Cardiopulmonary fitness in children with asthma versus healthy children

Abstract

ObjectivesTo evaluate, with a cardiopulmonary exercise test (CPET), the cardiopulmonary fitness of children with asthma, in comparison to healthy controls, and to identify the clinical and CPET parameters associated with the maximum oxygen uptake (VO2max) in childhood asthma.DesignThis cross-sectional controlled study was carried out in CPET laboratories from two tertiary care paediatric centres. The predictors of VO2maxwere determined using a multivariable analysis.ResultsA total of 446 children (144 in the asthma group and 302 healthy subjects) underwent a complete CPET. Mean VO2maxwas significantly lower in children with asthma than in controls (38.6±8.6 vs 43.5±7.5 mL/kg/min; absolute difference (abs. diff.) of −4.9 mL/kg/min; 95% CI of (−6.5 to −3.3) mL/kg/min; p<0.01) and represented 94%±9% and 107%±17% of predicted values, respectively (abs. diff. −13%; 95% CI (−17 to −9)%; p<0.01). The proportion of children with an impaired VO2maxwas four times higher in the asthma group (24% vs 6%, p<0.01). Impaired ventilatory efficiency with increased VE/VCO2slope and low breathing reserve (BR) were more marked in the asthma group. The proportion of children with a decreased ventilatory anaerobic threshold (VAT), indicative of physical deconditioning, was three times higher in the asthma group (31% vs 11%, p<0.01). Impaired VO2maxwas associated with female gender, high body mass index (BMI), FEV1, low VAT and high BR.ConclusionCardiopulmonary fitness in children with asthma was moderately but significantly altered compared with healthy children. A decreased VO2maxwas associated with female gender, high BMI and the pulmonary function.Trial registration numberNCT04650464.

Reference values of cardiopulmonary exercise test parameters in the contemporary paediatric population

“…[29] For example, in paediatric asthma, e.g., the most common paediatric chronic disease worldwide, physical aerobic tness is impaired in a quarter of children, with patterns of physical deconditioning in a third of them. [4] Previous studies have suggested that the hyperventilation syndrome during exercise, well described in adult patients, [41] was also present in paediatrics and re ected dysfunctional breathing and poor asthma control. [42] Moreover, our group recently showed that a lower breathing reserve was a predictor of limited physical capacity in children with asthma.…”

“…Finally, the existence of paediatric reference Z-score values for ventilatory exercise parameters will improve the interpretation of paediatric CPET, as exercise ventilation may be affected in many paediatric chronic diseases. [3,4,39,40] Ventilatory exercise parameters interact with each other and should not be interpreted independently. [29] For example, in paediatric asthma, e.g., the most common paediatric chronic disease worldwide, physical aerobic tness is impaired in a quarter of children, with patterns of physical deconditioning in a third of them.…”

“…[42] Moreover, our group recently showed that a lower breathing reserve was a predictor of limited physical capacity in children with asthma. [4] Moreover, children with expiratory ow limitation, as in cystic brosis, present an abnormal breathing pattern during exercise with rapid shallow breathing, evidenced by a higher RR max and a lower VT max . [40] Nevertheless, overall, exercise ventilatory parameters have been scarcely analysed in children.…”

“…There has been increasing interest in evaluating the health status of children by cardiopulmonary exercise test (CPET) [1]. In many paediatric chronic diseases, impaired physical capacity assessed by CPET correlates with lower healthrelated quality of life scores and may indicate the early onset of physical deconditioning, such as in congenital heart disease (CHD) [2], cancer [3], asthma [4], or kidney disease [5]. Therefore, CPET stands as a key examination to evaluate cardiopulmonary tness in healthy and chronically ill children [6], as well as to promote physical activity and cardiovascular rehabilitation from a young age [7].…”

Aerobic physical capacity and health-related quality of life in children with sickle cell disease

“…[20] Aerobic tness assessed by cardiopulmonary exercise test (CPET) best re ects physical capacity in children and adolescents with chronic conditions, providing an analysis of cardiac, respiratory, and peripheral exercise limitations. [21][22][23][24] Indeed, maximum oxygen uptake (VO 2max ) measured by CPET is a predictor of prognosis and HRQoL in various childhood diseases. [25][26][27][28] Nevertheless, aerobic capacity has been scarcely evaluated in children or adolescents with sickle cell disease, and no CPET study has assessed HRQoL in this population.…”