Exercise-induced Asthma In Children Research Articles

Features of atopic reactivity in children with bronchial asthma

Bronchial asthma is a chronic disease characterized by reversible airway obstruction with clinical manifestations of recurrent wheezing episodes, airway inflammation, and their hyperreactivity. Timely diagnosis of bronchial asthma in early childhood will allow adequate prescribing therapy and controlled management of patients, which in the future will reduce the risk of serious complications and improve the quality of life of patients.The aim of the study – to identify the influencing factors on the manifestations of atopic reactivity in children with bronchial asthma, depending on the content of IgE specific to house dust antigens in the blood serum, in order to optimize the management of the disease.Material and methods. A comprehensive clinical and paraclinical examination of 79 school-age children with atopic bronchial asthma was carried out in the Regional Children's Clinical Hospital and the City Children's Polyclinic in Chernivtsi. According to the concentration of specific IgE to the house dust allergen, the patients were divided into two clinical groups. The first (I) clinical group included 55 children in whom the concentration of these antibodies in the blood exceeded 3.5 kU / l, the second group (II) consisted of 24 patients in which the level of specific IgE was below this value. According to the main clinical signs, the comparison groups were compared.Results. It was found that the proportion of patients in the first group who had contact with tobacco smoking of their parents was higher than in the comparison group. Constant contact with tobacco smoke, when both parents have this bad habit in the family, increases the likelihood of developing hypersensitivity to house dust in children with asthma by almost 9 times. At the same time, bronchial asthma was more often combined with atopic dermatitis in these patients, while low concentration of specific IgE to house dust was associated with comorbidity of asthma with allergic rhinitis. The risk of moderate to severe bronchial asthma in patients with low IgE levels increases significantly. The probability of developing the phenotypes of late-onset asthma and exercise-induced asthma in children with low concentrations of specific IgE to house dust increases by 3 and 2 times, respectively. The number of schoolchildren with an extremely high concentration of IgE (more than 100 kU/l) to D. Pteronyssinus antigens was twice as high as in the comparison group, and every second patient also had very high levels of antibodies to D. Farinae tick.Conclusion. Children with atopic hypersensitivity to house dust allergens have an increased chance of comorbid bronchial asthma and atopic dermatitis, late-onset asthma and physical exertion, asthma is much more severe, which must be taken into account when personalizing specific therapy.

In this issue of Asia Pacific allergy.

