exercise in the black African athlete]. Mali Med 2012; 27:33-36. [PMID: 22766493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The bronchoconstriction induced by exercise (BIE) in urban black Africans is poorly known. The warm moist air would be a mitigating factor for its occurrence. The objective of this study was to measure the prevalence and determine the associated factors. SUBJECTS AND METHODS A prospective descriptive and analytical involving 40 student-athletes was conducted from September 12 to 24, 2010. The test was considered positive when the percentage fall in FEV from baseline in pre-test and the smallest value in post-test exceeded 10%. RESULTS The prevalence of bronchoconstriction induced by exercise was 40% CI (26.3-55.4). The presence of symptoms of atopy was higher in athletes with an BIE than in those without (66% vs. 33.33% p NS). CONCLUSION The proportion of the BIE in the middle of the black African athlete is as important as that observed in other countries, highlighting the weak influence of climate on its occurrence.
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Affiliation(s)
- G Agodokpessi
- Centre National Hospitalier de Pneumo-Phtisiologie, Faculte des Sciences de la sante, Cotonou, Benin.
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38
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Anderson SD. Exercise-induced bronchoconstriction in the 21st century. J Am Osteopath Assoc 2011; 111:S3-S10. [PMID: 22162377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Sandra D Anderson
- Department of Respiratory and Sleep Medicine at Royal Prince Alfred Hospital in Camperdown, New South Wales, Australia.
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39
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Romberg K, Tufvesson E, Bjermer L. Extended diagnostic criteria used for indirect challenge testing in elite asthmatic swimmers. Respir Med 2011; 106:15-24. [PMID: 22035852 DOI: 10.1016/j.rmed.2011.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/28/2011] [Accepted: 09/29/2011] [Indexed: 11/19/2022]
Abstract
UNLABELLED The aim of the study was to investigate the prevalence of asthma with or without exercise induced symptoms among elite and elite aspiring swimmers and to compare sport specific exercise provocation with mannitol provocation. METHODS 101 adolescent swimmers were investigated with mannitol provocation and sport specific exercise challenge test. Mannitol positivity was defined as either direct FEV(1) PD15 (ordinary criteria) or as β(2)-reversibility ≥15% after challenge (extended criteria). A direct positive exercise test was defined as a drop in FEV(1) of 10% (ordinary criteria) or a difference in FEV of ≥15% either spontaneous, variability, or with β2-agonist, reversibility (extended criteria). RESULTS We found a high prevalence of mannitol and/or exercise positivity. Twenty-six swimmers were mannitol direct positive and 14 were direct exercise positive using ordinary criteria. Using extended criteria 43 were mannitol positive and 24 were exercise positive. When including reversibility and variability to define a positive test the sensitivity for current asthma with or without exercise induced symptoms increased while the specificity remained roughly unchanged. Direct positivity for mannitol and exercise poorly overlapped using ordinary criteria but improved using extended criteria. CONCLUSION We found a high prevalence of asthma among elite swimmers. The use of variability and reversibility (liability) as additional criteria to define a positive test provided to our mind relevant information and should be considered.
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Affiliation(s)
- Kerstin Romberg
- Department of Clinical Science Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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40
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Krafczyk MA, Asplund CA. Exercise-induced bronchoconstriction: diagnosis and management. Am Fam Physician 2011; 84:427-434. [PMID: 21842790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Exercise-induced bronchoconstriction describes the narrowing of the airway that occurs with exercise. More than 10 percent of the general population and up to 90 percent of persons previously diagnosed with asthma have exercise-induced bronchoconstriction. Common symptoms include coughing, wheezing, and chest tightness with exercise; however, many athletes will present with nonspecific symptoms, such as fatigue and impaired performance. Spirometry should be performed initially to evaluate for underlying chronic asthma, although results are often normal. An empiric trial of short-acting beta₂ agonists or additional bronchial provocation testing may be necessary to confirm the diagnosis. Nonpharmacologic treatment options include avoiding known triggers, choosing sports with low minute ventilation, warming up before exercising, and wearing a heat exchange mask in cold weather. Short-acting beta₂ agonists are recommended first-line agents for pharmacologic treatment, although leukotriene receptor antagonists or inhaled corticosteroids with or without long-acting beta₂ agonists may be needed in refractory cases. If symptoms persist despite treatment, alternative diagnoses such as cardiac or other pulmonary etiologies, vocal cord dysfunction, or anxiety should be considered.
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Affiliation(s)
- Michael A Krafczyk
- St. Luke's Hospital and Health Network Primary Care Sport Medicine Fellowship Program, Bethlehem, PA 18017, USA.
