Abstract
IntroductionSeveral tests may be used to assess exercise intolerance in severe therapy-resistant asthma (STRA), including the gold standard cardiopulmonary exercise test (CPET) and the modified shuttle test (MST).ObjectiveTo correlate the distance achieved in the MST with peak oxygen uptake (VO2peak) and to compare the maximal heart rate (HRmax) obtained in both tests in children and adolescents with STRA.MethodsThis is a cross-sectional study, with 19 children and adolescents with STRA. Demographic, anthropometric, clinical data, and spirometric values were collected. CPET and the MST were performed in two consecutive visits. HRmax, pulse oxygen saturation, and dyspnea were compared between tests. The distance achieved in the MST was correlated with VO2peak.ResultsNineteen patients with a mean age of 11.5 ± 2.5 years were included. The mean HRmax (bpm) achieved was 180.8 ± 12.10 for the MST and 187.6 ± 9.35 for CPET, whereas the mean HRmax as a percentage of predicted (HRmax%) was 90.7 ± 6.5 for the MST and 93.8 ± 4.5 for CPET. A difference of only 6 bpm was found for HRmax (p = 0.10) and of 3% for HRmax% (p = 0.06) between tests. A strong correlation was found between the MST (r = 0.79; p = 0.001) and VO2peak measured through CPET. However, there were no correlations between the MST and both body mass index (r = −0.14; p = 0.564) and forced expiratory volume in the first second – FEV1 (r = −0.02; p = 0.917).ConclusionThe results demonstrate that the MST distance strongly correlates with VO2peak, measured through CPET, and the main physiological variable responses were similar between both tests. Our results provide additional data for the use of the MST to assess exercise capacity in children and adolescents with STRA.
Highlights
Several tests may be used to assess exercise intolerance in severe therapy-resistant asthma (STRA), including the gold standard cardiopulmonary exercise test (CPET) and the modified shuttle test (MST)
Regarding variables evaluated on CPET, the mean VO2peak was 34.6 ± 7.9 mL kg−1 min−1, VE was 39.6 ± 11.5 L min−1 and the median VO2peak was found at the 25th percentile (3.5–50)
The results of the present study demonstrated that the MST distance correlates strongly with maximal oxygen uptake measured through CPET in children and adolescents with STRA
Summary
Several tests may be used to assess exercise intolerance in severe therapy-resistant asthma (STRA), including the gold standard cardiopulmonary exercise test (CPET) and the modified shuttle test (MST). Among the children with asthma, around 5–10% of the patients have severe asthma (Simões et al, 2010; Rodrigues et al, 2015). Children with severe therapy-resistant asthma (STRA) are those in which the disease remains uncontrolled, even with optimization of clinical management, or if the disease can only be controlled with GINA step 4 or 5 treatment. These patients present recurrent asthma attacks, with visits to emergencies and frequent hospitalizations, limitation to physical activities, and, a more sedentary lifestyle. Objective measures of assessment are necessary to determine the exercise capacity of these patients (Carlsen et al, 2011; Chung et al, 2014)
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