This edition of Asia Pacific Allergy (AP Allergy) offers a diversity of papers covering topics such as drug allergy, milk allergy and atopic dermatitis risk, measures of exercise-induced asthma in children and a rare case of anaphylaxis following hydatid cyst rupture. Bhanegaonkar et al. [1] have taken a very interesting approach to the assessment of benefit of using partially hydrolysed formulas (PHF) as an allergy risk-reduction strategy for formula-fed high-risk infants who are not exclusively breastfed. They acknowledge that this is the recommended practice from a number of allergy organisations but state that PHF is an expensive option in developing nations. Their study was conducted to estimate the long-term clinical and economic impact of feeding with PHF versus cow's milk formula for the first 17 weeks of life on atopic dermatitis risk reduction among high-risk infants in urban Malaysia. Their results suggest that PHF in this population reduces the clinical and quality of life burden of atopic dermatitis while decreasing overall costs, even after including the higher PHF costs. In another study from Malaysia [2], Yadav and Naidu attempt to provide insight into how sensitisation to common food and aeroallergens evolves in children from a developing Asian country in comparison to other populations from more developed nations. In keeping with other similar studies, they found that with increasing age, there was a gradual transition from atopic dermatitis to predominantly respiratory symptoms, with a decreasing trend of sensitisation to common food allergens while aero-allergen sensitisation rose in allergic Malaysian children. Some differences in the food sensitisation rates were very interesting and will lead to further investigations. This is a retrospective study and ideally will be followed up with prospective studies examining this vital question. Akar et al. [3] have explored correlations between a number of spirometric measures, blood eosinophil counts and exercise-induced bronchospasm in a group of Turkish children with mild asthma. They found forced expiratory flow at 50% of the vital capacity and peak expiratory flow values decreased in response to exercise without changes in forced expiratory volume in one second in mild asthmatic patients. The links between vitamin D levels and various aspects of allergic disease are complex and confusing and are yet to be fully elucidated. Aldubi et al. [4] have compared vitamin D levels in children from Saudi Arabia with asthma, to those in normal healthy children. One of their most startling findings is that 78% of the study population could be considered to be deficient in vitamin D. This edition's featured review article is a thorough discussion by Dao et al. [5] from Taiwan of pharmacogenomics research in severe cutaneous adverse reactions (SCAR) that include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). They review and summarise a number of important pharmacogenomic associations with SCAR that have been found in different populations, particularly in Asian countries. Besides the human leukocyte antigen associations that have been described, they also explore the evidence for other factors such as impaired drug metabolism and the effect of altered renal excretion on how a drug may stimulate immune mechanisms important in driving reactions. The original research paper by Nguyen et al. [6] nicely complements the Taiwanese review. In Vietnam, it was not known whether the high incidence of SJS/TEN was secondary to the widespread use of carbamazepine or due to a high incidence of adverse effects to the drug. These authors demonstrate the presence of HLA-B*1502 in Vietnamese as a pharmacogenetic risk factor for developing carbamazepine-induced SJS/TEN, a finding similar to those in a number of previous studies in Asians with different ancestries such as Han Chinese, Thais, Malays, Indians and Singaporeans. Our case report this month comes from Turkey. Ozdemir et al. [7] report a rare complication from a disease that is endemic in their country. This edition of AP allergy marks the beginning of our fifth year of publication of a regional journal devoted to general allergy and immunology. As is the case with this edition, an examination of the countries of origin of manuscripts reveals a broad representation from the Region and beyond. The journal includes original research papers as well as review articles and, unlike many journals now, editorial policy has been to include case histories with an educational message [8] and these have proven very popular among our readers. I encourage all of you to consider submitting papers for consideration for publication so that AP allergy may continue to evolve, mature and better serve the educational needs of the region.

Urinary leukotriene excretion profile in children with exercise-induced asthma compared with controls: A preliminary study

BackgroundLeukotrienes are among the most important mediators associated with inflammatory responses in patients with exercise induced asthma (EIA). The aim of this study was to investigate the impact of exercise on the urinary leukotriene profile. Hence, we compared post exercise changes of urinary leukotriene E4 (LTE4) concentration between children with EIA and healthy controls. MethodsTen children with EIA and 15 controls were enrolled. Both groups underwent a standardised exercise challenge test (ECT). LTE4 concentration was measured in urine samples obtained pre and post ECT, using enzyme immunoassay and adjusted by urinary creatinine concentrations. ResultsMedian (minimum–maximum) pre ECT concentration of LTE4 was 17.82 (7.58–90.23pg/ml) in EIA and 17.24 (4.64–64.02pg/ml) in controls, p=0.86. LTE4 concentration post ECT were 23.37 (4.02–93.00pg/ml) in EIA and 11.74 (0.13–25.09pg/ml) in controls, p=0.02. Changes of LTE4 concentration post ECT were 2.54 (−31.98 to 43.31pg/ml) in cases and −13.53 (−46.00 to 11.02pg/ml) in controls, p=0.03. There was no significant correlation between basal predicted FEV1 [%] and changes in LTE4 concentration in cases (i.e., rs=0.14) nor controls (i.e., rs=0.12). There was a tendency towards more pronounced changes in LTE4 concentration post ECT in children with moderate/mild persistent asthma compared to those with mild but intermittent asthma. ConclusionsChildren with EIA had significantly higher changes of urinary LTE4 concentrations post ECT compared to healthy controls. Urinary measurement of LTE4 may be an interesting and non-invasive option to assess control of EIA in children.

