scholarly journals Exercise-Induced Bronchoconstriction Diagnostics: Impact of a Repeated Exercise Challenge Test

2014 ◽  
Vol 04 (02) ◽  
pp. 55-63
Author(s):  
Maj R. Angell ◽  
Liv Berit Augestad ◽  
Thorbjørn S. Haugen ◽  
Anne Frostad ◽  
Thor Arne Grønnerød ◽  
...  
Keyword(s):  
Challenge Test ◽  
Exercise Challenge ◽  
Repeated Exercise ◽  
Exercise Induced

Exercise, physical activity, and asthma

2017 ◽  
Author(s):  
Helge Hebestreit ◽  
Susi Kriemler ◽  
Thomas Radtke
Keyword(s):  
Physical Activity ◽  
Challenge Test ◽  
Well Being ◽  
Physical Activities ◽  
Shortness Of Breath ◽  
Chest Tightness ◽  
Exercise Challenge ◽  
Typical History ◽  
Children With Asthma ◽  
Exercise Induced

The incidence of asthma in children varies among countries and can be estimated to range between 5% and 20%. Exercise-induced asthma (EIA) is common in patients with asthma but can also occur in some children without asthma. Typical symptoms of EIA include cough, chest tightness, and shortness of breath shortly after exercise. The pathophysiology of EIA is not completely understood, but it has been shown that airway cooling and drying with increased ventilation during exercise and airway re-warming after exercise play a pivotal role. In addition, a lack of physical activity may also contribute to EIA. Regular exercise may increase fitness and psychological well-being but may also positively influence airway inflammation in children with asthma. The diagnosis of EIA is based on the typical history and may be verified by an exercise challenge test. Every child with EIA should be able to engage in all type of physical activities.

scholarly journals Assessing paediatric exercise-induced bronchoconstriction using electromyography

2020 ◽  
Vol 6 (2) ◽  
pp. 00298-2019
Author(s):  
Pascal B. Keijzer ◽  
Mattiènne R. van der Kamp ◽  
Boony J. Thio ◽  
Frans H.C. de Jongh ◽  
Jean M.M. Driessen
Keyword(s):  
Electrical Activity ◽  
Chronic Diseases ◽  
Surface Electromyography ◽  
Challenge Test ◽  
Alternative Measure ◽  
Uncontrolled Asthma ◽  
Post Exercise ◽  
Exercise Challenge ◽  
Forced Breathing ◽  
Exercise Induced

BackgroundAsthma is one of the most common chronic diseases in childhood, occurring in up to 10% of all children. Exercise-induced bronchoconstriction (EIB) is indicative of uncontrolled asthma and can be assessed using an exercise challenge test (ECT). However, this test requires children to undergo demanding repetitive forced breathing manoeuvres. We aimed to study the electrical activity of the diaphragm using surface electromyography (EMG) as an alternative measure to assess EIB.MethodsForty-two children suspected of EIB performed an ECT wearing a portable EMG amplifier. EIB was defined as a fall in FEV1 of more than 13%. Children performed spirometry before exercise, and at 1, 3 and 6 min after exercise until the nadir FEV1 was attained and after the use of a bronchodilator. EMG measurements were obtained between spirometry measurements.ResultsTwenty out of 42 children were diagnosed with EIB. EMG peak amplitudes measured at the diaphragm increased significantly more in children with EIB; 4.85 μV (1.82–7.84), compared to children without EIB; 0.20 μV (−0.10–0.54), (p<0.001) at the lowest FEV1 post-exercise. Furthermore, the increase in EMG peak amplitude could accurately distinguish between EIB and non-EIB using a cut-off of 1.15 μV (sensitivity 95%, specificity 91%).ConclusionEMG measurements of the diaphragm are strongly related to the FEV1 and can accurately identify EIB. EMG measurements are a less invasive, effort-independent measure to assess EIB and could be an alternative when spirometry is not feasible.

