Bronchospasm In Children Research Articles

Exercise-induced Bronchospasm in Children and Adolescents

The early recognition and appropriate management of EIB can allow children and adolescents to participate fully in physical activities and sport. The diagnosis by history of chest congestion, coughing, and decreasing performance with exercise is helpful but is aided by a more systematic questionnaire that can detect otherwise "normal" people with EIB. The diagnosis is documented by performance of an exercise challenge test such as a treadmill or cycloergometer to verify bronchospasm induced by exercise. The management can be accomplished by nonpharmacologic means such as an early vigorous warm-up, the use of a mask for rebreathing warmed air, and participation in a physical training program to increase anaerobic fitness. Pharmacologic management includes the appropriate use of cromolyn sodium, beta-adrenergic agonists, theophylline, ipratromium bromide, and calcium channel blocking agents. In addition, the antihistamine, terfenadine, can be used to block EIB effectively. These pharmacologic agents can be utilized in both national and international competition when approved by the appropriate national governing body or the U.S. Olympic Committee and the International Olympic Committee.

Protective effect of tulobuterol on methacholine-induced bronchospasm in asthmatic children.

In a single-blind, placebo-controlled trial 19 asthmatic children aged 10-14 years were studied during a stable phase of the disease. All patients were tested with a methacholine inhalation test on two consecutive days, on the first day after oral administration of a placebo, and on the second day following an oral dose of tulobuterol HCl. The cumulative methacholine dose required to produce at least a 20% decrease in FEV1 was significantly higher after tulobuterol than after the placebo. It is concluded that tulobuterol HCl reduces methacholine-induced bronchospasm in children.

Effects of Different Dosages of the Calcium Antagonist Verapamil in Exercise- and Methacholine-Induced Bronchospasm in Children with Chronic Asthma

The protective effect of 5 mg/2 ml and 10 mg/4 ml of the calcium antagonist verapamil on methacholine challenge and exercise were evaluated in two groups of asthmatic children. Saline solution was used as placebo. No significant differences were seen in baseline pulmonary function in and within groups. There was a minimal but significant bronchodilation 30 minutes after inhalation of verapamil 5 mg/2 ml. The drug did not reduce methacholine sensitivity at any dosage. After exercise, verapamil 5 mg/2 ml showed a significant change in the maximum percentage drop in forced expiratory volume in 1 second (FEV1) compared with placebo. This was not the case for the group treated with a double dosage. At this time, there is no evidence for a major role of verapamil in the treatment of childhood asthma.

Cough syncope mimicking epilepsy in asthmatic children.

Cough syncope is a more common complication of childhood asthma than formerly recognized. We report twelve children with typical cough syncope who were identified in a pediatric clinic over a period spanning seven years. The condition may be confused with epilepsy because of frequently associated brief clonic convulsive movements during the height of the cerebral anoxia. Cough syncope is readily distinguished from epilepsy by a thorough history. The management and prevention of cough syncope is directed at the aggressive control of bronchospasm in children with asthma.

Comparison of the Effects of Inhaled SCH 1000 and Fenoterol on Exercise-Induced Bronchospasm in Children

The effect of 40 microgram of SCH 1000 (ipratropium bromide, an anticholinergic agent) on bronchodilation and suppression of exercise-induced bronchospasm (EIB) was compared with 400 microgram of fenoterol and a placebo in a single-blind controlled study. Twenty-seven randomly selected asthmatic children performed a standardized treadmill exercise challenge and the 17 children who were shown to have EIB continued in the study. Pulmonary function was evaluated before and after drug administration and exercise. When individual results were analyzed and grouped according to the responsiveness of EIB to the drugs, two patterns emerged: (1) the EIB was more severe in those (6/17) children who did not respond to either drug than in the rest of children; (2) the resting pulmonary function was significantly better in the children (4/17) who responded to both drugs than in those (7/17) who responded to fenoterol alone. In conclusion SCH 1000 was shown to be an effective bronchodilator comparable to, but no better than, fenoterol. It had minimal side effects. As an EIB inhibitor it depended on relatively normal base line pulmonary function and only a moderate deterioration following exercise, whereas fenoterol depended on the exercise response alone. Although anticholinergic drugs are not very extensively used, SCH 1000 may be useful in some patients where the beta 2 adrenergic drugs cause signficant side effects or are contraindicated.

Comparison of aerosolized atropine sulfate and SCH 1000 on exercise-induced bronchospasm in children

The new anticholinergic compound Sch 1000 (ipratropium bromide) has been reported to be an effective bronchodilator without significant atropine-like side effects. We evaluated the effectiveness of different doses of nebulized Sch 1000 (40 μg and 80 μg) aerosolized atropine sulfate (1 mg) and placebo in the prevention of exercise-induced bronchospasm (EIB) in 20 children with atopic bronchial asthma. A random, crossover double-blind protocol was used. Standard exercise on a cycloergometer was used to induce EIB. Pulmonary function was determined before and after drug administration and exercise. Following no treatment or placebo, exercise resulted in average reductions of 33% to 43% in plethysmographic specific airway conductance (SGaw), of 20% to 25% in forced expiratory volume in 1 sec (FEV 1 ), and of 25% to 32% in maximal midexpiratory flow rate. Exercise following no treatment or placebo resulted in average increases of 23% to 30% in thoracic gas volume (Vtg). Prior to exercise atropine and either dose of Sch 1000 caused significant increases in SGaw (48% to 59%). After pretreatment with Sch 1000 or atropine, exercise caused SGaw to fall to values that were not significantly different from pretreatment medication values, but were significantly higher than values following exercise without pretreatment or after pretreatment with placebo. No significant differences were noted between the effects of atropine and Sch 1000 on EIB. We conclude that at the doses used atropine and Sch 1000 cause equivalent degrees of bronchodilation but neither drug specifically inhibits EIB.