Characterization of the late response in exercise-induced asthma

Bierman, C. Warren; Sg, Spiro; Petheram, Ian S.

doi:10.1016/0091-6749(84)90233-1

Cited by 74 publications

(32 citation statements)

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“…Most had either moderate persistent asthma or severe persistent asthma might be attributable to differences in the type of airway constriction during exercise. As an initial response, large and small airways both become constricted during exercise, (16) and this early response usually occurs in the morning hours. (6,17) Patients with asthma can have a diminished perception of dyspnea during EIB.…”

Section: Resultsmentioning

confidence: 99%

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

et al. 2010

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Objective: There is an indirect relationship between airway obstruction in asthma and the intensity of breathlessness (dyspnea). A word labeled visual analog dyspnea scale with a 0-3 score has been widely used for the assessment of the degree of bronchoconstriction, although the perception of such obstruction varies considerably. The objective of this study was to determine whether children and adolescents are able to perceive acute exercise-induced bronchoconstriction (EIB), as well as to measure the discriminatory power of a word labeled visual analog dyspnea scale in relation to the intensity of the EIB. Methods: A cross-sectional study involving 134 children and adolescents with asthma and submitted to a six-minute steady-state exercise test on a cycle ergometer. The intensity of dyspnea was determined using a word labeled visual analog dyspnea scale prior to each determination of FEV 1 . The scale is scored from 0 to 3, with a logical sequence of pictures, ranging from "no symptoms" to "severe dyspnea". Variables were determined at baseline, as well as at 5, 10, and 20 min after the exercise test. The accuracy of the dyspnea scale in identifying the degree of EIB was determined by means of ROC curves for the post-exercise fall in FEV 1 , using cut-off points of 10%, 20%, 30%, and 40%. Results: Of the patients selected, 111 finished the study, and 52 (46.8%) presented with EIB. The area under the ROC curve increased in direct proportion to increases in the degree of bronchoconstriction. Conclusions: Among children and adolescents with asthma, the accuracy of this dyspnea scale improves as the post-exercise percentage fall in FEV 1 increases. However, the predictive value of the scale is suboptimal when the percentage fall in FEV 1 is lower.Keywords: Asthma; Asthma, exercise-induced; Dyspnea. ResumoObjetivo: Existe uma relação indireta entre a obstrução das vias aéreas em asma e a intensidade de falta de ar (dispneia). Uma escala visual analógica legendada de dispneia com escore de 0-3 pontos tem sido amplamente utilizada na avaliação da broncoconstrição, embora a percepção de tal obstrução seja muito variável. O objetivo deste estudo foi determinar se crianças e adolescentes são capazes de perceber a broncoconstrição aguda induzida por exercício (BAIE), bem como medir o poder discriminatório de uma escala visual analógica legendada de dispneia em relação à intensidade de BAIE. Métodos: Estudo transversal com 134 crianças e adolescentes asmáticos que foram submetidos a um teste de broncoespasmo induzido por seis minutos de exercício em um cicloergômetro. A intensidade da dispneia foi determinada utilizando-se uma escala visual analógica legendada de dispneia antes de cada determinação de VEF 1 . A escala tem um escore de 0-3 pontos, com desenhos em uma sequência lógica variando entre "sem sintomas" e "dispneia grave". As variáveis foram determinadas no momento basal, assim como em 5, 10 e 20 minutos após o término do teste de exercício. A acurácia da escala de dispneia em detectar o grau de BAIE foi d...

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Section: Resultsmentioning

confidence: 99%

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

et al. 2010

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“…A cellular basis for this late event has not been demonstrated in man, although neutrophil chemotactic activity has been detected in the plasma of asthmatic subjects during this response [134]. The fact that a purported mast cell "stabilizing" drug attenuated the delayed response to exercise [54] suggests that mediator release contributes to its development, which is believed to primarily involve small airways [135]. A late increase in peripheral airway resistance (Rp) in the canine model is analogous to that reported in humans, and is characterized by neutrophil and eosinophil infiltration, and an increased concentration of leukotriene C 4 /D 4 in BALF recovered from dry air-exposed bronchi [9].…”