Fluticasone propionate/salmeterol and exercise‐induced asthma in children with persistent asthma

Exercise is a common trigger in children with persistent asthma and inhaled corticosteroids have been shown to effectively treat clinical manifestations of persistent asthma, including protection from decrements in lung function caused by exercise. The goal of this study was to evaluate the effectiveness of fluticasone propionate/salmeterol 100/50 mcg compared with fluticasone propionate 100 mcg for the prevention of airflow limitation triggered by standardized exercise challenge in pediatric and adolescent patients with persistent asthma. Multicenter, randomized, double-blind, parallel group trial of 248 subjects with persistent asthma (age 4-17 years) randomized to receive fluticasone propionate/salmeterol (100/50 mcg twice daily) or fluticasone propionate alone (100 mcg twice daily) via Diskus for 4 weeks. Exercise challenge tests were performed during screening and approximately 8 hr after administration of the blinded study medication on Treatment Day 28. After 4 weeks of therapy both treatments provided protection following exercise challenge. The protection estimated by the maximal fall in FEV(1) was significantly better for fluticasone propionate/salmeterol (9.5 +/- 0.8% [mean +/- SE]) compared with fluticasone propionate alone (12.7 +/- 1.1%, P = 0.021). Statistically significant differences were not observed for asthma rescue-free days and asthma symptom-free days. Chronic dosing with fluticasone propionate/salmeterol in a single device provides superior protection compared with an inhaled corticosteroid alone in protecting against exercise-induced asthma in children with persistent asthma.

Exercise-induced asthma in children

Exercise-induced bronchoconstriction affects 40–90% of people with asthma, compared with 3–15% of the general population. Exercise-induced asthma (EIA) is diagnosed on the basis of subjective symptoms of airflow obstruction during and after exercise, objective measures of airflow obstruction and the exclusion of alternative diagnoses. Although the pathogenesis of EIA has not been fully elucidated, two major theories have been proposed: the airway rewarming theory and the hyperosmolarity theory. Increasing evidence suggests that airway inflammation plays a major role in the pathogenesis of EIA. In this article, we review the prevalence, pathogenesis, methods for diagnosis and treatment of EIA, as well as the responsiveness of children and adolescents to EIA therapies.

Pharmaceutical treatment strategies for childhood asthma

Although great improvement has been obtained in quality of life and mastering of illness by asthmatic children over recent decades, controversies still exist related to asthma treatment. The objective of the present article is to discuss such controversies. Results from recent publications related to childhood asthma treatment question existing dogmas. Important for prescribing correct treatment to children is correct diagnosis. Phenotypes of childhood asthma related to treatment decisions are discussed. Early use of inhaled steroids in young children is still debated as well as the preference of inhaled long-acting beta2-agonists versus leukotriene receptor antagonists as add on to inhaled steroids. When present, both allergic rhinitis and asthma should be treated to obtain improved control. Also as regards the treatment of exercise-induced asthma in children, new results concerning use of leukotriene receptor antagonists is discussed as well as the acute treatment in infants with bronchial obstruction. There are still several controversies regarding treatment of the asthmatic child. New studies designed specifically for children are needed to solve these questions. One cannot rely on studies performed in adults for treatment in children. New studies designed for childhood asthma are needed to solve these controversies.

Exercise Challenge Test in 3- to 6-Year-Old Asthmatic Children

The exercise challenge test (ECT) is a common tool to assess exercise-induced asthma (EIA) in school-aged children. EIA has not been explored in the early childhood setting. To assess the existence of EIA in children in this age group. A 6-min, controlled, free-run test was performed in 55 children (age range, 3 to 6 years old) who were classified into the following groups: 30 children in whom asthma had been previously diagnosed (group A); and 25 children with prolonged coughing (group B). Spirometry measurements were obtained before the run, and at 1, 2, 3, 5, 10, and 20 min after the run. A positive finding of EIA was defined as a 13% decrease from baseline FEV(1) or baseline forced expiratory volume in the first 0.5 s (FEV(0.5)). The actual duration of each run was age-related (mean [+/- SD] duration, 4.8 +/- 0.8 min). The nadir in indexes occurred after a mean time of 2.98 +/- 1.31 min. A positive EIA finding determined by FEV(1) was present in 15 children, and by FEV(0.5) in 34 children. Twenty-six children were from group A, but only 8 children were from group B. Wheezing and/or prolonged expiration were associated with a positive test result in 31 of 34 children. Coughing was frequent in children with both negative and positive ECT findings. The present study documents for the first time the presence of EIA in response to a free-run test in early childhood. Our findings suggest that a free-run test for the presence of EIA is suitable, but that the running duration is limited by age. The duration of airflow limitation after exercise is significantly earlier and shorter in young children with asthma compared with older children. FEV(0.5) is a better index than the traditional FEV(1) for describing positive ECT results in young children. The association of wheezing and/or prolonged expiration may help in defining EIA in early childhood in the absence of a spirometer.

