Abstract
We investigated whether a 1-week stay in the mountains may have a positive impact on Exercise-Induced Bronchoconstriction (EIB) and cardiorespiratory endurance in asthmatic children from an urban area. Spirometry was performed before and 10 min after a 20 m shuttle run test (20mSRT) on the first and seventh day of a summer asthma camp in the Italian Alps at 900 m of altitude. Spirometry z-scores were derived from the Global Lung Initiative 2012 prediction equations, and percentiles of the 20mSRT performance were assigned according to De Miguel-Etayo’s and Tomkinson’s predictive equations. A FEV1 decrease ≥10% after the exercise was defined as EIB. Particulate matter pollution was monitored during the camp and in the urban area of provenience. Twenty-four subjects (age range 7–16 years) were included. Frequency of EIB decreased from 58% (14/24) at day-1 to 33% (8/24) at the end of the camp (p = 0.08). Most subjects with a 20mSRT in the lowest quartile at day 1 had EIB (9/11). The proportion of children with a 20mSRT <25° percentile decreased from 45% (11/24) at day-1 to 16% (4/24) at day-7 (p = 0.02). Conclusion: One-week climate therapy in the mountains improved both bronchial hyperreactivity and cardiorespiratory endurance in our cohort of asthmatic children.
Highlights
There is conflicting evidence regarding the benefits of climate therapy in the mountains for children with asthma [1,2,3,4,5,6], whereas higher evidence of effectiveness is available for adults with refractory asthma [1]
Sixteen patients were excluded because they had incomplete spirometry data or poor-quality spirometry at one of the data points
We found an improvement in the frequency of Exercise-Induced Bronchoconstriction (EIB) among asthmatic patients, the climate therapy was performed at a non-elevated altitude (900 m) where the distribution of allergens should not be dramatically different from lower altitudes [48]
Summary
Accepted: 8 November 2021There is conflicting evidence regarding the benefits of climate therapy in the mountains for children with asthma [1,2,3,4,5,6], whereas higher evidence of effectiveness is available for adults with refractory asthma [1]. Airway eosinophilia, type 2 inflammation and outdoor air pollution are recognized triggers of asthma at school-age [7]. UV exposure, may contribute to improving airway inflammation and asthma symptoms in a mountain setting [8]. In asthmatic children sensitized to house dust mites (HDM), allergen avoidance in the context of climate therapy in the mountains may improve bronchial hyperresponsiveness and exercise tolerance [9], decrease serum total IgE and specific IgE to HDM [9], and lead to a reduction of airway eosinophilic inflammation markers [9,10]. Cardiorespiratory fitness in these patients tends to normalize with a proper training, while EIB does not [20,21].
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