Assessment of Exercise-Induced Bronchoconstriction in Adolescents and Young Children (original) (raw)
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Journal of Clinical Medicine Research, 2017
Background: Unlimited physical activity is one of the key issues of asthma control and management. We investigated how reliable reported exercise-related respiratory symptoms (ERRS) are in predicting exercise-induced bronchoconstriction (EIB) in asthmatic children. Methods: In this prospective study, 179 asthmatic children aged 7-15 years were asked for specific questions on respiratory symptoms related to exercise and allocated into two groups according to whether they complained about symptoms. Group I (n = 134) consisted of children answering "yes" to one or more of the questions and group II (n = 45) consisted of children answering "no" to all of the questions. Results: Sixty-four of 179 children showed a positive exercise challenge test (ECT). There was no difference in the frequency of a positive test between children in group I (n = 48) and group II (n = 12) (P = 0.47). The sensitivity of a positive report for ERRS to predict a positive ECT was only 37%, with a specificity of 0.72. Conclusion: According to current guidelines, the report or lack of ERRS has direct consequences on treatment decisions. However, the history of ERRS did not predict EIB and one-third of asthmatic children without complaints of ERRS developed EIB during the ECT. This raises the question of the need for objective measures of bronchial hyperresponsiveness (BHR) in pediatric asthma management.
Assessing Exercise-Induced Bronchoconstriction in Children; The Need for Testing
Frontiers in Pediatrics, 2019
Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and a sign of insufficient disease control. EIB is diagnosed and monitored based on lung function changes after a standardized exercise challenge test (ECT). In daily practice however, EIB is often evaluated with self-reported respiratory symptoms and spirometry. We aimed to study the capacity of pediatricians to predict EIB based on information routinely available during an outpatient clinic visit. Methods: A clinical assessment was performed in 20 asthmatic children (mean age 11.6 years) from the outpatient clinic of the MST hospital from May 2015 to July 2015. During this assessment, video images were made. EIB was measured with a standardized ECT performed in cold, dry air. Twenty pediatricians (mean years of experience 14.4 years) each evaluated five children, providing 100 evaluations, and predicted EIB severity based on their medical history, physical examination, and video images. EIB severity was predicted again after additionally providing baseline spirometry results. Results: Nine children showed no EIB, four showed mild EIB, two showed moderate, and five showed severe EIB. Based on clinical information and spirometry results, pediatricians detected EIB with a sensitivity of 84% (95% CI 72-91%) and a specificity of 24% (95% CI 14-39%).The agreement between predicted EIB severity classifications and the validated classifications after the ECT was slight [Kappa = 0.05 (95% CI 0.00-0.17)]. This agreement still remained slight when baseline spirometry results were provided [Kappa = 0.19 (95% CI 0.06-0.32)]. Conclusion: Pediatricians' prediction of EIB occurrence was sensitive, but poorly specific. The prediction of EIB severity was poor. Pediatricians should be aware of this in order to prevent misjudgement of EIB severity and disease control.
Exercise-Induced Bronchoconstriction in Children without Asthma
The Journal of Allergy and Clinical Immunology, 2011
Background/purpose: The diagnosis of exercise-induced bronchoconstriction (EIB) was established by changes in lung function after exercise challenge. The prevalence of EIB and factors related to EIB were not fully described in children with asthma. The aim of this study was to investigate the prevalence and predictors of EIB in children with asthma. Methods: A total of 149 children with physician-diagnosed asthma above 5 years of age underwent standardized treadmill exercise challenge for EIB and methacholine challenge for airway hyper-responsiveness from October 2015 to December 2016. Results: EIB presented in 52.5% of children with asthma. Compared with children without EIB, there were more patients with atopic dermatitis in children with EIB (p Z 0.038). Allergic to Dermatohagoides pteronyssinus and Dermatophagoides farinae were also found more in children with EIB (p Z 0.045 and 0.048 respectively). Maximal decrease in forced expiratory volume in 1 s (FEV 1) were highest in patients who were most sensitive to methacholine provocation (provocation concentration causing 20% fall in FEV1 [PC 20 ] 1 mg/mL). Patients, who were more sensitive to methacholine challenge (with lower PC 20 levels), develop EIB with more decline in FEV 1 after exercise challenge (p Z 0.038). Among patients with EIB, airflow limitation development in patient with methacholine-induced airway hyper-responsiveness
Pediatric Pulmonology, 2012
Objective: Asthma control represents a major challenge in the management of asthmatic children; however, correct perception of control is poor. The aim of the study was to evaluate the association between subjective answers given to the Childhood Asthma Control Test (C-ACT) and objective evaluation of exercise-induced bronchonstriction (EIB) by standardized treadmill exercise challenge. Methods: EIB was evaluated by standardized treadmill exercise challenge and related to C-ACT scores in 92 asthmatic children. Results: Of the 92 studied children only six children had a concordance between a positive challenge test (DFEV1 ! 13%) and a positive response to the exercise-related issue of the C-ACT questionnaire (C-ACT total score 19). There was no significant association between the degree of EIB and the scores relative to the single question on exercise-related problems while a significant association was found when considering the whole questionnaire with C-ACT total score > 19 (r ¼ À0.40, P < 0.001). The two single questions showing a significant association were those focusing on nocturnal asthma. The areas under the ROC curve (AUC) for the sum of the scores of these questions in relationship to a positive response to the exercise test was 0.74. The AUC of the C-ACT total score was 0.76 and 0.55 for the specific question on EIB related problems. Conclusion: The discrimination power of the C-ACT total score in relationship to EIB was moderately good, and C-ACT questionnaire was capable of correctly predicting the absence of EIB in children reporting a global score > 19. However, direct questions on EIB are associated with a high number of false positive and negative responses; better associations are found questioning on the presence on nocturnal symptoms. Pediatr Pulmonol.
