Severity Of Exercise-induced Bronchospasm Research Articles

Obesity is a risk factor for exercise-induced bronchospasm in asthmatic adolescents.

Exercise-induced bronchospasm (EIB) is common in young asthmatics and obesity is becoming an epidemic in this population. Both conditions can give rise to or worsen respiratory symptoms upon exercise and may interfere with recreational and sports activities. To investigate the association between obesity and the risk and severity of EIB in asthmatic children and adolescents. This study included data from asthmatic patients aged between 7 and 19 years undergoing treadmill running tests to evaluate EIB, defined as a reduction greater than or equal to 10% in forced expiratory volume in the first second (FEV1 ) compared to baseline. Eutrophic, obese, and overweight individuals were categorized according to body mass index z-score (eutrophic, -0.5 < z ≤ 1; overweight, 1 < z < 2; and obese, z ≥ 2). Of the 156 individuals studied (42% female), 58% were eutrophic, 22% overweight, and 19% obese. Seventy-three individuals (47%) presented with EIB, with higher risk among obese (OR, 2.86; 95% CI, 1.00-8.14; P = .05). Asthma severity was another independent risk factor for EIB (OR, 2.95; 95% CI, 1.36-6.42; P = .006). The number of patients in whom FEV1 returned to baseline values (difference less than 10% from baseline) at the 13th minute after challenge was lower in obese individuals compared to eutrophic and overweight ones (P = .04). Baseline FEV1 , gender, or age were not found to be risk factors for EIB in any of the groups. Obese youngsters with asthma present a greater risk for EIB with slower recovery than their nonobese peers. Clinicians should be aware of this association, especially in those with more severe disease, for adequate recognition and treatment.

EFFECT OF PHYSICAL TRAINING ON EXERCISE-INDUCED BRONCHOSPASM IN YOUNG ASTHMATICS

ABSTRACT Introduction: Asthma is the most common chronic disease in childhood and its prevalence has increased in recent years. Although regular physical activity (PA) is considered to be beneficial for the health of asthmatics, especially children and adolescents, it can also be one of the elements that triggers asthma. This is known as exercise-induced bronchospasm (EIB), and is considered one of the factors that limits asthmatics’ participation in PA. Objective: This study aims to review the effects of physical conditioning on EIB in asthmatic children and adolescents. Methods: A systematic review was carried out on the Pubmed, Bireme and Web of Science databases, considering publications from 1998 to April 2019. Results: Eight articles were retrieved; five of the articles presented no significant difference in EIB parameters after physical training, and three demonstrated significant benefits in EIB. Conclusion: There is insufficient evidence that physical training helps reduce the frequency and severity of EIB in young asthmatics. There are still few studies that seek to show the effect of a physical training program on the improvement of EIB in children and adolescents. It is suggested that further randomized clinical trials be conducted, to investigate the effects of physical training on EIB parameters in children and adolescents. Level of Evidence II; Systematic review.

Exhaled RANTES and interleukin 4 levels after exercise challenge in children with asthma

BackgroundDespite the universality and clinical significance of exercise-induced bronchospasm (EIB), the mechanisms responsible for it are incompletely understood. ObjectiveTo investigate the role of exhaled RANTES (regulated on activation, normal T-cell expressed and secreted) and interleukin (IL) 4 in EIB in children with asthma. MethodsFifty-six children with asthma were evaluated with exercise challenge and exhaled RANTES and IL-4 levels. Exhaled breath condensate was collected before and 30 minutes after exercise challenge. RANTES and IL-4 concentrations were determined using a specific immunoassay kit. ResultsA significant increase was found in RANTES levels after exercise challenge in the asthmatic children (P<.001). A statistically significant increase in RANTES levels was noted after exercise challenge in both the asthmatic children with EIB (n=25, P=.007) and in the non-EIB asthmatic group (n=31, P=.005). Our study revealed that exhaled RANTES level correlates significantly well with percentage of forced expiratory volume in 1 second (FEV1), exacerbation frequency, serum IgE, and body mass index. No statistically significant increase was found in IL-4 levels after exercise challenge. The maximal postexercise decrease in FEV1 strongly correlated with total eosinophil count (P<.001, r=−0.61) and baseline ratio of FEV1 to forced vital capacity (FVC) (P=.002, r=0.40). Results from multivariate regression analysis adjusted for age, sex, and atopy as covariates showed that eosinophil count and FEV1/FVC ratio were significantly associated with EIB. ConclusionWe found that exercise challenge, leading to hyperosmolar stimulus, may increase exhaled RANTES levels in children with asthma. In addition, exhaled RANTES levels correlate well with serum IgE, severity of asthma, FEV1/FVC ratio, and body mass index. RANTES and IL-4 may not be independent predictors for EIB. Furthermore, eosinophil count and FEV1/FVC ratio may predict the presence and severity of EIB in asthmatic children.

