Pediatric Exercise-Induced Bronchoconstriction: Contemporary Developments in Epidemiology, Pathogenesis, Presentation, Diagnosis, and Therapy

Abstract

Exercise-induced bronchoconstriction is transient narrowing of the airways following strenuous exercise. It is the earliest sign of asthma and the last to resolve. EIB is found in 90 % of asthmatics and reflects underlying control of asthma. This review is focused on the contemporary developments in pediatric EIB: the epidemiology, pathogenesis, presentation, diagnosis and management. Proper diagnosis by objective pulmonary function and/or exercise challenge and therapy should allow the pediatric asthmatic to enjoy a healthy lifestyle including participation in the chosen sport.

Salbutamol and exercise induced inspiratory flow limitation in asthmatic children

“…Exercise induced hyperventilation dries the airway epithelium and leads to hyperosmolarity of the airway surface fluid, triggering residential mucosal mast cells to release inflammatory mediators such as histamine 1,16 . It is assumed that the bronchoprotective effect of salbutamol in EIB is largely attained by its stabilizing effect on beta 2 receptors on mast cells 1,9 .…”

“…It is assumed that the bronchoprotective effect of salbutamol in EIB is largely attained by its stabilizing effect on beta 2 receptors on mast cells 1,9 . Exercise also cools the airways, that rapidly rewarm and congest when exercise induced hyperventilation ceases.…”

“…For both exercise formats the same exercise challenge test guidelines were used 1,11 . During the four hours prior to the ECT's, children were not allowed to perform strenuous exercise.…”

“…Exercise induced bronchoconstriction (EIB) is a specific and common symptom of childhood asthma and of all asthma symptoms, considered to be the most detrimental on quality of life [1][2][3] . EIB is a sign of bronchial hyperresponsiveness (BHR) and featured by bronchial obstruction leading to expiratory flow limitation.…”

“…Inhaled salbutamol stabilizes inflammatory cells and can therefore provide excellent protection 1,9 . The pathofysiology of exercise induced inspiratory flow limitation is unknown but inflammatory mediators released may be directly or indirectly involved.…”