Exercise intolerance and exercise-induced bronchoconstriction in children
Frontiers in Bioscience, 2017
Respiratory symptoms at rest or during exercise may restrain the physical capabilities required for normal motor and psychosocial development in children. The most frequent cause of exercise intolerance, apart from poor physical fitness, is exerciseinduced bronchoconstriction (EIB), which may occur in some healthy children and in children with asthma. It is proposed that hyperventilation during exercise is associated with drying and cooling of airways, which can trigger a proinflammatory response. Several tests are used to confirm EIB, and the exercise-challenge test is the most common. Some nonpharmacologic therapies may induce airway refractoriness; warm-up exercise can result in the attenuation of EIB in more than half of the people with EIB. Prophylactic intermittent treatment with short-acting bronchodilators is the most commonly used treatment, but the conventional pharmacologic therapy for patients with uncontrolled asthma is the regular use of inhaled corticosteroids, with or without long-acting beta-agonists and montelukast. Therapy should result in optimal control of exercise-induced symptoms during habitual physical activity and also allow participation in sports activity in athletes.
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 1992
To investigate the bronchial response to exercise, we studied a random sample of 494 children and adolescents, aged 7-16 years, from Copenhagen. Exercise challenge consisted olstcady running on a lO' Vn sloping treadmill for 6 min in a climate chamber. Furthermore, in 464 subjects a hislamine challenge test was also performed. Of the 494 subjects studied, 81 (16"..) had at least 10% and 30 (6%) at least 15% reduction in FEV, within 15 min after exercise. Twenty-nine (6'/.,) subjects had bronchial hy[>erresponsiveness to both histamine and exercise, 48 (10%) subjects had bronchial hyper responsiveness to exercise, but histamine responsiveness within the normal range, whereas 340 (73%) subjects had neither bronchial hyperresponsiveness to exercise nor inhaled histamine. With regard to the presence of asthma defined as substantial exercise induced bronchoconstriction (A-FEV, ^ lO^.i), exercise testing may not be appropriate for identifying clinical asthma in a random sample, becausethehighest predictive value of a positive lest was 25%. On the other hand, a history of clinical asthma was frequently associated with increased bronchial responsiveness to exercise (77'^,)-In conclusion. 16% of a random sample o^ children and adolescents had abnormal bronchial responsiveness to exercise {AFEV|^10%), 6% of the subjects had a AFEVI5J15%. Furthermore, because of a low predictive value of a positive test, the exercise challenge test has only a supplementary role in the detection of clinical asthma in population samples.
Asthma Control Test and Bronchial Challenge with Exercise in Pediatric Asthma
Frontiers in Pediatrics, 2016
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest Author contribution statement ST setup and managed the study and recruited participants. ST and MB interpreted the data. MB revised and analyzed the data and wrote the final version of the manuscript. AD-B, OG and GR recruited participants and performed exercise tests. MC collected data and help to critically revise the work. SM-S conceptualized the study. IS and GR managed and cleaned database. ST, AD-B, SM-S, OG and IS co-drafted the initial version of the manuscript. All authors read and approved the present version of the manuscript.
The relation between age and time to maximal bronchoconstriction following exercise in children
Respiratory Medicine, 2009
Background: The exercise challenge test (ECT) is a common tool for assessment of asthma in children. Many studies suggest that the ''time to maximal bronchoconstriction'' (Nadir-t) after exercise challenge in asthmatic children may be age-dependent, although this has never been systematically studied. Such findings may influence epidemiological surveys where the schedule of post-exercise measurements is trimmed. This study systematically assesses the relation between age and time to maximal bronchoconstriction post-ECT. Methods: Data were collected retrospectively from 131 subjects (87 male; 3e18 years) who were referred for ECT. The routine ECT was performed according to ATS recommendation of a 6-min run. Spirometry was measured at 1, 3, 5, 10, 15, and 20 min post-exercise. The post-exercise nadir of FEV 1 (%baseline) (FEV 1 -nadir) and the time to maximal fall in Nadir-t (minutes) were sought and values were related to age. Results: Baseline FEV 1 values (mean AE SD) were 90.5 AE 13.8% predicted. FEV 1 -nadir was À23.6 AE 11.7% from baseline values. The Nadir-t was reached at 5.1 AE 2.6 min (range 2e12 min). A positive correlation between children's age and Nadir-t was observed (r 2 Z 0.542; SD of residuals Z 1.79; p < 0.001), regardless of FEV 1 -nadir, whether the cutoff of point was À10% or À15% of baseline FEV 1 .C h i l d r e n<10 years of age showed Nadir-t at 3.4 AE 1.7 min post-exercise and older children at 6.6 AE 2.5 min post-exercise (p < 0.0001). Conclusion: Our results indicate that the time to maximal bronchoconstriction is agedependent in children and adolescents, and imply that the schedule of post-exercise FEV 1 measurements should be cautiously trimmed. ª