Broncoespasmo induzido pelo exercício em adolescentes asmáticos obesos e não-obesos

OBJETIVO: Avaliar e comparar a frequência e intensidade do broncoespasmo induzido pelo exercício (BIE) em adolescentes asmáticos obesos e não-obesos. MÉTODOS: Estudo transversal e descritivo realizado com 39 adolescentes de ambos os sexos, com idade entre dez e 16 anos, divididos em dois grupos conforme o histórico clínico de asma e/ou rinite alérgica e o índice de massa corporal: asmáticos obesos (n=18); asmáticos não-obesos (n=21). Utilizou-se o teste de broncoprovocação com exercício para a avaliação do BIE, considerando-se positiva uma diminuição do volume expiratório forçado no primeiro segundo (VEF1) &gt;15% do valor pré-exercício. Para avaliar a intensidade e a recuperação do BIE, foram calculadas a queda percentual máxima do VEF1 (QM%VEF1) e a área acima da curva (AAC0-30). A análise estatística utilizou o teste exato de Fischer para comparar a frequência de BIE e o teste de Mann-Whitney para a intensidade e recuperação. Rejeitou-se a hipótese de nulidade se p&lt;0,05. RESULTADOS: Não houve diferença significativa na frequência de BIE entre os grupos de asmáticos obesos (50%) e não-obesos (38%). Entretanto, a queda máxima do VEF1 e a AAC0-30 foram maiores nos asmáticos obesos em comparação aos não-obesos (respectivamente 37,7% e 455 versus 24,5% e 214, p&lt;0,03). CONCLUSÕES: A obesidade não contribuiu para o aumento da frequência do BIE em asmáticos e não-asmáticos, entretanto, a obesidade contribuiu para o aumento da intensidade e do tempo de recuperação da crise de BIE em asmáticos

Exercise-induced bronchospasm in obese adolescents

Background Assess the frequency and severity of exercise-induced bronchospasm (EIB) in obese adolescents. Methods A cross-sectional descriptive study involving 80 adolescents of both genders, aged 10–16 years-old, divided into four groups according to clinical history of asthma and/or allergic rhinitis and body mass index as follows: asthmatic obese (n=18); asthmatic non-obese (n=21); obese non-asthmatic (n=26); and healthy individuals (n=15). An exercise bronchoprovocation test was used for EIB diagnosis, considered positive when the forced expiratory volume in one second (FEV 1) decreased ≥15% in relation to pre-exercise FEV 1. Maximum percent fall in FEV 1 (MF%FEV 1) and area above the curve (AAC 0−30) were calculated to evaluate EIB severity and recovery. Results No significant difference was found in EIB frequency between asthmatic obese (50.0%) and asthmatic non-obese (38.0%) individuals or between obese non-asthmatics (11.5%) and healthy individuals (6.7%). However, the MF%FEV 1 and AAC 0−30 were significantly greater in the asthmatic obese group compared to the asthmatic non-obese (37.7% and 455 vs 24.5% and 214, p<0.03). Conclusions Obesity did not contribute to increased EIB frequency in asthmatics and non-asthmatics. However, obesity did contribute to increased EIB severity and recovery among asthmatics.

A CROSS-SECTIONAL STUDY ON EXERCISE-INDUCED BRONCHOCONSTRICTION AMONG SCHOOL-AGED CHILDREN IN QUEZON CITY, METRO MANILA

PURPOSE: To determine the prevalence and severity of exercise-induced bronchospasm (EIB)among school-aged children in a government elementary school in Metro Manila.

Pretreatment with Albuterol versus Montelukast for Exercise‐Induced Bronchospasm in Children