LTC4S(A-444C) Polymorphism is Associated with Severity of Exercise-Induced Asthma in Children

LTC4S(A-444C) Polymorphism is Associated with Severity of Exercise-Induced Asthma in Children

Exercise-Induced Asthma in Children: Not an Easy Diagnosis

Exercise-induced asthma (EIA) often is diagnosed informally, based on vague self-reported symptoms. Canadian investigators performed clinical exams and

The effect of leukotriene receptor antagonist zafirlukast on exercise-induced asthma in children

目的 探讨扎鲁司特对儿童运动性哮喘的治疗作用。方法 选取40例运动性哮喘患儿，随机分为两组，治疗组予扎鲁司特口服。对两组分别进行运动激发试验．并监测FEV1变化。结果 运动激发后，两组患儿FEV1均有明显下降，但对照组降低幅度较治疗组显著，且运动激发后FEV1恢复时间较长。结论 扎鲁司特对儿童运动性哮喘有较好的治疗作用。

Small Airway Responsiveness to Exercise as an Objective Measure of Exercise-Induced Asthma in Children

Exercise has been proposed as a useful challenge test for measuring bronchial hyper-responsiveness. The accepted diagnosis of exercise-induced asthma (EIA) is an end FEV1- change index of at least 10-20% post standard exercise. This preliminary study aimed to demonstrate the importance of the contribution of the small airways to the obstruction postexercise. Ninety-one asthmatic children aged 6-17 years, of whom 70 had clinical presentation of EIA, participated in this study. They were subdivided into three groups according to the percentage fall index of FEV1 post an exercise challenge. Thirty-nine children showed a reduction of 35 ± 12% in FEV1, and a reduction of 50%, 55%, and 54% in FEF25%, FEF50%, and FEF75%, respectively. Thirty-one had a reduction of 12 ± 5% in FEV1, and a reduction of 21%, 29%, and 33% in FEF25%, FEF50%, and FEF75%, respectively. Twenty-one asthmatic children without clinical EIA demonstrated a percentage fall index in FEV1 (2 ± 2%) and a mean percentage fall in FEF25%, FEF50%, and FEF75% of 7%, 7%, and 6%, respectively. The results of the present study suggest that the end FEF50%-change index post exercise, at a cut-off point of 21%, may be superior to the currently accepted definition of EIA, which is based on end FEV1%-change.

Exercise-induced asthma in children: a marker of airway inflammation.

What we know: Exercise-induced asthma (EIA) occurs in up to 23% of schoolchildren. In 40% of children with demonstrable EIA, no clinical diagnosis of asthma has been made. Children with asthma and EIA have eosinophils in their sputum, consistent with active asthma. EIA is well controlled in 50%-65% of children with moderate to severe asthma, so that only a minority will need prophylactic therapy immediately before exercise. Beta(2)-agonists are not the most suitable therapy for preventing EIA if they need to be used on a daily basis. The severity of EIA appears to be an indirect index of the severity of airway inflammation. What we need to know: Do non-symptomatic children with EIA require treatment for asthma? Does failure to identify and treat children unaware of their airways narrowing after exercise lead to airflow limitation in the long term, particularly in the small airways? Can exercise, or surrogate tests used to identify EIA, also be used to assess children with asthma? What is the minimum dose of steroid required to inhibit EIA, as high doses of steroids may be inappropriate in children? What is the best prophylactic treatment for EIA in children whose asthma is otherwise well controlled by inhaled steroids? What is the best prophylactic treatment for EIA in children with frequent episodic asthma or mild persistent asthma? Are leukotriene antagonists alone better than beta(2)-agonists alone in preventing EIA throughout the day? How many children taking long-acting beta(2)-agonists twice daily, either alone or in combination with an inhaled steroid, experience breakthrough EIA during school and require rescue medication?

