scholarly journals Predictors of exercise-induced bronchoconstriction in subjects with mild asthma

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Maroon Salameh ◽  
Laura Pini ◽  
Federico Quadri ◽  
Fabio Spreafico ◽  
Damiano Bottone ◽  
...  
Keyword(s):  
Persistent Asthma ◽  
Progressive Increase ◽  
Cardiopulmonary Exercise Test ◽  
Mild Asthma ◽  
Small Airways ◽  
Forced Expiration ◽  
Respiratory Parameters ◽  
Expiratory Flow ◽  
Exercise Induced ◽  
Mild Persistent Asthma

Abstract Background Physical effort is capable of triggering airway obstruction in asthmatics, the so-called exercise-induced bronchoconstriction in asthma (EIBa). This study was performed in subjects with mild persistent asthma, aiming to find predictors for developing EIBa. Methods In 20 subjects with mild asthma, measurements of baseline functional respiratory parameters and airways responsiveness by a methacholine challenge were obtained on the first day. A maximal, symptom-limited incremental cardiopulmonary exercise test (CPExT) was performed the day after, with subsequent, repeated maneuvers of maximal full forced expiration to monitor the FEV1 change at 1,3,5,7,10 and 15 min after the end of the exercise. Results 19 subjects completed the two-days protocol. No functional parameters both at rest and during effort were useful to predict EIBa after stopping exercise. In asthmatics with EIBa, mean Inspiratory Capacity (IC) did not increase with increasing ventilatory requirements during CPExT because 6 of them (50%) displayed dynamic pulmonary hyperinflation (DH), as documented by their progressive increase of end-expiratory lung volume. This subgroup, showing earlier post-exercise FEV1 fall, had significantly lower forced mean expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%) at rest (p < 0.05) and higher airways responsiveness, expressed as PD20FEV1 (p < 0.05) as compared with other asthmatics with EIBa. Conclusions No functional respiratory parameters seem to predict EIBa in mild asthmatics. However, in those with EIBa, a subgroup developed DH during exercise, and this was associated with a baseline reduced forced expiratory flow rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.

scholarly journals Predictors of exercise-induced bronchoconstriction in subjects with mild asthma

2021 ◽  
Author(s):  
Maroon Salameh ◽  
Laura Pini ◽  
Federico Quadri ◽  
Fabio Spreafico ◽  
Damiano Bottone ◽  
...  
Keyword(s):  
Persistent Asthma ◽  
Progressive Increase ◽  
Cardiopulmonary Exercise Test ◽  
Mild Asthma ◽  
Small Airways ◽  
Forced Expiration ◽  
Respiratory Parameters ◽  
Expiratory Flow ◽  
Exercise Induced ◽  
Mild Persistent Asthma

Abstract Background Physical effort is a stimulus capable of triggering airway obstruction in asthmatics, the so-called exercise-induced bronchoconstriction in asthma (EIBa). This study was performed in subjects with mild persistent asthma, aiming to find predictors for developing EIBa. Methods In 20 subjects with mild asthma, measurements of baseline functional respiratory parameters and airways responsiveness by a methacholine challenge were obtained on the first day. The day after, a maximal, symptom-limited incremental cardiopulmonary exercise test (CPExT) was performed, with subsequent, repeated maneuvers of maximal full forced expiration to monitor the FEV 1 change at 1,3,5,7,10 and 15 minutes after the end of exercise. Results 19 subjects completed the two-days protocol. No functional parameters both at rest and during effort were useful to predict EIBa after stopping exercise. In asthmatics with EIBa, mean Inspiratory Capacity (IC) did not increase with increasing ventilatory requirements during CPExT, because 6 of them (50%) displayed dynamic pulmonary hyperinflation (DH), as documented by their progressive increase of end-expiratory lung volume. This subgroup, showing earlier post-exercise FEV 1 fall, had significantly lower forced mean expiratory flow between 25% and 75% of forced vital capacity (FEF 25-75% ) at rest (p<0.05) and higher airways responsiveness, expressed as PD 20 FEV 1 (p<0.05) as compared with other asthmatics with EIBa. Conclusions No functional respiratory parameters seem to predict EIBa in mild asthmatics. However, in those with EIBa, a subgroup developed DH during exercise, and this was associated with a baseline reduced forced expiratory flow-rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.

