Exercise Challenge Test in 3- to 6-Year-Old Asthmatic Children

Vilozni, Daphna; Bentur, Lea; Efrati, Ori; Barak, Asher; Szeinberg, Amir; Shoseyov, David; Yahav, Yaacov; Augarten, Arie

doi:10.1378/chest.07-0052

Cited by 52 publications

(44 citation statements)

References 28 publications

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“…Importantly, spirometry was obtained at earlier timings, i.e. starting 1 or 3 min after cessation of exercise (3,(22)(23)(24), and this could contribute to improve sensitivity because larger spirometric changes have been reported 3 min than 5 min after exercise (25). Asthmatics (3) and one control group (22) exercised on treadmill, whereas the other two healthy groups exercised by outdoor free run (23,24).…”

Section: Discussionmentioning

confidence: 99%

“…The target heart rate of our exercise protocol was 80% of predicted maximal value, as recommended in adults rather than children (2,16), and it is possible that the cutoff change in FEV 1 could have been increased by aiming at 90% predicted maximal heart rate (27). However, the current endpoint for heart rate was also used in another pediatric study and found satisfactorily to separate preschool children with asthma from those with nonspecific respiratory symptoms (25). Furthermore, the maximal heart rate actually achieved here was within the range reported in previous studies in children of comparable age (3,23).…”

Section: Discussionmentioning

confidence: 99%

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Airway Response to Exercise by Forced Oscillations in Asthmatic Children

et al. 2010

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Forced expiratory volume in 1 s (FEV 1 ) detection of exercise-induced bronchoconstriction (EIB) to identify asthma has good specificity but rather low sensitivity. The aim was to test whether sensitivity may be improved by measuring respiratory resistance (RRS) by the forced oscillation technique (FOT). Forty-seven asthmatic and 50 control children (5-12 y) were studied before and after running 6 min on a treadmill. RRS in inspiration (RRSi) and expiration (RRSe), FEV 1 and RRSi response to a deep inhalation (DI) were measured before and after exercise. In asthmatics versus controls, exercise induced significantly larger increases in RRSi (p Ͻ 0.001) and larger decreases in FEV 1 (p ϭ 0.004). Asthmatics but not controls showed more bronchodilation by DI after exercise (p ϭ 0.02). At specificity Ͼ0.90, sensitivity was 0.53 with 25% increase RRSi and 0.45 with 27% increase RRSe or 5% decrease FEV 1 . It is concluded that the FOT improves sensitivity of exercise challenge, and the RRSi response to DI may prove useful in identifying the mechanism of airway obstruction. (Pediatr Res 68: 537-541, 2010) E xercise-induced bronchoconstriction (EIB) is closely linked to airway inflammation and unlikely to develop in healthy children (1), so that detecting airway hyperresponsiveness to exercise in the lung function laboratory is considered highly specific of asthma, i.e. it is associated with low rate of false-positive responses. A limitation is the rather low sensitivity of the test (2,3). EIB has been identified in primary school children by changes in forced expiratory volume in 1 s (FEV 1 ) or peak expiratory flow, and decision levels were mostly based on the former parameter (3). Respiratory resistance (RRS) measured by the forced oscillation technique (FOT) offers an alternative assessment of airway caliber, the time variations of which may be characterized for instance using a single excitation frequency (4). Computing RRS separately in inspiration and expiration (RRSi and RRSe, respectively) rather than over the whole breathing cycle may be of interest because the upper airways, which may represent a confounding factor in assessing the intrathoracic airways, are known to contribute differently to airway mechanics in inspiration and expiration (5,6). Furthermore, the RRS change in relation to volume history, more specifically the bronchomotor alteration that follows a deep inhalation (DI), has potential relevance in identifying the mechanism of EIB (7-9). Indeed, stretching the acutely contracted bronchial smooth muscle promotes bronchial wall relaxation, which in turn could be taken as an indicator of the magnitude of the airway response (10). To the best of our knowledge, a systematic analysis of diagnostic value of single-frequency RRS has not been performed during case-control identification of EIB in the lung function laboratory at school age.Therefore, the aim of this study was to assess the value of the FOT in identifying EIB in asthmatic children. More specifically, RRSi and RRSe and the change in...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Airway Response to Exercise by Forced Oscillations in Asthmatic Children