MONTELUKAST ATTENUATES PULMONARY DECLINE DURING COMBINED COLD AIR/EXERCISE PROVOCATIONS IN CHILDREN WITH MILD ASTHMA

Leukotrienes appear to play a role in the etiology of exercise induced asthma (EIA). The use of cold air and exercise (CACEX) is a more sensitive provocative test than either exercise or cold air alone. To date, no studies have addressed the role of the leukotriene receptor antagonist in children with mild asthma and EIA subjected to this type of combined provocation. PURPOSE: This study was designed to determine whether montelukast (MNT) attenuates CACEX induced asthma in children. METHODS: Twenty children (AVG: 10.9, 6.5 – 14.5 yrs; 13M:7F) with mild asthma (FEV1% predicted: 98.4 ± 13.6) participated in a randomized, placebo-controlled, double-blind, cross-over design using MNT. All asthma medications were withheld prior to the study. After a screening CACEX test confirmed the presence of EIA, subjects were randomized to receive either two days of MNT 5mg nightly or placebo (PL) with a washout period of four days between conditions. A CACEX test followed each condition. RESULTS: The primary outcome variable of maximum decline in FEV1 compared to baseline was 15.5 ± 14.3% in MNT compared to 21.9 ± 19.5% in PL (p < 0.08). Similar findings were seen in peak expiratory flow (PEF), 16.0 ± 12.5% in MNT compared to 26.5 ± 20.5% in PL (p < 0.05). The area under the FEV1 vs. time curve (AUC) was −335.7 ± 353.5% min in MNT compared to −780.8 ± 735.7 in PL (p < 0.05). Similar results for the AUC of PEF were seen in MNT (−549.5 ± 475) and PL (−960.5 ± 907.4, p < 0.05). The time to return to within 5% of baseline FEV1 was reduced in the MNT group (7.8 ± 14.5 min) compared to the PL group (21.6 ± 24.6, p < 0.05). CONCLUSION: Compared to placebo, montelukast given for 2 days appears to attenuate the effects of cold air EIA in children with mild asthma. Supported by a grant from Merck & Co, Inc.

Exercise-induced asthma in children.

Exercise-induced asthma (EIA) is a relatively common problem in children, but may not be recognized because children either do not report their symptoms, or avoid activities that cause it. Clarifying the diagnosis of EIA, in particular separating EIA from other causes of exertional dyspnea, is essential. Treating EIA in children is challenging because of the nature of their physical activities, which are often not planned, and may be prolonged. Keeping children active is an important goal to ensure healthy physical and social development. Many children with EIA are well managed with an inhaled short-acting beta(2)-adrenoceptor agonist before exercise or if symptoms develop. The approach to more troublesome EIA depends on whether the child has persistent asthma and requires better prevention, or the EIA is an isolated clinical problem. The options for treatment also depend on the timing, frequency, and duration of activity that induces EIA. Options include the addition of a cromone, a leukotriene modifier, an inhaled corticosteroid, or switching to use a long-acting beta(2)-adrenoceptor agonist. The use of warm-up exercises has been shown to be helpful by using the refractory period but is not practical for most children with EIA. A final consideration for successful management of EIA in children is that the delivery of medication needs to be age-appropriate.

Exercise-Induced Asthma in Children

Exercise-Induced Asthma in Children

Choices of therapy for exercise-induced asthma in children.

Cough and wheezing interferes with sport and other forms of physical activity in half of asthmatic children. Airway obstruction can be induced by a standard exercise test in over 70% of children with asthma. A beta-adrenergic agonist or cromone taken by inhalation beforehand will usually inhibit bronchoconstriction provoked by a free running exercise test. The duration of protective effect with salbutamol, terbutaline and cromones is less than 4 h. The long acting beta-adrenergic agonists formoterol and salmeterol give protection against exercise-induced airway obstruction for up to 12 h, which implies that treatment given in the morning will offer protection from the effects of physical activity throughout the day. However, the duration of protective effect after a morning dose declines if these compounds are given regularly. Leukotriene receptor antagonists (LRAs) also provide good protection against exercise-induced asthma. Regular administration of LRAs is not associated with tolerance and loss of protective effect. The oral route makes for unobtrusive administration and this may help adherence to prescribed regimens.