scholarly journals Predictors of Exercise-Induced Bronchoconstriction in Subjects with Mild Asthma

2020 ◽  
Author(s):  
Maroon Salameh ◽  
Laura Pini ◽  
Federico Quadri ◽  
Fabio Spreafico ◽  
Damiano Bottone ◽  
...  
Keyword(s):  
Exercise Test ◽  
Persistent Asthma ◽  
Mild Asthma ◽  
Small Airways ◽  
Forced Expiration ◽  
Functional Parameters ◽  
Respiratory Parameters ◽  
Stable Conditions ◽  
Expiratory Flow ◽  
Exercise Induced

Abstract Background: Physical effort is one of the natural stimuli capable of triggering airway obstruction in asthmatics, the so called exercise-induced bronchoconstriction in asthma (EIBa). This study was performed in subjects with mild persistent asthma suspected for EIBa, aiming to find predictors among functional parameters at rest and during exercise for developing EIBa. Methods: In 20 subjects with mild asthma in stable conditions who reported respiratory symptoms on exertion in the past, measurements of baseline functional respiratory parameters and airways responsiveness by a methacholine challenge were obtained on the first day of the study after an adequate pharmacological washout. The day after, a maximal symptom-limited incremental cardiopulmonary exercise test (CPExT) was performed, with subsequent, repeated maneuvers of maximal full forced expiration to monitor the FEV1 change at 1,3,5,7,10 and 15 minutes after the end of exercise for diagnosing EIBa.Results: 19 subjects aged 27±5 years completed the two-days protocol. No functional parameters both at rest and during effort were useful to predict EIBa after stopping exercise that actually occurred in 12 individuals. In contrast to asthmatics without EIBa, in those with EIBa, however, mean Inspiratory Capacity (IC) did not increase with increasing ventilatory requirements during CPExT because 6 of them (50%) displayed dynamic pulmonary hyperinflation (DH) throughout the exercise, as documented by the progressive increase of end-expiratory lung volume. This subgroup of asthmatics with EIBa who in turn showed earlier and greater post-exercise FEV1 fall had significantly lower forced mean expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%) at rest (p<0.05) and higher airways responsiveness, expressed as PD20FEV1 (p<0.05).Conclusions No functional respiratory parameters either at rest or during the effort seem to predict EIBa in mild asthmatics after maximal exercise test. In those with EIBa, however, a subgroup developed DH during exercise, and this was associated with baseline reduced forced expiratory flow-rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.

Flow-Volume Curves in Infants with Lung Disease

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 517-522
Author(s):  
S. Godfrey ◽  
E. Bar-Yishay ◽  
I. Arad ◽  
L. I. Landau ◽  
L. M. Taussig
Keyword(s):  
Lung Disease ◽  
Airway Obstruction ◽  
Lung Volume ◽  
Airway Resistance ◽  
Whole Body ◽  
Small Airways ◽  
Forced Expiration ◽  
Flow Volume ◽  
Complete Evaluation ◽  
Expiratory Flow

Partial expiratory flow-volume maneuvers have been performed on nine occasions on six infants with a variety of pulmonary problems using a new tech nique for thoracic compression. The infants were placed within an inflatable bag that was, itself, within a canvas bag. By sudden controlled inflation of the inner bag at end inspiration, partial expiratory flow-volume curves were generated and recorded by means of a face mask and pneumotachograph. By comparing these flow results with those airway resistance and lung volume measurements obtained from the infants in whole body plethysmography and by noting the effect of inhaling a helium/oxygen gas mixture, it was possible to partition the airway obstruction between large and small airways. The presence of small airway obstruction was noted in the absence of changes in airway resistance or lung volume in several instances. A complete evaluation of airway function should include this test of forced expiration for greater understanding and treatment of lung disease in infancy.

