Controversies and challenges of exercise-induced bronchoconstriction and their implications for children

Becker, Allan B.

doi:10.1002/ppul.2005

Cited by 5 publications

(1 citation statement)

References 48 publications

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“…Many patients with asthma experience bronchoconstriction after exercise, a condition known as exerciseinduced bronchoconstriction (EIB). 1 EIB is important especially in children, because exercise not only has physical benefits for asthmatic children but also plays a key role in their social and neuromotor development. 2 EIB is thought to occur as a result of evaporative water loss increasing the osmolarity of the airway surface liquid and causing inflammatory cells to release their mediators.…”

Section: Introductionmentioning

confidence: 99%

Airway refractoriness to inhaled mannitol after repeated challenge

Suh

Lee

Kim

et al. 2011

Pediatric Pulmonology

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Exercise and inhaled mannitol are thought to cause bronchoconstriction through a similar mechanism in asthma. The response to exercise becomes refractory with repeated challenges. This study aimed to investigate whether repeated challenge with mannitol induces refractoriness, as with exercise. Forty-one children with asthma underwent two consecutive dose-response mannitol challenges (Phase 1); the second challenge proceeded after recovery (FEV(1) : 95% or more of baseline value) from the first. The response to mannitol was expressed as a provocative dose causing a 15% fall in FEV(1) (PD(15) ) and the response-dose ratio (RDR) (% fall in FEV(1) /cumulative dose). In 18 subjects who were deemed to have mannitol refractoriness in Phase 1, a mannitol challenge was performed before and after a methacholine challenge (Phase 2). In Phase 1, the time taken for the FEV(1) to recover after the first mannitol challenge ranged from 20 to 100 min with a median of 50 min. In the 23 subjects with a measurable mannitol PD(15) in both challenges, the geometric mean (95%CI) PD(15) in the second challenge (163 mg [114-232]) was significantly higher than that in the first challenge (66 mg [50-88], P < 0.001). The geometric mean (95%CI) RDR decreased from the value of 0.083%/mg (0.055-0.125) in the first challenge to 0.029%/mg (0.017-0.048) in the second challenge (P < 0.001). In Phase 2, prior challenge with methacholine or mannitol did not significantly alter subsequent bronchoconstriction to the opposite challenge. Repeated challenge with mannitol resulted in less bronchoconstriction when compared with the initial challenge. This refractoriness seems not to be attributable to functional loss of responsiveness or non-specific effect of prior bronchoconstriction.

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Section: Introductionmentioning

confidence: 99%

Airway refractoriness to inhaled mannitol after repeated challenge

Suh

Lee

Kim

et al. 2011

Pediatric Pulmonology

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Evaluation of Severity of Bronchial Asthma Through an Exercise Bronchial Challenge

2005

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Optimum treatment of bronchial asthma requires accurate diagnosis and severity classification. We studied the use of an exercise bronchial challenge in the asthmatic patient as a diagnostic tool. An exercise bronchial challenge test was carried out in 431 asthmatic children and 114 children without a history of asthma in a moderate-altitude environment (2,230 m above sea level/7,314 feet above sea level). Values of peak expiratory flow (baseline and maximum fall) were analyzed through time in each asthma severity group (intermittent, mild persistent, moderate persistent, severe persistent, and nonasthmatic controls). There was a significant difference among responses of asthma severity groups for almost all variables. No difference was found between nonasthmatic and intermittent groups who had similar behavior, except in bronchodilator response. An exercise bronchial challenge helps classify a patient according to asthma severity; it is easy to reproduce and does not require expensive equipment. It allows diagnosing and classifying asthma severity easily and supplementing the clinical evaluation. Based on our results, we propose a fall of PEF >or= 11% as new cutoff point for making a diagnosis of persistent bronchial asthma. A fall of 11-25% indicates mild persistent asthma; from 25-50%, moderate persistent asthma; and a bigger fall, severe persistent asthma.

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Asthma and the Athlete

Stempel¹

2010

Pediatric Allergy: Principles and Practice

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Controversies and challenges of exercise-induced bronchoconstriction and their implications for children

Cited by 5 publications

References 48 publications

Airway refractoriness to inhaled mannitol after repeated challenge

Airway refractoriness to inhaled mannitol after repeated challenge

Evaluation of Severity of Bronchial Asthma Through an Exercise Bronchial Challenge

Asthma and the Athlete

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