Exercise-Induced Asthma in Children—A Comparative Study of Freeand Treadmill Running

Garcia DelaRubia S, Pajarone-Fernandez MJ, Sanchez-Solis M, et alAnn Allergy Asthma Immunol.801996232237Because exercise is one of the most common triggering factors for asthma in children, the purpose of this study was to determine if there are any differences in postexercise spirometry after treadmill and free running provocation tests.The results of a treadmill test performed by 30 children with asthma and 30 children without asthma were compared with those of a free running test in similar environmental conditions of temperature, humidity, and exercise intensity, assessed by heart rate as well as airway status at the time of the test.Seventy-three percent of the patients had a positive treadmill test and 63% had a positive running test. For the spirometric parameters that were used, there were no significant differences in the percent decrease post-exercise after either of the provocation tests. For the forced expiratory volume in 1 second (FEV1), which is the most highly regarded and sensitive diagnostic parameter, the sensitivity was 53% for the treadmill test and 67% for the free-running test and the specificity was 100% for both tests. Peak flow sensitivity was 43% for treadmill and only 27% for free-running with a specificity of 94% and 97%, respectively.Maintaining the same environmental conditions and exercise intensity, the treadmill and free-running tests can be used interchangeably for the evaluation of exercise-induced asthma.This is a useful study that demonstrates that treadmill and free-running tests are overall equivalent in the assessment of exercise-induced asthma. This study supports the usefulness of a free-running test for screening purposes, as it appears to be as sensitive as a treadmill, provided spirometry is used as the index, and environmental conditions and exercise intensity are controlled. A free-running test offers the further advantages of familiarity, simplicity of use, and inexpensive status, although it is more difficult to control for cardiopulmonary measurements.

Reduction of exercise-induced asthma in children by short, repeated warm ups.

AIM: To study the effect of a warm up schedule on exercise-induced asthma in asthmatic children to enable them to engage in asthmogenic activities. METHOD: In the first study, peak...

Functional Effects of Controlled Physical Activity in Children and Young Adults Affected by Exercise-Induced Asthma Treated with Corticosteroids and ??2-Agonists

Objective: The aim of the study was to evaluate the influence and validity of a controlled physical exercise programme and two different premedications in preventing exercise-induced asthma in children and young adults.

GC/MS analysis of urinary excretion of 9alpha,11beta-PGF2 in acute and exercise-induced asthma in children.

9Alpha,11beta-prostaglandin (PG) F2 is an initial metabolite of PGD2 which has a potent bronchoconstrictive activity. We measured the urinary levels of 9alpha,11beta-PGF2 in asthmatic children to investigate its role in not only acute asthmatic attack in a time course study but also in exercise-induced asthma (EIA). In the acute asthma study, 30 asthmatic children were examined. Urine samples were collected on the first, third, and sixth days. Urinary levels of 9alpha,11beta-PGF2 were measured with gas chromatography mass spectrometry using the electron impact method. In the exercise challenge study, 14 children with EIA and 14 children without EIA were studied. Urine samples were collected before exercise challenge, and at 1 h, and 5 h after exercise challenge. Urinary levels of 9alpha,11beta-PGF2 were measured. Elevated urinary levels of 9alpha,11beta-PGF2, which were observed on the first day when treatment was started in the hospital, were gradually decreased on the third day (P < 0.05), and on the sixth day (P < 0.01). A significant correlation between urinary levels of 9alpha,11beta-PGF2 and symptom scores (P < 0.005) was observed on the first day. In EIA, there was a significant increase in urinary levels of 9alpha,11beta-PGF2 at 1 h (P < 0.01) and at 5 h (P < 0.01) after exercise challenge, but not in the children without EIA. 9Alpha,11beta-PGF2 may be involved in the pathogenesis of acute and exercise-induced asthma in children.