Not all who wheeze have asthma

Backer, Vibeke

doi:10.1183/18106838.0701.016

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…9 It is important to be aware that exercise-induced symptoms could mask a variety of other diseases or conditions, such as poor physical fitness, vocal cord dysfunction (VCD), exercise-induced paradoxical arytenoid motion (EPAM), exercise-induced laryngomalacia (EIL), exercise -induced hyperventilation and hyper-trophic cardiomyopathy or arrhythmias with long Q-wave to T-wave interval QT. 10 The timing of the appearance of breathlessness in relation to exercise can provide some clue about an alternative diagnosis as the nadir of EIB happens 5 to 10 minutes after vigorous and sustained exercise, 11 as opposed to the shortness of breath experienced due to a lack of fitness or pre - existing airflow limitation where shortness of breath develops during exercise but improves afterwards.…”

Section: Diagnosis Of Eibmentioning

confidence: 99%

Safety, Efficacy, and Patient Acceptability of Montelukast in Exercise-Induced Asthma

Kansra

Mazzei

Bhatt

2012

Clinical Medicine Insights: Therapeutics

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Exercise-induced bronchoconstriction (EIB) can be a troublesome problem in asthmatic children and in some children withoutasthma.Self-reportedexerciserelatedsymptomsshouldbeverifiedformally.EIBismediatedbychangesintemperatureand humidityintheairwayandissecondarytoreleaseofseveralmediatorsofthebronchoconstrictionincludingleukotrienes.Montelukast asaleukotrienereceptorantagonistoffersprotectionagainstbutdoesnotcompletelyameliorateEIB.Regularusedoesnotappearto leadtotolerance.Nightmares,abdominalpain,fever,nauseaandaggressivenessarecommonlydescribedsideeffects;however,the overallsafetyprofileofmontelukastisgoodanddoesnotchangewithlongtermuse.Thereareindividualdifferencesinresponseto montelukastforprotectionagainstEIB.Bronchoconstrictiontriggeredbyexerciserespondstocessationofexerciseinitsnaturalcourse. Duetoitspharamacokineticprofile,montelukastmaybemoreusefulasaprophylaxisthantorelievesymptoms.

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Section: Diagnosis Of Eibmentioning

confidence: 99%

Safety, Efficacy, and Patient Acceptability of Montelukast in Exercise-Induced Asthma

Kansra

Mazzei

Bhatt

2012

Clinical Medicine Insights: Therapeutics

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“…However, no technique has shown good sensitivity and specificity33–35 and it is still difficult to diagnose EIVCD 36…”

Section: Introductionmentioning

confidence: 99%

Eucapnic voluntary hyperpnoea and exercise-induced vocal cord dysfunction

Turmel

Gagnon

Bernier³

et al. 2015

BMJ Open Sport Exerc Med

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IntroductionExercise-induced bronchoconstriction (EIB) is a common condition in endurance athletes. Exercise-induced vocal cord dysfunction (EIVCD) is a frequent confounder of EIB. The diagnosis of EIVCD may be challenging and can be missed as the problem is often intermittent and may only occur during intense exercise. Eucapnic voluntary hyperventilation (EVH) is the best test to detect EIB. This pilot study aimed to assess if EVH could be helpful in the diagnosis of EIVCD associated or not to EIB in athletes.MethodsA nasolaryngoscopy was performed during a 6 min EVH test, in 13 female athletes suspected to have VCD, aged 21±7 years. Image analysis was conducted by two Ear Nose and Throat surgeons in random order.ResultsDuring the EVH, three athletes showed incomplete paradoxical vocal cords movement, without inspiratory stridor. However, 12 athletes showed marked supraglottic movement without inspiratory stridor. In two athletes, this supraglottic movement was severe, one showing a marked collapse of the epiglottis with an almost complete obstruction of the larynx by the arytenoid cartilage mucosa. In 3 of the 12 athletes with supraglottic movement, severe vibration of the mucosa covering the arytenoid cartilages was also observed.ConclusionsEVH challenge in athletes can provide information on various types of glottic and supraglottic obstruction in reproducing laryngeal movements during hyperventilation. Our findings make us suggest that exercise induced upper airway obstructions should be named: Exercise-induced laryngeal obstruction (EILO). Then, EILO should be divided in three categories: supraglottic, glottic (EIVCD) and mixed (glottic and supraglottic) obstruction.

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“…An important differential or mimic of EIB is exercise-induced laryngeal obstruction (EILO), in which clinical features of dyspnoea and wheeze are generated from a transient obstruction of the upper airways during exercise (Table 3). 13 Bronchial provocation challenge is often necessary to establish definitive evidence of variable airflow obstruction (ie to demonstrate airway narrowing in response to a provocative substance, such as exercise). Specifically, an athlete performs serial spirometry tests before and following a challenge; typically looking for a 10% fall in forced expiratory volume (FEV 1 ) from baseline values.…”

Section: Overview Of Respiratory Physiology In Athletesmentioning

confidence: 99%

Managing respiratory problems in athletes

et al. 2012

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-Respiratory problems are common in athletes of all abilities and can significantly impact upon their health and performance. In this article, we provide an overview of respiratory physiology in athletes. We also discuss the assessment and management of common clinical respiratory conditions as they pertain to athletes, including airways disease, respiratory tract infection and pneumothorax. We focus on providing a pragmatic approach and highlight important caveats for the physician treating respiratory conditions in this highly specific population.

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Not all who wheeze have asthma

Cited by 7 publications

References 31 publications

Safety, Efficacy, and Patient Acceptability of Montelukast in Exercise-Induced Asthma

Safety, Efficacy, and Patient Acceptability of Montelukast in Exercise-Induced Asthma

Eucapnic voluntary hyperpnoea and exercise-induced vocal cord dysfunction

Managing respiratory problems in athletes

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