Exercise but not methacholine differentiates asthma from chronic lung disease in children.

Godfrey, Simon; Springer, Chaim; Noviski, Natan; Maayan, Ch.; Avital, A.

doi:10.1136/thx.46.7.488

Cited by 141 publications

(95 citation statements)

References 34 publications

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“…10 Therefore, whereas the exercise test has a relatively poor role in population-based studies in assessing the incidence of asthma, it is quite useful in clinical trials and in distinguishing asthma from other chronic lung diseases, including those with bronchial hyperresponsiveness to methacholine. 6,7 In the present study, the positivity of the ergometer exercise was slightly lower than that described in patients with intermittent asthma, which corresponds to approximately 60%. 12 However, it should be underscored that not all patients were responsive to bronchoconstriction with methacholine, which reduces the response to the test.…”

Section: Exercisecontrasting

confidence: 58%

“…4 Bronchial provocation challenge by exercise has been proposed for the diagnosis of asthma. 5 This test is usually more specific and can distinguish asthma from other chronic lung diseases, 6,7 but it is less sensitive than bronchial provocation with methacholine or histamine in diagnosing asthma. Some authors also observed that bronchial provocation challenge by exercise and methacholine or histamine does not always identify the same individuals.…”

Section: Introductionmentioning

confidence: 99%

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Testes de broncoprovocação com metacolina e com exercício em bicicleta e corrida livre em crianças com asma intermitente

Souza¹,

Pereira²

2005

J. Pediatr. (Rio J.)

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Suggested citation: Souza AC, Pereira CA. Bronchial provocation tests using methacholine, cycle ergometer exercise and free running in children with intermittent asthma. J Pediatr (Rio J). 2005;81:65-72. AbstractObjective: To compare airway responsiveness to methacholine, cycle ergometer exercise and free running in children with intermittent asthma.Methods: A randomized study was conducted with 30 children of both genders with intermittent asthma. Each child was submitted to challenge testing on three separate days, in random order: a) Methacholine challenge using a dosimeter; b) Exercise challenge testing free running along a 50-meter-long corridor; c) Dry-air exercise challenge on a cycle ergometer. Target heart rate during exercise was 80 to 90% of the maximum predicted value. Spirometry was performed 3, 6,10,15,20 and 30 minutes after exercise. Exercise-induced bronchospasm was defined as a decrease in FEV 1 of > 10% in comparison to pretest values.Results: Mean age was 11±3 years. FEV 1 and FEV 1 /FVC ratios were normal and similar before all provocation tests. The maximum heart rate was 178±7 bpm during cycling and 181±6 bpm during the free running test (p > 0.05). Significant bronchospasm was observed with methacholine in 23 cases, after free running in 19 and after cycling in 14 children (p < 0.05, methacholine vs exercise tests). Taking all FEV 1 measurements after exercise into account, the free running test resulted in greater exercise-induced bronchospasm in comparison with exercise made on a cycle ergometer (p = 0.003, χ 2 = 8.948). There was a significant, but poor, correlation between the maximum percentage decrease in FEV 1 after free running and cycling (r = 0.46, p < 0.01). Conclusions:Methacholine challenge identifies a greater number of asthmatics in comparison to exercise tests. When bronchial provocation test with methacholine is not available, free running should be the test of choice due to its simplicity and greater ability to induce bronchospasm. J Pediatr (Rio J). 2005;81(1):65-72: Asthma, bronchial provocation tests, methacholine chloride, exercise test, exercise-induced asthma.

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Section: Exercisecontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Testes de broncoprovocação com metacolina e com exercício em bicicleta e corrida livre em crianças com asma intermitente

Souza¹,

Pereira²

2005

J. Pediatr. (Rio J.)

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“…For other measures of indirect bronchial responsiveness, the sensitivity of exercise testing for EIB is rather low [110], especially in children treated with inhaled steroids [107]. This is understandable, as one of the main goals for treating asthma in childhood is the mastering of EIB.…”

Section: Arterial Oxygen Desaturation During Exercisementioning

confidence: 99%

“…However, the specificity of the EIB test for the diagnosis of asthma is high [109,110]. By adding inhalation of cold air during the test, the sensitivity may be increased while maintaining the specificity [109].…”

Section: Arterial Oxygen Desaturation During Exercisementioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

Eur Respir J

562

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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“…The test results were expressed as a dose-response slope according to the method of O'CONNOR et al [18]. AHR was defined as greater than the value delimiting the 5% with the highest fall in FEV1 among never-smoking subjects with no previous history of asthma or asthma-like symptoms [19]. The upper 5th percentile in the reference group was 0.68% per mmol.…”

Section: Pulmonary Function Testsmentioning

confidence: 99%

High-sensitive C-reactive protein is associated with reduced lung function in young adults

Rasmussen¹,

Mikkelsen²,

Hancox³

et al. 2008

Eur Respir J

105

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Systemic inflammation has been associated with reduced lung function. However, data on the interrelationships between lung function and inflammation are sparse, and it is not clear if low-grade inflammation leads to reduced lung function.Associations between high-sensitive C-reactive protein (CRP) and spirometric lung function were assessed in a population-based cohort of ,1,000 Danes aged 20 yrs.In males, the average decline in forced expiratory volume in one second (FEV1) in the highest CRP quintile was 23 mL?yr -1 versus 1.6 mL?yr -1 in the lowest quintile. In females, the average decline was 6.2 mL?yr -1 in the highest CRP quintile versus an increase of 1.8 mL?yr -1 in the lowest CRP quintile. In a multiple regression analysis adjusted for sex, body mass index, cardiorespiratory fitness, smoking, asthma, airway hyperresponsiveness and serum eosinophil cationic protein, higher levels of CRP at age 20 yrs were associated with a greater reduction in both FEV1 and forced vital capacity between ages 20 and 29 yrs. The findings show that higher levels of C-reactive protein in young adults are associated with subsequent decline in lung function, suggesting that low-grade systemic inflammation in young adulthood may lead to impaired lung function independently of the effects of smoking, obesity, cardiorespiratory fitness, asthma and eosinophilic inflammation.

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Exercise but not methacholine differentiates asthma from chronic lung disease in children.

Abstract: Bronchial provocation challenges with exercise and methacholine were performed on the same day or within a short interval in 52 children with asthma, 22

Cited by 141 publications

References 34 publications

Testes de broncoprovocação com metacolina e com exercício em bicicleta e corrida livre em crianças com asma intermitente

Testes de broncoprovocação com metacolina e com exercício em bicicleta e corrida livre em crianças com asma intermitente

Recommendations on the use of exercise testing in clinical practice

High-sensitive C-reactive protein is associated with reduced lung function in young adults

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