Mechanisms of exercise‐induced asthma

Makker, Himender; Holgate, S. T.

doi:10.1111/j.1365-2362.1994.tb01109.x

Cited by 26 publications

(15 citation statements)

References 101 publications

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“…They suggested that the respiratory water loss during exercise can lead to a hypertonicity of the airway lining fluid, and that the osmotic and not the cooling effect of exercise due to evaporated water is the more important factor in determining EIA. This theory is supported by other data [3]. Furthermore, in a recent study, ARGYROS et al [9] found that the EIA is correlated to the loss of mucosal water and that it can be achieved without significant heat loss or airway cooling.…”

supporting

confidence: 73%

“…The mechanisms of exercise-induced asthma (EIA) are not completely clear, and there are controversies about the precise nature of the stimuli responsible for inducing bronchoconstriction [3]. This contributes to maintaining the debate on the occurrence of late-phase reactions (LPR).…”

Section: Mechanisms Of Exercise-induced Asthmamentioning

confidence: 99%

“…KIKAWA et al [24] used an improved methodology for leukotriene measurement and showed increased urinary levels of leukotriene E 4 (LTE 4 ) following exercise test in asthmatic children with EIA. The difficulty in demonstrating increases in leukotriene concentrations in BAL fluid may be due to the lack of sensitivity of the available assays or to the small contribution of the leukotriene in this fluid compartment in comparison to the whole body content [3]. A clear indication of the role of these molecules in EIA can be drawn from studies evaluating the effects of LTD 4 receptor antagonists in the prevention of EIA.…”

Section: Mechanisms Of Exercise-induced Asthmamentioning

confidence: 99%

“…The rapid resupply of heat to the airways may cause asthma by means of an exaggerated hyperaemia and bronchial oedema [4]. There are many studies supporting the respiratory heat loss theory and the consequent thermal changes in the airways as the stimulus for EIA [3]. DEAL et al [5] and MCFADDEN and co-workers [6] measured the temperature at different points of the tracheobronchial tree using thermocouples and clearly demonstrated that the fall in the airway temperature is directly related to the minute ventilation and inversely related to the inspired air temperature and water content.…”

Section: Mechanisms Of Exercise-induced Asthmamentioning

confidence: 99%

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Exercise-induced asthma: is there space for late-phase reactions?

Peroni

Boner²

1996

European Respiratory Journal

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EDITORIALExercise challenge provokes bronchoconstriction in the majority of asthmatics. The reaction is particularly frequent in childhood, with an estimated prevalence of 70-90% in asthmatic children, because of the high level of physical activity in this age group [1,2]. Bronchoconstriction is maximal 5-10 min after the challenge and tends to a complete recovery within 30-90 min, depending on the degree of the initial response. Although the topic has been extensively published, there are still diverse opinions about the existence of an exercise-induced late asthmatic response. Mechanisms of exercise-induced asthmaThe mechanisms of exercise-induced asthma (EIA) are not completely clear, and there are controversies about the precise nature of the stimuli responsible for inducing bronchoconstriction [3]. This contributes to maintaining the debate on the occurrence of late-phase reactions (LPR). The determinants of the bronchoconstrictor response are most likely the temperature and the water content of the inspired air and the minute ventilation during exercise; the inflammation of the airways and the underlying degree of airway responsiveness play a further contributory role.MCFADDEN and co-workers [4] have provided evidence that the respiratory heat loss during exercise, which causes airway cooling followed by rapid rewarming, may act as the appropriate stimulus for EIA. The rapid resupply of heat to the airways may cause asthma by means of an exaggerated hyperaemia and bronchial oedema [4]. There are many studies supporting the respiratory heat loss theory and the consequent thermal changes in the airways as the stimulus for EIA [3]. DEAL et al. [5] and MCFADDEN and co-workers [6] measured the temperature at different points of the tracheobronchial tree using thermocouples and clearly demonstrated that the fall in the airway temperature is directly related to the minute ventilation and inversely related to the inspired air temperature and water content. These variations are present both in normal and asthmatic subjects. Some subjects may develop EIA because of an increased sensitivity of their airways due to the previous degree of inflammation or to the difference in postexertional thermal events, since asthmatic airways rewarm twice as rapidly as those of controls [7]. However, at the present time, there is a lack of evidence of direct changes in the airway blood flow due to airway temperature variations.The second major hypothesis concerning the mechanisms of EIA was proposed by ANDERSON and co-workers [8]. They suggested that the respiratory water loss during exercise can lead to a hypertonicity of the airway lining fluid, and that the osmotic and not the cooling effect of exercise due to evaporated water is the more important factor in determining EIA. This theory is supported by other data [3]. Furthermore, in a recent study, ARGYROS et al. [9] found that the EIA is correlated to the loss of mucosal water and that it can be achieved without significant heat loss or airway cooling. ANDERSON and co-workers ...

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supporting

confidence: 73%

Section: Mechanisms Of Exercise-induced Asthmamentioning

confidence: 99%

Section: Mechanisms Of Exercise-induced Asthmamentioning

confidence: 99%

Section: Mechanisms Of Exercise-induced Asthmamentioning

confidence: 99%

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Exercise-induced asthma: is there space for late-phase reactions?

Peroni

Boner²

1996

European Respiratory Journal

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“…Children suffering from EIB may complain about any of the following symptoms during or after strenuous exercise: wheezing, shortness of breath, cough or chest pain [4,5]. The bronchoconstrictor response to exercise is determined by the level of ventilation reached during exercise, as well as the temperature and water content of the inspired air [6]. The precise mechanism by which EIB occurs is still a matter of debate.…”

mentioning

confidence: 99%

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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