Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population

Johansson, Henrik; Norlander, Katarina; Berglund, Lars; Janson, Christer; Malinovschi, Andreï; Nordvall, Lennart; Nordang, Leif; Emtner, Margareta

doi:10.1136/thoraxjnl-2014-205738

Cited by 192 publications

(211 citation statements)

References 26 publications

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“…These differences, in the site of breathing discomfort, are consistent with previous literature (17) and may indicate the presence of upper airway closure precipitating dyspnoea and more specifically may indicate the presence of exercise-induced laryngeal obstruction (EILO); a mimic of asthma caused by closure of the laryngeal inlet, which does not respond to asthma medication (18)(19)(20)(21).…”

Section: Discussionsupporting

confidence: 78%

Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception

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Hull

Ansley

et al. 2016

Respiratory Medicine

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Section: Discussionsupporting

confidence: 78%

Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception

Price

Hull

Ansley

et al. 2016

Respiratory Medicine

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“…[20][21][22][23] Breathlessness is universal if sufficiently intense exercise is undertaken. In this context, it is opportune to remember that only about half of those complaining of exercise-induced breathlessness have a formal diagnosis of asthma or exercise-induced laryngeal obstruction (EILO) 24 ; the rest (who were not more obese) were just deconditioned or consciously or unconsciously exaggerating their symptoms. Symptoms should not be taken at face value.…”

Section: Not Asthma At All: Wrong Diagnosismentioning

confidence: 99%

Severe asthma in children

2017

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Most children with asthma have their disease easily controlled if low-dose inhaled corticosteroids (ICSs) are regularly and correctly administered. If a child presents with asthma which is apparently resistant to therapy with high-dose ICS and other controllers, then they have problematic severe asthma. However, in light of the UK National Review of Asthma Deaths, definitions of severe asthma based solely on the levels of prescribed treatment are too narrow. A detailed assessment of all such children should be performed. First, the diagnosis of asthma should be confirmed, then co-morbidities assessed. Next, a nurse-led assessment further characterizes the problem, conventionally categorizing the child as either having difficult asthma or severe therapy-resistant asthma. Here, we reassess in particular the interactions between, and management of, these two categories, highlighting that this dichotomous classification may need reconsideration. We use bronchoscopy and an intramuscular steroid injection to determine if the child has steroid-resistant asthma, using a novel, multidomain approach because the adult definition does not apply to around half the children we see. Finally, we highlight some mechanistic data which have emerged from this protocol such as the absence of T-helper 2 (TH2) cytokines even in eosinophilic severe asthma and the potential role of the innate epithelial cytokine IL-33, novel data on lineage negative innate lymphoid cells, which we can measure in induced sputum, and demonstrating that intraepithelial neutrophils are associated with better, not worse asthma outcomes. Severe paediatric asthma is very different from severe asthma in adults, and approaches must not be uncritically extrapolated from adult disease to children.

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“…A recent cross-sectional study of 12-13-year-olds in Sweden demonstrated a population prevalence of approximately 6%. 3 Another study has shown that EILO may be as prevalent as exercise-induced bronchoconstriction, explaining 'treatmentrefractory' symptoms in around a quarter of young athletic patients referred with exertional respiratory symptoms. 4 Nielsen et al found EILO coexisting with exerciseinduced bronchoconstriction in just over 10% of individuals, perhaps explaining why 'partial' resolution of symptoms is seen in some young patients treated with inhaler therapy.…”

Section: Prevalencementioning

confidence: 99%

Exercise-induced laryngeal obstruction: a common and overlooked cause of exertional breathlessness

et al. 2016

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Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population

Cited by 192 publications

References 26 publications

Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception

Exercise-induced bronchoconstriction in athletes – A qualitative assessment of symptom perception

Severe asthma in children

Exercise-induced laryngeal obstruction: a common and overlooked cause of exertional breathlessness

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