To compare pretreatment with albuterol versus montelukast added to the current asthma regimen for protection against exercise-induced bronchospasm in children with mild-to-moderate asthma, and to determine whether cysteinyl leukotriene (Cys-LT) concentrations measured in the exhaled breath condensate correlated with response to montelukast. Prospective, randomized, double-blind, double-dummy, crossover study. Asthma clinic at a university-affiliated medical center. Eleven children aged 7-17 years with physician-diagnosed mild-to-moderate asthma for at least 6 months and with self-reported exercise-induced bronchospasm (defined as > or = 15% decrease in forced expiratory volume in 1 sec [FEV(1)] at screening and baseline visit). Patients were randomly assigned to receive 3-7 days of oral montelukast 5-10 mg/day or 2 puffs of an albuterol metered-dose inhaler just before an exercise challenge and then were crossed over to the alternate therapy for the last visit. Serial spirometry was performed before and at 0, 5, 10, 15, 30, 45, and 60 minutes after the exercise challenge at each visit. Measurement of exhaled breath condensate was performed at the screening visit and study visits 1 and 2. The primary outcome was the maximum change in FEV(1) after exercise. Secondary outcomes were the area under the curve for FEV(1) (expressed as percentage decrease from baseline) during the first 60 minutes (AUC(0-60)) after exercise and the proportion of patients in whom exercise-induced bronchospasm was prevented (defined as < 15% decrease in FEV(1) after exercise challenge). The mean +/- SD maximum decrease in FEV(1) was 27.5 +/- 7.9% at baseline. Patients receiving montelukast had an 18.3 +/- 13.7% decrease in FEV(1) compared with 0.7 +/- 1.6% in patients receiving albuterol (p=0.002, paired t test). Exercise-induced bronchospasm was prevented in 100% of the patients receiving albuterol compared with 55% receiving montelukast (p<0.05, McNemar's test). The AUC(0-60) was significantly smaller with albuterol compared with montelukast (p<0.001, Wilcoxon signed rank test). No correlations were found between Cys-LT concentration and the severity of exercise-induced bronchospasm or the response to montelukast. Pretreatment with albuterol is more effective than montelukast for prevention of exercise-induced bronchospasm in children with asthma.

Airway Inflammation in Exercise-Induced Bronchospasm Occurring in Athletes Without Asthma

Exercise-induced bronchospasm (EIB) occurs in athletes with and without asthma. Studies have suggested an inflammatory basis for EIB in asthmatics; however whether inflammation plays a similar role in EIB in athletes without asthma remains unclear. Our objective was to determine whether there is evidence of an inflammatory basis for exercise-induced bronchospasm occurring in non-asthmatic athletes._Ninety-six athletes without asthma from varsity college teams underwent eucapnic voluntary hyperventilation testing. Sputum was induced from subjects with hypertonic saline inhalation post-eucapnic voluntary hyperventilation testing and was analyzed with enzyme-linked immunosorbent assays for IL-5, IL-8, IL-13, cysteinyl-leukotrienes, prostaglandin E2, histamine, leukotriene B4, and thromboxane B2. In addition, inflammatory (neutrophils, lymphocytes, eosinophils, and macrophages) and epithelial cell counts in sputum were recorded._Multivariate regression modeling showed a significant correlation between concentrations of select inflammatory mediators after eucapnic voluntary hyperventilation testing and severity of EIB. Means of the log-transformed concentrations of inflammatory mediators in EIB-positive athletes were significantly higher post-eucapnic voluntary hyperventilation than in EIB-negative athletes. Similar findings were not demonstrated with inflammatory cells._Concentrations of inflammatory mediators are higher in EIB-positive athletes than in EIB-negative athletes without asthma after eucapnic voluntary hyperventilation testing. The severity of EIB in our cohort also is significantly correlated with increased concentrations of select inflammatory mediators suggesting a potential inflammatory basis for EIB in athletes without asthma.

Airway Hyperresponsiveness to Hypertonic Saline as a Predictive Index of Exercise-Induced Bronchoconstriction

BackgroundChanges in airway mucosal osmolarity are an underlying mechanism of bronchoconstrictive responses to exercise and hypertonic saline (HS). The purpose of this study was to examine whether an osmotic challenge test using HS can predict exercise-induced bronchospasm (EIB) in asthma patients.MethodsThirty-six young male asthmatic patients underwent bronchial challenge tests based on 4.5% HS, exercise (> 24h later), and methacholine (MCh) at the Chonnam National University Hospital. The relationships between responses to HS and exercise, and between MCh and exercise were evaluated.ResultsThe maximal fall in forced expiratory volume in one second following exercise was significantly higher in the HS-responders (n=19) than in the HS-nonresponders (n=17, 35.9±4.1% vs. 17.9±2.7%, p<0.001), and there was a significant correlation between the severity of EIB and HS-airway hyperresponsiveness (AHR). When compared with the MCh-AHR test in terms of predicting EIB, the HS-AHR test showed higher specificity (71.4% vs. 42.9%), but a lower sensitivity (58.6% vs. 89.7%) and negative predictive value (29.4% vs. 50.0%). At the moderate AHR cutoff value, the MCh-AHR test had a specificity that was comparable with and predictive values that were higher than those of the HS-AHR test.ConclusionsThe HS-AHR test was more specific than the MCh-AHR test, but was less sensitive and had a poorer negative predictive value, which in combination preclude the use of the HS-AHR test as a screening tool for EIB. The MCh-AHR test had a cutoff value for moderate AHR that may be more useful for predicting EIB in asthmatic patients.