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41
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Exercise-induced wheezing. Am Fam Physician 2011; 84:436. [PMID: 21842791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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42
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Bianchi A, Di Rienzo Businco A, Bondanini F, Mistrello G, Carlucci A, Tripodi S. Rosaceae-associated exercise-induced anaphylaxis with positive SPT and negative IgE reactivity to Pru p 3. Eur Ann Allergy Clin Immunol 2011; 43:122-124. [PMID: 21980800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Food-dependent-exercise-induced anaphylaxis (FDEIA) is characterized by anaphylactic symptoms after exercise following ingestion of food. We present a case of FDEIA induced by Rosacee fruits showing some diagnostic problems. MATERIAL AND METHODS A 12 years-old boy with seasonal allergy to olive and cypressus pollens, experienced two distinct episodes of FDEIA, grade 4 and 3 of the Sampson Scale respectively, during intense exercise, about 30 minutes after eating a peach with peel or some cherries. SPT with commercial peach extract and fresh Rosacee fruits scored positive while SPT with a date palm profilin-enriched extract was negative. On in vitro tests total IgE were 44 kU/l and IgE for peach, cherry, Prup 3, Prup 1, Bet v 1, Bet v 2, Bet v 4 were negative. SPT with Prup 3 UniCAP device (cellulose polymer in a plastic reserve highly binding allergen protein) was negative. An oral food challenge, performed at rest using a commercial peach juice, scored negative. An immunoblot analysis performed with peach extract was negative. DISCUSSION The main peculiarity of this case of FDEIA is the discrepancy between positive SPT and negative in-vitro findings. The positive SPT with the commercial peach extract suggested hypersensitivity to lipid transfer protein; however, no IgE reactivity to rPrup 3 was found in-vitro. The negative immunoblot analysis, possibly caused by the low levels of specific IgE, did not allow us to investigate the nature of the relevant allergen protein further. It is possible that this patient reacted to a different peach allergen or, alternatively, that he recognized an isoform of LTP that is different fr-om that in Uni-CAP. CONCLUSION This case emphasizes once more the diagnostic relevance of SPT with extracts and fresh material to be performed before investigating IgE reactivity to single allergen components in-vitro.
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MESH Headings
- Allergens/adverse effects
- Allergens/immunology
- Antigens, Plant
- Asthma, Exercise-Induced/complications
- Asthma, Exercise-Induced/diagnosis
- Asthma, Exercise-Induced/physiopathology
- Child
- Cupressus
- Disease Progression
- Epitopes
- Food Hypersensitivity/complications
- Food Hypersensitivity/diagnosis
- Food Hypersensitivity/physiopathology
- Fruit/adverse effects
- Humans
- Immunization
- Immunoglobulin E/blood
- Immunoglobulin E/immunology
- Male
- Olea
- Plant Extracts/administration & dosage
- Plant Extracts/adverse effects
- Plant Proteins
- Pollen/adverse effects
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/physiopathology
- Rosaceae
- Skin Tests
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Affiliation(s)
- A Bianchi
- Mazzoni Hospital, Pediatric Department, Ascoli Piceno, Italy.
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43
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023]
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Hildebrand K, Przybyłowski T, Maskey-Warzęchowska M, Chazan R. [Usefulness of selected tests in the diagnosis of exercise induced bronchoconstriction]. Pneumonol Alergol Pol 2011; 79:397-406. [PMID: 22028118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Indirect airway challenge tests are commonly used in the diagnosis of exercise-induced bronchoconstriction (EIB), defined as a post-exercise decrease in FEV(1) ≥ 10%. The aim of this study was to evaluate the diagnostic value of bronchial hyperreactivity tests in the diagnosis of EIB. MATERIAL AND METHODS Forty two subjects were allocated to 3 groups: A - 19 steroid naive asthma patients; D - 11 no-asthma patients reporting symptoms suggestive for EIB (dyspnea, wheeze and cough provoked by exercise) and K - 12 healthy controls. Subjects filled a questionnaire regarding symptoms related to exercise and underwent: inhaled bronchial challenge to methacholine (Mch), adenosine 5'-monophosphate (AMP) and exercise challenge on a treadmill. With a cutoff of ≥ 10% or ≥ 15% decrease in FEV1 post exercise EIB was diagnosed in 47% and 37% of asthma patients, respectively; 27% of subjects in group D and in none of controls, irrespectively of the ΔFEV(1) criterion. RESULTS The analysis of questionnaire revealed that a single symptom cannot be used to predict EIB. Symptoms occurring after termination of exercise, but not during exercise characterize EIB more precisely. The analysis showed that the most useful measure to diagnose EIB can be a combination of bronchial challenge to AMP and typical symptoms of exercise induced bronchoconstriction (i.e. dyspnea, wheezes and cough provoked by exercise) with a sensitivity of 70%, specifity of 94%, PPV of 78%, NPV of 91% and LR of 11.2. CONCLUSIONS Symptoms suggestive of EIB do not have acceptable sensitivity and specifity for the diagnosis of exercise-induced bronchoconstriction. The most useful measure to diagnose EIB is a combination of typical symptoms of EIB with positive challenge to AMP.