Effects of atropine on potentiation of exercise-induced bronchospasm by cold air

1978 ◽  
Vol 45 (2) ◽  
pp. 238-243 ◽  
Author(s):  
E. C. Deal ◽  
E. R. McFadden ◽  
R. H. Ingram ◽  
J. J. Jaeger
Keyword(s):  
Ambient Air ◽  
Small Airways ◽  
Flow Limitation ◽  
Ambient Conditions ◽  
Cold Air ◽  
Relative Contribution ◽  
Maximal Expiratory Flow ◽  
Before And After ◽  
Expiratory Flow ◽  
Exercise Induced

The role of vagal efferent activity in the cold air potentiation of exercise-induced asthma was assessed by exercising nine subjects who breathed air at ambient and subfreezing temperatures before and after cholinergic blockade. Lung volumes and maximal expiratory flow volume curves with air and with 80% helium-20% oxygen were obtained before and 5--10 min after each challenge. Isovolume comparisons of maximal expiratory flow rates with the two gases were used to assess relative contributions of large and small airways to flow limitation. Exercise under ambient conditions resulted in the expected airway obstruction and cold air exaggerated the response. Atropine pretreatment had no effect on the cold air potentiation. After atropine with ambient air exercise, there was an increase in the relative contribution of large airways to flow limitation, whereas exercise with cold air resulted in an increase in the contribution of small airways. We concluded that the potentiating effects of cold air are local and suggest that the immediate stimulus is related to cooling of intrathoracic airways.

Oral and Inhaled Salbutamol in the Prevention of Exercise-Induced Bronchospasm

PEDIATRICS ◽  
1980 ◽  
Vol 66 (1) ◽  
pp. 103-108
Author(s):  
Paul W. J. Francis ◽  
Inese R. B. Krastins ◽  
Henry Levison
Keyword(s):  
Forced Expiratory Volume ◽  
Small Airways ◽  
Onset Of Action ◽  
Asthmatic Children ◽  
Oral Preparation ◽  
Maximum Expiratory Flow ◽  
Forced Expiratory Flow ◽  
Expiratory Flow ◽  
Exercise Induced ◽  
Single Blind

Oral salbutamol in a dose of 0.15 mg/kg of body weight was compared to a total dose of 0.2 mg of salbutamol aerosol in its ability to produce bronchodilation and to prevent exercise-induced bronchospasm (EIB) in 16 asthmatic children in a single-blind crossover study. The degree of bronchodilation seen 120 minutes after the oral salbutamol was equal to that seen 40 minutes after the salbutamol aerosol as assessed by peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow during the middle half of the FVC (FEF25-75%), and maximum expiratory-flow after 75% of the FVC had been expired (V25). With respect to changes in PEF and FEV1, both active agents were equally effective in blocking EIB following a standardized treadmill exercise test. However, in assessing changes in FEF25-75%, and V25 following exercise, the aerosol was slightly but significantly more effective than the oral preparation in blocking EIB. Oral salbutamol was clinically effective in preventing EIB for 4.9 to 5.8 hours. The aerosol route has the advantages of a faster onset of action, fewer side effects, and greater protection against EIB with respect to small airways function. Nevertheless, for patients who are unable to use a metered aerosol, oral salbutamol is a useful alternative both as a bronchodilator and in preventing EIB.

scholarly journals Budesonide-Formoterol as Needed for The Treatment of Mild Persistent Asthma