Broncoespasmo induzido pelo exercício em crianças e adolescentes com diagnóstico de asma

INTRODUÇÃO: A broncoconstrição temporária após o exercício físico tem elevada prevalência em crianças e adolescentes asmáticos. OBJETIVO: Determinar a freqüência e gravidade do broncoespasmo induzido pelo exercício em crianças e adolescentes, com diagnóstico clínico de asma leve, moderada e grave. MÉTODO: Foi realizado um estudo descritivo, tipo transversal, não controlado. A amostra constituiu-se de 40 indivíduos asmáticos, de ambos os sexos, com idade entre 7 e 18 anos, que não utilizavam regularmente medicação anti-inflamatória. Foi realizado teste padronizado de provocação brônquica com exercício de corrida em esteira rolante. A espirometria foi padronizada em seis manobras expiratórias, realizadas antes e aos 1, 5, 10, 15, 20 e 30 minutos após o término do exercício, sendo escolhida a de maior valor. O volume expiratório forçado no primeiro segundo (VEF1) foi utilizado para o diagnóstico e classificação da gravidade do broncoespasmo. Os pacientes asmáticos apresentavam condições clínicas e espirométricas adequadas para os testes (VEF1 &gt; 70% do valor previsto). Foi utilizada como critério de positividade para o broncoespasmo induzido pelo exercício queda &gt;10% em relação ao VEF1 prévio ao exercício. RESULTADOS: Vinte e seis (65%) pacientes desenvolveram broncoespasmo após o exercício. Dos pacientes com asma leve 44%, e dos com asma moderada e grave, 100% desenvolveram broncoespasmo. Houve associação significativa entre a freqüência do broncoespasmo induzido pelo exercício e a gravidade da asma (p&lt; 0,05), e diferença significativa entre a sua gravidade (confirmada por uma queda no VEF1) e a gravidade da asma (p &lt; 0,05). CONCLUSÃO: A freqüência e gravidade do broncoespasmo induzido pelo exercício estiveram relacionadas com a gravidade clínica da asma.

The Effect of swimming training on the severity of exercise-induced bronchospam

O objetivo deste estudo foi verificar o efeito do treinamento em natação sobre a severidade do broncoespasmo induzido por exercício (BIE). Trinta e dois adolescentes asmáticos, sendo 16 do grupo experimental (GE), submetidos a um programa de treinamento em natação durante 10 semanas, com três sessões semanais de 45 minutos cada, e 16 do grupo controle (GC), não submetidos a treinamento, participaram deste estudo. As funções pulmonares foram avaliadas através de espirometria computadorizada, realizada cinco minutos &lt; antes e cinco minutos após uma corrida de 7-8 minutos em esteira rolante com inclinação de 10% e intensidade de 85-90% da freqüência cardíaca máxima, antes e depois do período de treinamento. Os valores do fluxo expiratório forçado entre 25 e 75% da capacidade vital forçada (FEF25.75), comparando-se antes versus depois do treinamento, não foram significativamente diferentes (p &gt; 0,05), tanto em repouso quanto no pós-exercício. Entretanto, houve diferença significativa (p &lt; 0,05) èntre os valores do fluxo expiratório máximo (FEM) em repouso (4,82 l.s versus. 5,61 l.s antes versus depois do treinamento, respectivamente) e no pós-exercício (3,13 l.s* versus 4,01 l.s , antes versus depois do treinamento, respectivamente) e também entre os valores da capacidade vital forçada • (CVF) em repouso (3,21 1 versus 3,42 1, antes versus depois do treinamento, respectivamente) e no pós-exercício (2,43 1 versus 2,91 1, antes versus depois do treinamento, respectivamente). Estes resultados sugerem que, apesar destes indivíduos continuarem sendo asmáticos, portadores de BIE, o treinamento em natação aplicado reduziu a severidade do BIE destes indivíduos. Isto pode ter implicações clínicas importantes para estes indivíduos em suas * atividades diárias, especialmente na prática de atividade física. Futuros estudos devem ser realizados para esclarecer os mecanismos responsáveis pelos efeitos observados

Blood eosinophil counts for the prediction of the severity of exercise-induced bronchospasm in asthma