Section: The Late Phase Responsementioning

confidence: 99%

Models and mechanisms of exercise-induced asthma

An¹

1995

Eur Respir J

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M Mo od de el ls s a an nd d m me ec ch ha an ni is sm ms s o of f e ex xe er rc ci is se e--i in nd du uc ce ed d a as st th hm ma a A.N. FreedModels and mechanisms of exercise-induced asthma. A.N. Freed. ERS Journals Ltd 1995. ABSTRACT: Airflow-induced bronchoconstriction (AIB) in mammals can be broadly categorized as either vagal-dependent or vagal-independent. Among mammals, rabbits and cats belong to the former and guinea-pigs belong to the latter categories. Although insufficient data are available to classify monkeys, dogs and man appear to occupy the middle ground in which a small but significant parasympathetic component modulates airflow-induced bronchoconstriction. The fact that vagal activity can only partially account for airflow-induced bronchoconstriction in some asthmatic subjects suggests that vagal-dependent models may be of limited value in studying the human condition, but should prove valuable in elucidating the parasympathetic component of this mechanism. Although airflow-induced bronchoconstriction appears to be remarkably similar in guinea-pigs, dogs and humans, there are important differences concerning the potential role of specific mediators in producing airflow limitation. Concordant data from animal models and man suggest that: 1) airflow-induced bronchoconstriction is a basic mammalian response to airway desiccation; 2) airway drying stimulates and cooling inhibits this response; 3) hyperpnoea with dry air may damage the bronchial mucosa and contribute to this response; 4) biochemical mediators contribute to the development of this response; 5) vascular engorgement and airway oedema do not appear to be the primary effectors of this response, and in fact may antagonize it; 6) airway smooth muscle constriction is involved in the production of airflow-induced bronchoconstriction, and airway oedema may enhance its effect; and 7) airway and vascular responses to dehydration may protect against acute dry air-induced mucosal injury.Finally, although one must be cautious in extrapolating results from animals to humans, the similarities that do exist suggest that the investigation of airflow-induced bronchoconstriction in carefully selected animal models will continue to provide new insights concerning its development in humans.

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“…Since its first description in 1980 [9], there has been considerable controversy in the literature on the potential development of a late asthmatic response (LAR) to exercise in asthma. It is known that the occurrence of a LAR after allergen challenge is associated with an influx of inflammatory cells and the development of bronchial hyperresponsiveness [10].…”

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confidence: 99%

“…A number of studies have been published describing the occurrence of a LAR after exercise with prevalence ranging 10-89% [11][12][13][14][15][16][17]. However, nearly as many studies have been unable to document a LAR [18][19][20][21][22][23].…”

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confidence: 99%

“…Furthermore, when evaluating the results of these studies, there seems to be considerable lack of agreement among the various investigators on the definition of the LAR after exercise. The LAR has been defined as either a 10% [12,15], 15% [14,20,23] or 20% [16,17,19,21], fall in lung function (e.g. the forced expiratory volume in one second (FEV1)) during different time-periods after exercise challenge.…”

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confidence: 99%

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Occurrence of a late response to exercise in asthmatic children: multiple regression approach using time-matched baseline and histamine control days

Hofstra¹,

Sterk²,

Neijens³

et al. 1996

European Respiratory Journal

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At the present time, there is still controversy concerning the presence of a late asthmatic response (LAR) to exercise challenge in asthma. We have, therefore, investigated the occurrence of a LAR after exercise in asthmatic children visiting an out-patient clinic, using time-matched baseline and histamine control days, and a statistical analysis according to recently published recommendations.After a screening exercise day, 17 children (aged 7-14 yrs) randomly performed, on three subsequent study days, either: a second standardized exercise challenge; or a histamine challenge whilst matching the bronchoconstriction after exercise; or measurement of baseline lung function without any challenge. Measurements of forced expiratory volume in one second (FEV1) were made repeatedly during 8 h. Analysis was performed using multiple regression analysis for each patient, with FEV1 as the dependent, and test day (exercise or control) and clock time as independent variables during the period 2-8 h after exercise. A significant interaction (p<0.05) between test day and clock time was considered to be indicative of a LAR.Fifteen children completed the study. All children showed an early asthmatic reaction to exercise (range 14-62% fall in FEV1). In two children, a significant interaction (p<0.05) was found between test day and clock time. However, the difference in FEV1 between exercise and control days for each clock time did not exceed the 99.6% confidence limits of normal diurnal variation in any of the children.We conclude that, in children with mild-to-moderate asthma, a LAR to exercise does not occur. This suggests that exercise is only a symptomatic trigger of asthma. Whether exercise is capable of inducing inflammation needs to be further investigated.

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Characterization of the late response in exercise-induced asthma

Cited by 74 publications

References 13 publications

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

Desempenho de uma escala analógica visual legendada na determinação do grau de dispneia durante teste de broncoespasmo induzido por exercício em crianças e adolescentes asmáticos

Models and mechanisms of exercise-induced asthma

Occurrence of a late response to exercise in asthmatic children: multiple regression approach using time-matched baseline and histamine control days

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