et al. 2010

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“…Children 8 -16 years with asthma, diagnosed by a pediatrician, were recruited from the outpatient clinic of the pediatric department of Medisch Spectrum Twente, Enschede (MST) from October 2013 to February 2014. Children were eligible if they demonstrated exercise induced inspiratory flow limitation with or without EIB during an exercise challenge test (ECT) within a period of two weeks prior to the study 10 . There were no restrictions to the use of medication, but children had to cease long acting bronchodilators or leukotriene antagonists 24 hours and short acting bronchodilators 8 hours before the ECT 5,11 .…”

Section: Patientsmentioning

confidence: 99%

“…Heart rate was continuously monitored by a radiographic device (Garmin Forerunner 610) and the target was to achieve 80-90% of their maximum heart rate. An exercise induced fall in FEV 1 of ≥13% compared to baseline was considered as positive for EIB 10 . For a reliable measurement of the MIF 50 the forced inspiratory vital capacity had to be within 7.5% of the forced expiratory vital capacity.…”

Section: Exercise Challenge Testmentioning

confidence: 99%

Salbutamol and exercise induced inspiratory flow limitation in asthmatic children

Visser

2016

MRAJ

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Objective: Exercise induced bronchoconstriction (EIB) is a frequent and specific symptom of childhood asthma featured by expiratory flow limitation. A recent study showed that exercise can also induce inspiratory flow limitation, independent of EIB. The aim of this study was to investigate whether salbutamol protects against exercise induced inspiratory flow limitation in asthmatic children. Methods: The study had a prospective double-blind placebo-controlled randomized cross-over design with two exercise challenge tests preceded by the inhalation of 200µg salbutamol or placebo. Children 8-16 years old with documented exercise induced inspiratory flow limitation performed two exercise challenge tests (ECT's) to assess EIB. EIB was defined as a fall in forced expiratory volume in 1 second (FEV 1 ) ≥ 13% whereas inspiratory flow limitation was defined as a fall in mid inspiratory flow (MIF 50 ) ≥ 25%. Results: 63% of the children (19/30) with exercise induced flow limitation showed an inspiratory flow limitation. Salbutamol significantly reduced the mean exercise induced fall in MIF 50 in children with exercise induced inspiratory flow limitation compared to placebo (17.6% versus 24.9%, p=0.004). Conclusions: There was a significant but inconsistent, individually variable protection of salbutamol against exercise induced inspiratory flow limitation observed in contrast to the consistent protective effect of salbutamol against EIB. A substantial number of the children with exercise induced flow limitation have an inspiratory flow limitation. Asthmatic children who experience persistent exercise induced asthmatic symptoms despite the use of (prophylactic) salbutamol, may suffer from an inspiratory flow limitation as a component of their asthma.

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“…While peak expiratory flow (PEF) was once commonly used for identifying EIB it is not as repeatable as FEV1 and is no longer recommended. In very young children measurement of FEV0.5 can be useful [7]. Field testing with sports specific exercise for athletes usually means performing the actual sport for as long as it takes to provoke the symptoms.…”

Section: Availabilitymentioning

confidence: 99%

Bronchial challenge tests: usefulness, availability and limitations

Anderson

2011

BRE

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Exercise Challenge Test in 3- to 6-Year-Old Asthmatic Children

Cited by 52 publications

References 28 publications

Airway Response to Exercise by Forced Oscillations in Asthmatic Children

Airway Response to Exercise by Forced Oscillations in Asthmatic Children

Salbutamol and exercise induced inspiratory flow limitation in asthmatic children

Bronchial challenge tests: usefulness, availability and limitations

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