Reanalysis of the refractory period in exertional asthma

1981 ◽  
Vol 50 (3) ◽  
pp. 503-508 ◽  
Author(s):  
D. R. Stearns ◽  
E. R. McFadden ◽  
F. J. Breslin ◽  
R. H. Ingram
Keyword(s):  
Refractory Period ◽  
Voluntary Hyperventilation ◽  
Short Intervals ◽  
Exercise Challenge ◽  
Repeated Exercise ◽  
Time Periods ◽  
Exercise Induced

In an effort to determine whether the refractory period in exercise-induced asthma derived from mediator consumption we had seven asthmatic subjects repeatedly perform both exercise and eucapnic hyperventilation at matched minute ventilations under precisely controlled inspired air conditions. We reasoned that, if airway cooling were causing an agent to be released whose depletion resulted in less responsiveness, we should be able to observe this phenomenon irrespective of how cooling was produced. Repetitive exercise at short intervals produced a diminution in the obstructive response that disappeared when the interval between challenges was extended to 2 h. However, the degree of obstruction that occurred after voluntary hyperventilation remained constant irrespective of when the provocations were performed and equaled that seen with the first and last exercise challenge. Because the thermal burdens were identical for each challenge and all time periods, these results are incompatible with mediator depletion and suggest that it may be the secondary sympathoadrenal consequences of repeated exercise that cause the airways to temporarily lose their responsivity.

scholarly journals The Need for Testing—The Exercise Challenge Test to Disentangle Causes of Childhood Exertional Dyspnea

2022 ◽  
Vol 9 ◽  
Author(s):  
Vera S. Hengeveld ◽  
Mattiènne R. van der Kamp ◽  
Boony J. Thio ◽  
John D. Brannan
Keyword(s):  
Challenge Test ◽  
Real Life ◽  
Common Symptom ◽  
Exertional Dyspnea ◽  
Asthmatic Children ◽  
Exercise Challenge ◽  
Common Causes ◽  
Physiological Limit ◽  
Dysfunctional Breathing ◽  
Exercise Induced

Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom. Common causes of exertional dyspnea are exercise induced bronchoconstriction (EIB), dysfunctional breathing, physical deconditioning and the sensation of dyspnea when reaching the physiological limit. These causes frequently coexist, trigger one another and have overlapping symptoms, which can impede diagnoses and treatment. In the majority of children with exertional dyspnea, EIB is not the cause of symptoms, and in asthmatic children it is often not the only cause. An exercise challenge test (ECT) is a highly specific tool to diagnose EIB and asthma in children. Sensitivity can be increased by simulating real-life environmental circumstances where symptoms occur, such as environmental factors and exercise modality. An ECT reflects daily life symptoms and impairment, and can in an enjoyable way disentangle common causes of exertional dyspnea.

Exercise-Induced Alterations in Phospholipid Hydrolysis, Airway Surfactant and Eicosanoids and their Role in Airway Hyperresponsiveness in Asthma

2021 ◽  
Author(s):  
Ryan Conrad Murphy ◽  
Ying Lai ◽  
James D Nolin ◽  
Robier A Aguillon Prada ◽  
Arindam Chakrabarti ◽  
...  
Keyword(s):  
Osmotic Stress ◽  
Airway Hyperresponsiveness ◽  
Apical Surface ◽  
Phospholipase Activity ◽  
Absolute Change ◽  
Phospholipid Hydrolysis ◽  
Exercise Challenge ◽  
Surfactant Degradation ◽  
Exercise Induced ◽  
Phospholipid Structure

The mechanisms responsible for driving endogenous airway hyperresponsiveness (AHR) in the form of exercise-induced bronchoconstriction (EIB) are not fully understood. We examined alterations in airway phospholipid hydrolysis, surfactant degradation, and lipid mediator release in relation to AHR severity and changes induced by exercise challenge. Paired induced sputum (n=18) and bronchoalveolar lavage (BAL) fluid (n=11) were obtained before and after exercise challenge in asthmatic subjects. Samples were analyzed for phospholipid structure, surfactant function and levels of eicosanoid and secreted phospholipase A2 group 10 (sPLA2-X). A primary epithelial cell culture model was used to model effects of osmotic stress on sPLA2-X. Exercise challenge resulted in increased surfactant degradation, phospholipase activity, and eicosanoid production in sputum samples of all patients. Subjects with EIB had higher levels of surfactant degradation and phospholipase activity in BAL fluid. Higher basal sputum levels of cysteinyl leukotrienes (CysLTs) and prostaglandin D2 (PGD2) were associated with direct AHR and both the post-exercise and absolute change in CysLTs and PGD2 levels were associated with EIB severity. Surfactant function was either abnormal at baseline or became abnormal after exercise challenge. Baseline levels of sPLA2-X in sputum and the absolute change in amount of sPLA2-X with exercise were positively correlated with EIB severity. Osmotic stress ex vivo resulted in movement of water and release of sPLA2-X to the apical surface. In summary, exercise challenge promotes changes in phospholipid structure and eicosanoid release in asthma, providing two mechanisms that promote bronchoconstriction, particularly in individuals with EIB who have higher basal levels phospholipid turnover.

