Exercise-induced bronchodilation in natural and induced  asthma: effects on ventilatory response and performance

Crimi, Emanuele; Pellegrino, Riccardo; Smeraldi, Attilio; Brusasco, Vito

doi:10.1152/japplphysiol.01248.2001

Cited by 50 publications

(48 citation statements)

References 32 publications

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“…In contrast, data in canine isolated airway smooth muscle indicate that it takes almost 8 min for the force to redevelop after an initial stretching (11). In a recent study (6), it was shown that deep breathing on exercise during natural or induced asthma had a bronchodilator effect that was about eight times greater than that of a single deep breath taken at rest. The increase in flow occurred since the first exercise steps and was proportional to the increase in EILV.…”

Section: Discussionmentioning

confidence: 96%

Attenuation of induced bronchoconstriction in healthy subjects: effects of breathing depth

Salerno¹,

Pellegrino²,

Trocchio³

et al. 2005

Journal of Applied Physiology

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The effects of breathing depth in attenuating induced bronchoconstriction were studied in 12 healthy subjects. On four separate, randomized occasions, the depth of a series of five breaths taken soon (ϳ1 min) after methacholine (MCh) inhalation was varied from spontaneous tidal volume to lung volumes terminating at ϳ80, ϳ90, and 100% of total lung capacity (TLC). Partial forced expiratory flow at 40% of control forced vital capacity (V part) and residual volume (RV) were measured at control and again at 2, 7, and 11 min after MCh. The decrease in V part and the increase in RV were significantly less when the depth of the five-breath series was progressively increased (P Ͻ 0.001), with a linear relationship. The attenuating effects of deep breaths of any amplitude were significantly greater on RV than V part (P Ͻ 0.01) and lasted as long as 11 min, despite a slight decrease with time when the end-inspiratory lung volume was 100% of TLC. In conclusion, in healthy subjects exposed to MCh, a series of breaths of different depth up to TLC caused a progressive and sustained attenuation of bronchoconstriction. The effects of the depth of the five-breath series were more evident on the RV than on V part, likely due to the different mechanisms that regulate airway closure and expiratory flow limitation. deep breath; airflow obstruction; partial forced expiratory flow; residual volume SEVERAL STUDIES HAVE DOCUMENTED the ability of reversing induced airway narrowing by deep breaths in healthy humans (4, 5, 7, 14, 18, 23-25, 31, 35, 38). This effect has been inferred from the increase in forced expiratory flows or the decrease in airway resistance or residual volume (RV) when a full lung inflation was taken after exposing the airways to a constrictor agent. This phenomenon is basically absent or modest in asthma and chronic obstructive pulmonary disease and may contribute to explain the degree of airway hyperresponsiveness (2,4,5,14,(23)(24)(25). The understanding of the mechanisms regulating airway tone in healthy conditions becomes central to the knowledge of the pathophysiology of obstructive lung diseases. All studies have so far focused on the effects of deep breaths taken to total lung capacity (TLC), but little is known about the effects of submaximal inspirations. The only few studies that addressed this issue were conducted in animals after exposing the airways or isolated airway smooth muscle to a constrictor agent and documented a progressive decrease in airway resistance or decrease in airway smooth muscle force with gradual increments of the depth of lung inflations (11, 32).The present study was conducted in healthy humans to examine the effects on airway function of a series of five breaths of variable depth taken soon after inducing airway narrowing by methacholine (MCh). It was intended to address three main questions. First, is induced airway narrowing progressively attenuated by increasing the amplitude of the breaths, or is there a threshold for the effects of lung inflation to become apparent? Second, f...

