An update on exercise-induced bronchoconstriction with and without asthma

Randolph, Christopher

doi:10.1007/s11882-009-0064-8

Cited by 41 publications

(18 citation statements)

References 47 publications

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“…2 The absence of apparent dyspnea associated with EIB was also seen when EIB was observed in children with rhinitis but no asthma. Others have reported as high as 40% prevalence of EIB associated with only allergic rhinitis.…”

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confidence: 90%

Is Exercise-Induced Bronchoconstriction Exercise-Induced Asthma?

Weinberger

Abu-Hasan

2016

Respir Care

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The article in this issue of RESPIRATORY CARE by Burnett et al 1 reports that 34 of 80 college athletes had exerciseinduced bronchoconstriction (EIB), most in the absence of symptoms. The authors further suggest that these athletes are at risk and that the identification of those with EIB may prevent morbidity and mortality. The implication is that the presence of EIB is evidence for asthma. But is the presence of EIB in the absence of exercise-induced dyspnea or other symptoms of asthma the same as exercise-induced asthma?EIB in the normal population and in athletes has been described previously. 2 The absence of apparent dyspnea associated with EIB was also seen when EIB was observed in children with rhinitis but no asthma. Others have reported as high as 40% prevalence of EIB associated with only allergic rhinitis. 3 EIB was also reported in children with decreased levels of physical activity and no clinical evidence of asthma. 4 But is EIB of clinical importance in the absence of dyspnea? Is a Ͼ10% decrease in FEV 1 subsequent to exercise in the absence of clinical dyspnea sufficient for the diagnosis of exercise-induced asthma? The presence of EIB in a child without symptoms of asthma may be, as suggested by Burnett et al, 1 predictive that some minority will eventually develop symptoms of asthma, but most apparently will not. This study as well as most previous studies relating to EIB and asthma symptoms are cross-sectional. The higher incidence of EIB compared with symptoms in previous studies calls for longitudinal studies to determine a better or possibly more stringent criteria for EIB that might include higher cutoff value in FEV 1 change, reproducibility of symptoms during testing, and reversibility with bronchodilators to help identify subjects at true risk of exercise-induced asthma and in need of attention and/or treatment.We have previously reported 5 our experience with exercise studies in 140 children examined because of a complaint of dyspnea on exertion. Most had been previously diagnosed and/or treated as having asthma by their primary care physician, but their negative response to albuterol before exercise was inconsistent with an asthma diagnosis. Despite reproducing their symptom of dyspnea on exertion, only 11 of those 140 had EIB. None of the others, most of whom were high school athletes, had EIB or other evidence of asthma. Their reproduced dyspnea on exertion was associated with various physiological findings. The difference in prevalence of EIB between our study 5 and other SEE THE ORIGINAL STUDY ON PAGE 571 reports of EIB in subjects without asthma, including that of Burnett et al, 1 is probably related to the more stringent criteria we used to define positive EIB. Our study included a higher cutoff value (drop in FEV 1 of Ͼ15% as opposed to Ͼ10%) than the study published in this issue of the Journal. Our study found EIB to be uncommon (8%) in children seen because of dyspnea on exertion, whereas Burnett et al 1 reported an EIB prevalence of 43% in college athletes, most having no ...

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confidence: 90%

Is Exercise-Induced Bronchoconstriction Exercise-Induced Asthma?

Weinberger

Abu-Hasan

2016

Respir Care

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“…Exposures of airways to chemicals, gases, particulates and biological agents, shear stress, and sudden temperature and osmotic changes generate cascade of events and mediators to trigger sensory neuronal signals, which are transmitted to the afferent parasympathetic autonomic nervous system leading to constriction of airway smooth muscle (ASM) [1**, 2,3,4,5,6,7,8]. The resulting clinical symptoms include wheezing, chest tightness, shortness of breath, and dyspnea and are features of asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD) [9,10,11,12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of bronchoconstriction

Bácsi

Pan

et al. 2016

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review To provide an overview on the present understanding of roles of oxidative DNA damage repair in cell signaling underlying bronchoconstriction common to, but not restricted to various forms of asthma and chronic obstructive pulmonary disease Recent findings Bronchoconstriction is a tightening of smooth muscle surrounding the bronchi and bronchioles with consequent wheezing and shortness of breath. Key stimuli include air pollutants, viral infections, allergens, thermal and osmotic changes, and shear stress of mucosal epithelium, triggering a wide range of cellular, vascular and neural events. Although activation of nerve fibers, the role of G-proteins, protein kinases and Ca++, and molecular interaction within contracting filaments of muscle are well defined, the overarching mechanisms by which a wide range of stimuli initiate these events are not fully understood. Many, if not all, stimuli increase levels of reactive oxygen species (ROS), which are signaling and oxidatively modifying macromolecules, including DNA. The primary ROS target in DNA is guanine, and 8-oxoguanine is one of the most abundant base lesions. It is repaired by 8-oxoguanine DNA glycosylase1 (OGG1) during base excision repair processes. The product, free 8-oxoG base, is bound by OGG1 with high affinity, and the complex then functions as an activator of small GTPases, triggering pathways for inducing gene expression and contraction of intracellular filaments in mast and smooth muscle cells. Summary Oxidative DNA damage repair-mediated cell activation signaling result in gene expression that “primes” the mucosal epithelium and submucosal tissues to generate mediators of airway smooth muscle contractions.

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“…Importantly, up to 90% of adults with asthma are thought to have exercise-induced asthma (EIA) [4,5]. EIA may be a barrier to adoption and maintenance of regular exercise in adults with asthma as it is associated with coughing, wheezing, shortness of breath and discomfort [6].…”

Section: Introductionmentioning

confidence: 99%