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Affiliation(s)
- Katarzyna Hildebrand
- Katedra i Klinika Chorób Wewnętrznych, Pneumonologii i Alergologii Warszawskiego Uniwersytetu Medycznego
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Hildebrand K. [Exercise-induced bronchoconstriction]. Pneumonol Alergol Pol 2011; 79:39-47. [PMID: 21190152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Terms exercise-induced asthma (EIA) or exercise-induced bronchoconstriction (EIB) are used to describe transient bronchoconstriction occurring during or immediately after vigorous exercise in some subjects. For the diagnosis of EIB it is necessary to show at least 10% decrease in FEV1 from baseline following physical exercise. The prevalence of EIB has been reported to be 12-15% in general population, 10-20% in summer olympic athletes, affecting up to 50-70% of winter athletes (particularly ski runners and skaters). There are two key theories explaining EIB: thermal and osmotic. Differential diagnosis of EIB should include chronic cardio-pulmonary diseases, vocal cord dysfunction, hyperventilation syndrome and poor physical fitness or overtraining. According to the ATS guidelines from 1999 for the diagnosis of EIB a standardized exercise on a treadmill or cycle ergometer test with stable environmental conditions regarding temperature and humidity of inhaled air, should be employed. Other laboratory tests assessing bronchial hyperresponsiveness to indirect stimuli including eucapnic voluntary hyperpnea (EVH), mannitol, hypertonic saline, AMP or measurement of exhaled nitric oxide (FENO) are also successfully used. In the prevention of EIB include both pharmacologic and non-pharmacologic treatment. In patients with poorly controlled asthma intensification of anti-inflammatory treatment can decrease the frequency and severity of EIB. Short and long acting beta2-agonists, antileukotriene drugs can be used prior to exercise to prevent EIB.
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Affiliation(s)
- Katarzyna Hildebrand
- Katedra i Klinika Chorób Wewnętrznych, Pneumonologii i Alergologii Warszawskiego Uniwersytetu Medycznego.
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46
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Franczuk M. [Recognition of exercise-induced bronchoconstriction: a task for a medal]. Pneumonol Alergol Pol 2011; 79:379-381. [PMID: 22028115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Monika Franczuk
- Zakład Fizjopatologii Oddychania, Instytut Gruźlicy i Chorób Płuc, Warszawa
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Stickland MK, Spooner CH, Dryden DM, Rowe BH. The need for standardization in exercise challenge testing for exercise-induced asthma/bronchoconstriction. J Allergy Clin Immunol 2010; 126:878-880.e6. [PMID: 20920779 DOI: 10.1016/j.jaci.2010.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 07/15/2010] [Accepted: 07/21/2010] [Indexed: 11/18/2022]
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Kaslovsky RA, Sondike SB, Cummings S. Exercise intolerance in obese children--is it asthma? W V Med J 2010; 106:12-15. [PMID: 21928556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is a pilot study designed to examine the frequency of asthma in obese children who have exertional dyspnea. Obese children who complained of breathlessness with exercise and who denied asthma were invited to enroll. If there was evidence of airflow limitation on spirometry, nebulized albuterol was administered and spirometry was repeated. If there was no significant improvement or if the baseline spirometry was normal, exercise testing was performed. A total of 20 patients (ages from 8 to 16 years) with BMI from 22 to 61 were enrolled. Of the 19 who completed the study, 9 (47.3%) met criteria for asthma. Recognizing and treating asthma may lead to improved exercise tolerance and improved weight status in these obese individuals.
