The relation between age and time to maximal bronchoconstriction following exercise in children (original) (raw)
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Assessment of Exercise-Induced Bronchoconstriction in Adolescents and Young Children
Immunology and Allergy Clinics of North America, 2013
Recent research shows important differences in exercise induced bronchoconstriction (EIB) between children and adults, suggesting a different pathophysiology of EIB in children. Although exercise can trigger classic symptoms of asthma, in children symptoms can be subtle and nonspecific; parents, children, and clinicians often do not recognise EIB. With an age-adjusted protocol, an exercise challenge test can be performed in children as young as 3 years of age. However, an alternative challenge test is sometimes necessary to assess potential for EIB in children. This review summarises age-related features of EIB and recommendations for assessing EIB in young children and adolescents.
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.
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.
Monitoring pulmonary function during exercise in children with asthma
Archives of Disease in Childhood, 2011
Objective Exercise-in duced bronchoconstriction (EIB) is defi ned as acute, reversible bronchoconstriction induced by physical exercise. It is widely believed that EIB occurs after exercise. However, in children with asthma the time to maximal bronchoconstriction after exercise is short, suggesting that the onset of EIB in such children occurs during exercise. Aim In this study the authors investigate pulmonary function during exercise in cold air in children with asthma. Methods 33 Children with asthma with a mean age of 12.3 years and a clinical history of exercise induced symptoms, underwent a prolonged, submaximal, exercise test of 12 min duration at approximately 80% of the predicted maximum heart rate. Pulmonary function was measured before and each minute during exercise. If EIB occurred (fall in forced expiratory volume in 1 s >15% from baseline), exercise was terminated and salbutamol was administered. Results 19 Children showed EIB. In 12 of these children bronchoconstriction occurred during exercise (breakthrough EIB), while seven children showed bronchoconstriction immediately after exercise (non-breakthrough EIB). Breakthrough EIB occurred between 6 and 10 min of exercise (mean 7.75 min). Conclusion In the majority of children with EIB in this study (ie, 12 out of 19), bronchoconstriction started during, and not after, a submaximal exercise test.
Pilot study: The effect of reducing treatment on exercise induced bronchoconstriction
Pediatric Pulmonology, 2010
Rationale: Asthma therapy should be stepped up or stepped down in response to changes in asthma control. However, there is little evidence available on the optimal timing, sequence and degree of medication reductions. In this study we analyzed clinically stable asthmatic children who underwent a medication reduction from a combination preparation consisting of an inhaled corticosteroid (ICS) and long acting beta2-agonists (LABA) to monotherapy with the same dose of the ICS. We hypothesized that the extent of exercise induced bronchoconstriction (EIB) would not increase after the cessation of the LABA.
Predictors of Exercise-Induced Bronchoconstriction in Subjects with Mild Asthma
2020
Background: Physical effort is one of the natural stimuli capable of triggering airway obstruction in asthmatics, the so called exercise-induced bronchoconstriction in asthma (EIBa). This study was performed in subjects with mild persistent asthma suspected for EIBa, aiming to nd predictors among functional parameters at rest and during exercise for developing EIBa. Methods: In 20 subjects with mild asthma in stable conditions who reported respiratory symptoms on exertion in the past, measurements of baseline functional respiratory parameters and airways responsiveness by a methacholine challenge were obtained on the rst day of the study after an adequate pharmacological washout. The day after, a maximal symptom-limited incremental cardiopulmonary exercise test (CPExT) was performed, with subsequent, repeated maneuvers of maximal full forced expiration to monitor the FEV 1 change at 1,3,5,7,10 and 15 minutes after the end of exercise for diagnosing EIBa. Results: 19 subjects aged 27±5 years completed the two-days protocol. No functional parameters both at rest and during effort were useful to predict EIBa after stopping exercise that actually occurred in 12 individuals. In contrast to asthmatics without EIBa, in those with EIBa, however, mean Inspiratory Capacity (IC) did not increase with increasing ventilatory requirements during CPExT because 6 of them (50%) displayed dynamic pulmonary hyperin ation (DH) throughout the exercise, as documented by the progressive increase of end-expiratory lung volume. This subgroup of asthmatics with EIBa who in turn showed earlier and greater post-exercise FEV 1 fall had signi cantly lower forced mean expiratory ow between 25% and 75% of forced vital capacity (FEF 25-75%) at rest (p<0.05) and higher airways responsiveness, expressed as PD 20 FEV 1 (p<0.05). Conclusions No functional respiratory parameters either at rest or during the effort seem to predict EIBa in mild asthmatics after maximal exercise test. In those with EIBa, however, a subgroup developed DH during exercise, and this was associated with baseline reduced forced expiratory ow-rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.
Interrupter technique for evaluation of exercise-induced bronchospasm in children
Pediatric Pulmonology, 1999
The free running test is a useful method for evaluation of exercise-induced bronchospasm in children. In young children this test simulates real-life circumstances and can be done more easily than histamine or methacholine challenges. The interrupter technique is a noninvasive method for measuring airflow resistance during tidal breathing. This approach requires minimal cooperation, and is therefore promising for use in young children. Fifty children aged 5-15 years with asthma symptoms were tested by exercise challenge consisting of free outdoor running for 8 min at 85% of maximal predicted heart rate for age. Pulmonary function was measured by using the interrupter technique (IR), with a Wright's peak flow meter (WPEF), and by flow-volume spirometry (FVS). The measurements were done before and 10 min after exercise. In addition, WPEF was measured at 5, 15, and 20 min after exercise. A fall of 15 % or more in WPEF associated with wheezing or cough symptoms was considered a positive test.
Influence of Exercise on Pulmonary Function tests in young individuals
Background and Aim: Measurement of the ventilatory adaptation to exercise may provide useful information about the functional reserve capacity of the lungs in individuals with respiratory diseases. However it is essential to define the mode of response to exercise in a normal population before identifying the individuals with an abnormal response. Hence the present study aimed to study the influence of acute exercise on pulmonary function tests in normal young individuals. Materials and Methods: A total of 100 students comprising of 50 males and 50 females in the age group of 18-21 years were divided into four groups based on their body mass index as Underweight, normal, overweight and obese individuals. Respiratory parameters (VC, FVC, FEV1, FEV1% and PEF) were measured at rest and after an incremental form of acute exercise in the bicycle ergometer. Results: No significant changes were observed in all the four groups before and after exercise in males. However the post exercise values of FVC and VC were reduced than the baseline values in overweight and obese females (p < 0.01). Conclusion: Acute exercise did not significantly affect the respiratory parameters. However the body fat distribution of the individual may significantly influence the ventilatory response to acute exercise in otherwise healthy individuals.
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.