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Section: Discussionmentioning

confidence: 96%

Attenuation of induced bronchoconstriction in healthy subjects: effects of breathing depth

Salerno¹,

Pellegrino²,

Trocchio³

et al. 2005

Journal of Applied Physiology

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“…The observation that some, but not all, asthmatics with normal baseline spirometric results exhibited tidal EFL during exercise is probably related to the fact that some asthmatics exhibit bronchoconstriction during exercise [21][22][23][24][25][26], whereas others do not [26][27][28]. BECK et al [22] had shown that, in asthmatics, there was a reduction in FEV1 during exercise and, subsequently, also demonstrated that, during interval and constant-load exercise, asthmatics exhibit a reduced ventilatory reserve, as well as a higher endexpiratory lung volume (i.e.…”

Section: Discussionmentioning

confidence: 99%

Exercise-induced flow limitation, dynamic hyperinflation and exercise capacity in patients with bronchial asthma

Kosmas

Milic–Emili²,

Polychronaki³

et al. 2004

European Respiratory Journal

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It is known that, in stable asthmatics at rest, tidal expiratory flow limitation (EFL) and dynamic hyperinflation (DH) are seldom present. This study investigated whether stable asthmatics develop tidal EFL and DH during exercise with concurrent limitation of maximal exercise work rate (WRmax).A total of 20 asthmatics in a stable condition and aged 32 ¡ 13 yrs (mean ¡ SD) with a forced expiratory volume in one second (FEV1) of 101¡21% of the predicted value were studied. Only three patients exhibited an FEV1 below the normal limits. On a first visit, patients performed a symptom-limited incremental (20 W?min -1 ) bicycle exercise test. On the second visit, the occurrence of EFL (using the negative expiratory pressure technique) and DH (via reduction in inspiratory capacity) were assessed at rest and when cycling at 33, 66 and 90% of their predetermined WRmax. FEV1 was measured to detect exercise-induced asthma, 5 and 15 min after stopping exercise at 90% WRmax.Only one patient showed EFL at rest, whereas 13 showed EFL and DH during exercise. In these 13 asthmatics, exercise capacity was significantly reduced (WRmax 75¡9% pred) compared to the seven non-EFL patients (WRmax 95¡13% pred). Moreover, a significant correlation of WRmax (% pred) to the change in inspiratory capacity (percentage of resting value) from rest to 90% WRmax was found. Tidal EFL during exercise was not associated with exercise-induced asthma, which was detected in only three patients.In conclusion, tidal expiratory flow limitation and dynamic hyperinflation during exercise are common in stable asthmatics with normal spirometric results and without exercise-induced asthma, and may contribute to reduction in exercise capacity.

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“…Epinephrine levels increase during exercise (46) and may influence bronchomotor tone. Crimi et al (47) showed that exercise has a potent bronchodilator effect in subjects with induced or spontaneous asthma. In the healthy athlete, bronchodilation during exercise has been described during studies of exercise performance with and without inhaled b 2 -agonists.…”

Section: Changes In Airway Calibre During Exercisementioning

confidence: 99%

Exercise‐induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: Part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA²LEN

Carlsen

Anderson

Bjermer³

et al. 2008

Allergy

289

269

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Aims: To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features of these conditions and to make recommendations for their diagnosis. Methods: The Task Force reviewed present literature by searching Medline up to November 2006 for relevant papers by the search words: asthma, bronchial responsiveness, EIB, athletes and sports. Sign criteria were used to assess level of evidence and grades of recommendation.Results: The problems of sports-related asthma and allergy are outlined. Epidemiological evidence for an increased prevalence of asthma and BHR among competitive athletes, especially in endurance sports, is provided. The mechanisms for development of asthma and bronchial hyperresponsiveness in athletes are outlined. Criteria are given for the diagnosis of asthma and exercise induced asthma in the athlete. Conclusions: The prevalence of asthma and bronchial hyperresponsiveness is markedly increased in athletes, especially within endurance sports. Environmental factors often contribute. Recommendations for the diagnosis of asthma in athletes are outlined.

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Exercise-induced bronchodilation in natural and induced asthma: effects on ventilatory response and performance

Cited by 50 publications

References 32 publications

Attenuation of induced bronchoconstriction in healthy subjects: effects of breathing depth

Attenuation of induced bronchoconstriction in healthy subjects: effects of breathing depth

Exercise-induced flow limitation, dynamic hyperinflation and exercise capacity in patients with bronchial asthma

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