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Affiliation(s)
- Robert A Kaslovsky
- Pediatric Pulmonary Division, Baystate Children's Hospital, Springfield, MA, USA
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49
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Anderson SD, Pearlman DS, Rundell KW, Perry CP, Boushey H, Sorkness CA, Nichols S, Weiler JM. Reproducibility of the airway response to an exercise protocol standardized for intensity, duration, and inspired air conditions, in subjects with symptoms suggestive of asthma. Respir Res 2010; 11:120. [PMID: 20807446 PMCID: PMC2939602 DOI: 10.1186/1465-9921-11-120] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/01/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise testing to aid diagnosis of exercise-induced bronchoconstriction (EIB) is commonly performed. Reproducibility of the airway response to a standardized exercise protocol has not been reported in subjects being evaluated with mild symptoms suggestive of asthma but without a definite diagnosis. This study examined reproducibility of % fall in FEV1 and area under the FEV1 time curve for 30 minutes in response to two exercise tests performed with the same intensity and duration of exercise, and inspired air conditions. METHODS Subjects with mild symptoms of asthma exercised twice within approximately 4 days by running for 8 minutes on a motorized treadmill breathing dry air at an intensity to induce a heart rate between 80-90% predicted maximum; reproducibility of the airway response was expressed as the 95% probability interval. RESULTS Of 373 subjects challenged twice 161 were positive (≥ 10% fall FEV1 on at least one challenge). The EIB was mild and 77% of subjects had <15% fall on both challenges. Agreement between results was 76.1% with 56.8% (212) negative (< 10% fall FEV1) and 19.3% (72) positive on both challenges. The remaining 23.9% of subjects had only one positive test. The 95% probability interval for reproducibility of the % fall in FEV1 and AUC0-30 min was ± 9.7% and ± 251% for all 278 adults and ± 13.4% and ± 279% for all 95 children. The 95% probability interval for reproducibility of % fall in FEV1 and AUC0-30 min for the 72 subjects with two tests ≥ 10% fall FEV1 was ± 14.6% and ± 373% and for the 34 subjects with two tests ≥ 15% fall FEV1 it was ± 12.2% and ± 411%. Heart rate and estimated ventilation achieved were not significantly different either on the two test days or when one test result was positive and one was negative. CONCLUSIONS Under standardized, well controlled conditions for exercise challenge, the majority of subjects with mild symptoms of asthma demonstrated agreement in test results. Performing two tests may need to be considered when using exercise to exclude or diagnose EIB, when prescribing prophylactic treatment to prevent EIB and when designing protocols for clinical trials.
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Affiliation(s)
- Sandra D Anderson
- Department of Respiratory & Sleep Medicine, 11 West, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia
- Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - David S Pearlman
- Colorado Allergy and Asthma Centers, Suite 150/125 Rampart Way, Denver CO 80230- 6405, USA
| | - Kenneth W Rundell
- Professor of The Basic Sciences, The Commonwealth Medical College, 150 North Washington Avenue, Scranton PA, PA 18503-1843, USA
| | - Claire P Perry
- Department of Respiratory & Sleep Medicine, 11 West, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia
| | - Homer Boushey
- Asthma Clinical Research Center, University of California, San Francisco CA 90089, USA
| | - Christine A Sorkness
- Department of Medicine, Allergy and Asthma Clinical Research, University of Wisconsin, Madison, WI 53705, USA
| | - Sara Nichols
- CompleWare Corporation, PO Box 3090, North Liberty, IA 52317, USA
| | - John M Weiler
- CompleWare Corporation, PO Box 3090, North Liberty, IA 52317, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA52242, USA
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Pitsios C, Del Giacco SR, Grigoreas C. Is Free Running Asthma Screening Test still useful? W INDIAN MED J 2010; 59:287-290. [PMID: 21291108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the usefulness of Free Running Asthma Screening Test (FRAST) as a method that may help the diagnosis of exercise-induced bronchospasm (EIB) in children from a rural area and to compare the results with their history of asthma. METHODS A FRAST challenge took place at 9 schools. It lasted for 6 minutes and pupils performed it properly with the help of an athlete. The best out of three Peak Expiratory Flow Rate (PEFR) efforts was recorded before and after challenge, using a mini-Wright peak-flow-meter. A more than 15% drop in PEFR was considered an indication of EIB. A questionnaire defining asthmatic symptoms had been distributed and already completed by their parents. RESULTS The exercise was successfully performed by 268 children. Eleven children presented a fall of PEFR of at least 15%, five or ten minutes after the exercise; among these, only three boys had a history of asthma, while the remaining 8 children were undiagnosed. No difference regarding age, gender or locations' altitude was found. CONCLUSION FRAST can be of great use in the diagnosis of EIB in areas that lack proper tools and specialized personnel. A poor correlation between self-reported symptoms and the results of exercise challenges was confirmed.
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Affiliation(s)
- C Pitsios
- Simopoulo Health Center, Amaliada's General Hospital, Amalias, Greece.
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