Effect of Continuous Positive Airway Pressure on Airway Reactivity in Asthma. A Randomized, Sham-controlled Clinical Trial

Holbrook, Janet T.; Sugar, Elizabeth A.; Brown, Robert H.; Drye, Lea T.; Irvin, Charles G.; Schwartz, Alan R.; Tepper, Robert S.; Wise, Robert A.; Yasin, Razan; Busk, Michael F.

doi:10.1513/annalsats.201601-043oc

Cited by 29 publications

(20 citation statements)

References 49 publications

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“…Chronic mechanical strain produced by CPAP was shown to reduce airway responsiveness in an animal study and 1‐week CPAP therapy in human subjects . However, poor CPAP adherence and no significant change in the bronchial reactivity were shown in another RCT after 12 weeks of CPAP among patients with asthma . Whether better adherence of CPAP therapy would lead to change in bronchial reactivity remains to be tested in larger RCT.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there could be potential influence on the subjective outcome as the patients involved were not blinded. However, asthma patients on sham CPAP had poor CPAP adherence in a previous study (52% using CPAP ≤4 h/night) and suffered from more nasal congestion and headache . Moreover, the relatively small sample size was not powered to detect changes in spirometry or bronchial challenge studies.…”

Section: Discussionmentioning

confidence: 99%

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Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

Chan

et al. 2018

Respirology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

Chan

et al. 2018

Respirology

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“…Asthma outcomes improve for patients with obstructive sleep apnea receiving treatment via continuous positive airway pressure 54 . Continuous positive airway pressure may improve airway reactivity in asthmatics without obstructive sleep apnea, but has not been shown to improve asthma control 55 . If available, pulmonary rehabilitation programs and treatment of obstructive sleep apnea can be important, nonpharmacologic tools for improving asthma control.…”

Section: Introductionmentioning

confidence: 97%

Management of Severe Asthma before Referral to the Severe Asthma Specialist

Carr

Kraft

2017

The Journal of Allergy and Clinical Immunology: In Practice

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Severe asthma is associated with significant morbidity and can be challenging to assess and control, due to heterogeneity of disease, complexity of diagnosis, and impact of comorbidities. A structured approach to the assessment and management of severe asthma may be helpful to the practicing clinician. First, it is important to confirm a diagnosis of asthma. In patients who are either not responding to treatment, or who require high doses of medication to control symptoms, it is highly possible that disease mimickers or comorbidities are present and can inhibit therapeutic responsiveness. The assessment and management of common comorbidities of asthma may dramatically impact disease control and thus medication requirement. Determining medication adherence and optimizing drug dose and delivery may separate out truly severe asthmatics from those not using medications regularly or properly. Next, while true personalized medicine for severe asthma is not yet realized, for those individuals with severe asthma, phenotypic characteristics of each patient may guide which therapeutic options may be most effective for that patient. Finally, evaluation and management of severe asthma at a referral center can add additional phenotyping, therapeutic, and diagnostic strategies.

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“…One potential mechanism is a functional change in airway smooth muscles via airway stretching during increased ventilation with endurance-type exercise interventions in asthmatics. Although results regarding the effect of repetitive passive airway stretching by use of continuous positive airway pressure (CPAP) on bronchial hyperresponsiveness in asthmatic humans at rest are conflicting [4, 5], research in animals has shown that repetitive passive airway stretching via CPAP [6] or the removal thereof via chest wall strapping [7] have the potential to alter airway smooth muscle contractility and to decrease (or increase) bronchial hyperresponsiveness. Thus, isolated respiratory exercises such as volitional hyperpnea (HYP) without concomitant exercise could be an alternative to whole-body exercise training or an even more effective airway-specific treatment to complement regular exercise training since higher levels of ventilation and larger tidal volumes can be achieved compared to those present during strenuous physical exercise of the same duration [8].…”

Section: Introductionmentioning

confidence: 99%

Similar Airway Function after Volitional Hyperpnea in Mild-Moderate Asthmatics and Healthy Controls

et al. 2019

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Background: The beneficial effects of exercise training for asthmatics might relate to repetitive airway stretching. Thus, a training with more pronounced airway stretch using isolated, volitional hyperpnea (HYP) might be similarly or more effective. However, in healthy subjects, a bout of HYP training is known to cause an acute FEV₁ decline. Objective: The aim of the present study was therefore to test whether these changes are more pronounced in asthmatics, possibly putting them at risk with HYP training. Methods: Nine subjects with mild-moderate asthma (confirmed by mannitol challenge) and 11 healthy subjects performed six 5-min bouts (with 6-min breaks; HYP₁) and one 30-min bout (HYP₂) of normocapnic HYP at 60% of maximal voluntary ventilation using warm and humid air. FEV₁ and airway resistance (R5) were measured before, in breaks (HYP₁), and immediately after HYP, and during 60 min of recovery. Results: In both groups, a significant and similar decrease in FEV₁ during HYP₁ (asthmatics: –3 ± 3%; healthy subjects: –2 ± 3%), after HYP₁ (asthmatics: –2 ± 5%; healthy subjects: –1 ± 4%), and after HYP₂ (asthmatics: –4 ± 5%; healthy subjects: –3 ± 3%), and an increase in R5 during and after both HYPs were observed. Maximal changes in FEV₁ and R5 did not correlate with baseline lung function or responsiveness to mannitol. Conclusions: A bout of HYP does not lead to relevant bronchoconstriction and the observed changes in lung function and airway resistance are neither of the magnitude of clinical relevance, nor do they differ from responses in healthy individuals. Thus, HYP training can safely be tested as an airway-specific exercise training alternative (or add-on) modality to regular aerobic exercise training.

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Effect of Continuous Positive Airway Pressure on Airway Reactivity in Asthma. A Randomized, Sham-controlled Clinical Trial

Cited by 29 publications

References 49 publications

Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

Continuous positive airway pressure for obstructive sleep apnoea does not improve asthma control

Management of Severe Asthma before Referral to the Severe Asthma Specialist

Similar Airway Function after Volitional Hyperpnea in Mild-Moderate Asthmatics and Healthy Controls

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