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Emily B. Walsh ◽  
Alicia B. Forinash ◽  
Rebecca L. Stauffer ◽  
Abigail Yancey ◽  
Erica F. Crannage ◽  
...  
Keyword(s):  
Low Dose ◽  
Data Extraction ◽  
Symptom Control ◽  
Asthma Management ◽  
Persistent Asthma ◽  
Global Strategy ◽  
Beta Agonist ◽  
Mild Asthma ◽  
Inhaled Corticosteroid ◽  
Mild Persistent Asthma

Objective: To summarize literature assessing the safety and efficacy of budesonide/formoterol, a low dose inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) used as needed for the treatment of adult patients with mild persistent asthma requiring step 2 therapy compared to low dose inhaled corticosteroid (ICS) plus short-acting beta agonist (SABA) and SABA monotherapy. Data Sources: A literature search of PubMed (1966-October 2020), EMBASE (1973-October 2020) and clinicaltrials.gov was conducted using the following search terms: budesonide, formoterol, as needed, and mild asthma. Study selection and data extraction: Randomized, controlled trials with data describing as needed use of budesonide-formoterol in the treatment of mild, persistent asthma were included. Data synthesis: Current trials demonstrate a reduced risk of exacerbation and an improvement in symptom control in patients receiving budesonide/formoterol as needed when compared to as needed SABA alone. However, when compared to scheduled budesonide maintenance, patients receiving budesonide/formoterol as needed experienced worse symptom control and mixed exacerbation results. Relevance to patient care and clinical practice: This review evaluates the efficacy and safety of budesonide/formoterol as needed for patients with mild asthma. The Global Initiative for Asthma (GINA), a global strategy for asthma management and prevention adopted this change in 2019, and the most recent updated Expert Panel Report 4 of the National Asthma Education and Prevention Program (NAEPP) did not address this area. Conclusions: Based on this review of the literature, further study is needed to determine the place in therapy for budesonide/formoterol as needed in the treatment of mild persistent asthma. Low-dose ICS should remain the standard of therapy in patients with mild asthma requiring Step 2 therapy.

scholarly journals Efficacy and compliance of montelukast as prophylaxis in mild persistent asthma

2018 ◽  
Vol 5 (6) ◽  
pp. 2133
Author(s):  
Sreejyothi G. ◽  
Maya Menon ◽  
Raveendranath K.
Keyword(s):  
Allergic Rhinitis ◽  
Bronchial Asthma ◽  
Treatment Options ◽  
Persistent Asthma ◽  
Good Control ◽  
Age Group ◽  
Asthma Morbidity ◽  
Exercise Induced ◽  
Mild Persistent Asthma ◽  
A Prospective Study

Background: Bronchial Asthma is characterized by hyperresponsiveness of airways to various triggers. The management goals of asthma therapy are to control asthma so that the affected child can lead a normal life without asthma exacerbations. In spite of several advances in the management aspects, asthma morbidity remains the same. Under diagnosis, inappropriate therapy and poor compliance are the major contributors to asthma morbidity. In the recent years the knowledge about different clinical and biological phenotypes of asthma has helped in deciding the treatment options in bronchial asthma. Montelukast has proven to be particularly effective in exercise induced asthma and asthma associated with allergic rhinitis. The aim of this study is to assess the efficacy and compliance of montelukast for prophylaxis in mild persistent asthma in children aged 1-12 years.Methods: This is a prospective study which included children between age group 1-12 years with mild persistent asthma who was started on montelukast during the 12-month period from September 2016 to October 2017. No. of children who were controlled with moutelukast and who needed step up treatment were noted. Comorbidities of children who were controlled on montelukast were also studied.Results: At the end of 6 months, 86.4% of children were well controlled and 13.6% were not well controlled.91.5% who were well controlled belonged to 1-5 years age group. Children with comorbidities like allergic rhinitis had good control with moutelukast. Response to montelukast was good when viral infection was a trigger.Conclusions: It is a safe drug with modest benefits in bronchial asthma. It is useful in mild persistent asthma where ICS administration is impractical and also in patients with comorbidities like allergic rhinitis. It is also found to decrease the episode of viral induced wheeze in young children. 

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