It has been suggested that airway eosinophilic inflammation is associated with the severity of exercise-induced bronchospasm (EIB). Blood eosinophils are known to be an indirect marker of airway inflammation in asthma. The aim of this study is to investigate that a simple and easy blood test for blood eosinphil counts may predict the severity of EIB in asthma. Seventy-seven men with perennial asthma (age range 18–23 years) were included. Lung function test, skin prick test, and blood tests for eosinophils counts and total IgE levels were performed. Methacholine bronchial provocation test and, 24 h later, free running test were carried out. EIB was defined as a 15% reduction or more in post-exercise FEV1 compared with pre-exercise FEV1 value. Atopy score was defined as a sum of mean wheal diameters to allergens. EIB was observed in 60 (78%) of 77 subjects. Asthmatics with EIB showed significantly increased percentages of eosinophils (P<0·01), log eosinophil counts (P<0·001), and atopy scores (P<0·05) and decreased log PC20 values (P<0·05) compared with asthmatics without EIB. Asthmatics with eosinophils of >700 μ l−1 (36·9±12·7%) had significantly greater maximal % fall in FEV1 after exercise than asthmatics with eosinophils of <350 μl−1 (24·7±16·6%, P <0·05). Blood eosinophil counts >350 μ l−1 yielded the specificity of 88% and positive predictive value of 93% for the presence of EIB. When a multiple regression analysis of maximal % fall in FEV1 according to log eosinophil counts, log PC20, log IgE and atopy score was performed, only blood eosinophil counts were significant factor contributing to the maximal % fall in FEV1 after exercise. These findings not only suggest that a simple blood test for eosinophils may be useful in the prediction of the severity of EIB, but also reinforce the view that airway eosinophilic inflammation may play a major role in EIB in asthma.

Standardization of the severity of exercise‐induced bronchospasm in Japanese children with asthma:‐ A report of the Committee on Standardization of EIB, Japanese Society of Pediatric Allergy‐

AbstractThe correlation between the severity of asthmatic symptoms and of EIB (exercise‐induced bronchospasm) was studied by changes in PEFR (peak expiratory flow rate). This was accomplished by bicycle ergometer exercise of 12.6 kpm/kg of body weight for 6 minutes, or by treadmill exercise of 6km/h, 10% incline for 6 minutes, by children with bronchial asthma in 7 institutions in Japan (both inpatients and outpatients).The incidence of EIB in those using bicycle ergometers was 63.7%, and the clinical severity paralleled the EIB severity closely, showing complete agreement in 71% and almost complete agreement in 94%. The severity of EIB was as follows: no EIB in less than 15%, mild EIB in15–20%, moderate EIB in 21 ‐45%, and severe EIB in over 45%.The incidence of EIB in those using the treadmill was 65.2% and did not correlate as well as with the clinical severity as in those using the bicycle ergometer. The maximum % fall in PEFR of those judged to be EIB positive using the treadmill was more than 25%.We recommend the use of the bicycle ergometer to determine the severity of bronchial asthma in children.

Evaluation of exercise-induced bronchospasm in the adult asthmatic

It has been shown that most asthmatics respond to exercise with bronchospasm. This study was undertaken to develop a safe and reliable method for quantifying exercise-induced bronchospasm in the asthmatic adult. Five normal adult volunteers and 12 stable asthmatics were exercised to 80% of their predicted maximal heart rate according to a multistage branching treadmill protocol. Their responses in terms of forced expiratory volume in 1 sec (FEV 1) and maximum midexpiratory flow rate (MMEFR) at 5, 15, and 30 min after exercise were assessed, while standing, with a Jones Pulmonar II waterless spirometer. This submaximal stress test was chosen because 80% of predicted maximal heart rate could be obtained by all individuals and allowed the asthmatics to exercise long enough for inducible bronchospasm to occur. Audible wheezing was induced in 100% of the asthmatics and in none of the nonasthmatics. In the normal individuals, FEV 1 and MMEFR increased significantly during the postexercise period. When compared to normal subjects, the 12 asthmatic patients demonstrated a significant reduction in FEV 1 an MMEFR (ΔFEV 1: 5 min, −300; 15 min, −304; 30 min, −208 ml; −18%, −17%, and −15%; ΔMMEFR: 5 min, −15; 15 min, −9; 30 min, −1L/M; −23%, −18%, and −6%) (p < 0.01). The use of a rigidly controlled exercise stress with a cardiovascular endpoint in the measurement of FEV 1 and MMEFR in the postexercise period appears to be a useful tool in assessing the presence and severity of exercise-induced bronchospasm in the adult asthmatic.