The prevention of exercise-induced bronchoconstriction: what are the options?

Anderson, Sandra D.

doi:10.1586/ers.12.33

Cited by 10 publications

(12 citation statements)

References 20 publications

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“…EIB reflective of the underlying asthma condition is reported in up to 90% of subjects with identified asthma but EIB can occur in individuals without a clinical history of asthma (14). Athletes particularly suffer from EIB without known asthma (15, 16), more frequently those with risk factors such as lung injury secondary to prematurity (17) or neonatal chronic lung conditions (18). However EIB is more commonly reported when asthma is associated to heavy exercise like in competitive athletes.…”

Section: Prevalencementioning

confidence: 99%

“…Anyway at the moment, we there is not a firm consensus for the conditions under which exercise should be performed (4). The challenge is performed with 2 min to ramp up to at least 85% of the maximum heart rate or 95% for children or athletes, maintaining this heart rate for 6 min (53) and monitoring pulmonary functions every 5 min until 30 min after challenge (15, 19, 29). The difference between the preexercise FEV1 value and the lowest FEV1 value recorded within 30 min after exercise is expressed as a percentage of the preexercise value.…”

Section: Diagnosismentioning

confidence: 99%

“…Alternative diagnostic tests comprise inhalation of hyperosmolar saline, eucapnic voluntary hyperpnea of dry air and inhalation of dry powder mannitol (54). Is possible to diagnose EIB in 3–6 years of age children by measurement of FEV0.5 and airway resistance using the interrupt technique in 5–12 years old (15, 19, 29). In fact among bronchoprovocation tests in preschool children, interrupter resistance (RINT) has been used in association with spirometry to evaluate the presence of EIB.…”

Section: Diagnosismentioning

confidence: 99%

“…Many therapeutic options are available to prevent EIB. For example, inhalation of β2 agonist at recommended dose immediately before exercise effectively prevents the symptoms by stimulating β2 receptors on mast cells inhibiting release of contractile mediators and inducing relaxation of the airway smooth muscle like an antagonist of such mediators (15). Principal pharmacologic treatments are short-acting b2-agonists (SABAs) and long-acting b2-agonists (LABAs), ICSs, and leukotriene receptor antagonists (LTRAs).…”

Section: Treatmentmentioning

confidence: 99%

“…Montelukast is reported to reduce the% fall in FEV1 by 40–60% and to reduce the recovery’s time of FEV1, without tolerance induction (59). Combined therapy of antihistamine with montelukast can be useful and more effective than a single drug but the combination is not generally recommended (15). In terms of stabilization of mast cells, sodium cromoglycate and nedocromil sodium may be a valid therapeutic option, effective since from the first administration, made shortly before exercise, but with short duration of action both alone and with other drugs are indicated in case of EIB (4, 60).…”

Section: Treatmentmentioning

confidence: 99%

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Exercise-Induced Bronchospasm and Allergy

et al. 2017

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Sport is an essential part of childhood, with precious and acknowledged positive health effects but the impact of exercise-induced bronchoconstriction (EIB) significantly reduces participation in physical activity. It is important to recognize EIB, differentiating EIB with or without asthma if the transient narrowing of the airways after exercise is associated with asthmatic symptoms or not, in the way to select the most appropriate treatment among the many treatment options available today. Therapy is prescribed based on symptoms severity but diagnosis of EIB is established by changes in lung function provoked by exercise evaluating by direct and indirect tests. Sometimes, in younger children it is difficult to obtain the registration of difference between the preexercise forced expiratory volume in the first second (FEV1) value and the lowest FEV1 value recorded within 30 min after exercise, defined as the gold standard, but interrupter resistance, in association with spirometry, has been showed to be a valid alternative in preschool age. Atopy is the main risk factor, as demonstrated by epidemiologic data showing that among the estimated pediatric population with EIB up to 40% of them have allergic rhinitis and 30% of these patients may develop adult asthma, according with atopic march. Adopting the right treatment and prevention, selecting sports with no marked hyperventilation and excessive cooling of the airways, children with EIB can be able to take part in physical activity like all others.

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Section: Prevalencementioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Exercise-Induced Bronchospasm and Allergy

et al. 2017

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Protective effect of a low single dose inhaled steroid against exercise induced bronchoconstriction

Visser

Wind²,

Graaf

et al. 2014

Pediatr Pulmonol.

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Asthma as a disruption in iron homeostasis

Ghio

2016

Biometals

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Over several decades, asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories, pathophysiologies, responses to treatment, and distinctive molecular pathways. With the application of Occam's razor to asthma, it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues. This deficiency can be either absolute (e.g. asthma in the neonate and during both pregnancy and menstruation) or functional (e.g. asthma associated with infections, smoking, and obesity). Comparable associations between asthma co-morbidity (e.g. eczema, urticaria, restless leg syndrome, and pulmonary hypertension) with iron deficiency support such a shared mechanistic pathway. Therapies directed at asthma demonstrate a capacity to impact iron homeostasis, further strengthening the relationship. Finally, pathophysiologic events producing asthma, including inflammation, increases in Th2 cells, and muscle contraction, can correlate with iron availability. Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron.

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The prevention of exercise-induced bronchoconstriction: what are the options?

Cited by 10 publications

References 20 publications

Exercise-Induced Bronchospasm and Allergy

Exercise-Induced Bronchospasm and Allergy

Protective effect of a low single dose inhaled steroid against exercise induced bronchoconstriction

Asthma as a disruption in iron homeostasis

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