scholarly journals Altered ventricular mechanics after 60 min of high-intensity endurance exercise: insights from exercise speckle-tracking echocardiography

2015 ◽  
Vol 308 (8) ◽  
pp. H875-H883 ◽  
Author(s):  
Glenn M. Stewart ◽  
Akira Yamada ◽  
Luke J. Haseler ◽  
Justin J. Kavanagh ◽  
Gus Koerbin ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Cardiac Troponin ◽  
Troponin T ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Cardiac Troponin T ◽  
Low Intensity ◽  
Exercise Challenge ◽  
Exercise Induced ◽  
Low Intensity Exercise

Transient reductions in myocardial strain coupled with cardiac-specific biomarker release have been reported after prolonged exercise (>180 min). However, it is unknown if 1) shorter-duration exercise (60 min) can perturb cardiac function or 2) if exercise-induced reductions in strain are masked by hemodynamic changes that are associated with passive recovery from exercise. Left ventricular (LV) and right ventricular global longitudinal strain (GLS), LV torsion, and high-sensitivity cardiac troponin T were measured in 15 competitive cyclists (age: 28 ± 3 yr, peak O2 uptake: 4.8 ± 0.6 l/min) before and after a 60-min high-intensity cycling race intervention (CRIT60). At both time points (pre- and post-CRIT60), strain and torsion were assessed at rest and during a standardized low-intensity exercise challenge (power output: 96 ± 8 W) in a semirecumbent position using echocardiography. During rest, hemodynamic conditions were different from pre- to post-CRIT60 (mean arterial pressure: 96 ± 1 vs. 86 ± 2 mmHg, P < 0.001), and there were no changes in strain or torsion. In contrast, during the standardized low-intensity exercise challenge, hemodynamic conditions were unchanged from pre- to post-CRIT60 (mean arterial pressure: 98 ± 1 vs. 97 ± 1 mmHg, not significant), but strain decreased (left ventricular GLS: −20.3 ± 0.5% vs. −18.5 ± 0.4%, P < 0.01; right ventricular GLS: −26.4 ± 1.6% vs. −22.4 ± 1.5%, P < 0.05), whereas LV torsion remained unchanged. Serum high-sensitivity cardiac troponin T increased by 345% after the CRIT60 (6.0 ± 0.6 vs. 20.7 ± 6.9 ng/l, P < 0.05). This study demonstrates that exercise-induced functional and biochemical cardiac perturbations are not confined to ultraendurance sporting events and transpire during exercise that is typical of day-to-day training undertaken by endurance athletes. The clinical significance of cumulative exposure to endurance exercise warrants further study.

Definition of an exercise intensity threshold in a challenge test to diagnose food-dependent exercise-induced anaphylaxis

Allergy ◽  
2009 ◽  
Vol 64 (10) ◽  
pp. 1560-1561 ◽  
Author(s):  
M. Loibl ◽  
S. Schwarz ◽  
J. Ring ◽  
M. Halle ◽  
K. Brockow
Keyword(s):  
Exercise Intensity ◽  
Challenge Test ◽  
Intensity Threshold ◽  
Exercise Induced ◽  
Definition Of

scholarly journals Airways Hyperresponsiveness and Atopy: A Comparison of Inuit and Montreal Schoolchildren

1995 ◽  
Vol 2 (2) ◽  
pp. 92-96 ◽  
Author(s):  
Brenda Hemmelgarn ◽  
Esther Loozen ◽  
Sheila Saralegui ◽  
Susan Chatwood ◽  
Pierre Ernst
Keyword(s):  
Skin Testing ◽  
Challenge Test ◽  
Bronchial Hyperresponsiveness ◽  
Forced Expiratory Volume ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
History Of ◽  
Exercise Induced ◽  
Allergy Skin Testing ◽  
Airways Hyperresponsiveness

OBJECTIVE: To compare the prevalence ol exercise induced bronchial hyperresponsiveness in Inuit children with that or children in Montreal, and to identify possible genetic and environmental determinants of the differences observed.DESIGN: Cross-sectional survey.SETTING: Salluit, an isolated Inuit community in northern Quebec, and Montreal.POPULATION STUDIED: All children attending school in Salluit in grades 2 to 6 were eligible to participate. For the Montreal study, 18 schools were selected and from each of these one class from each of grades 1, 3 and 5 were chosen.MEASUREMENTS: Data collection for both locations included an exercise challenge test to assess exercise induced bronchial hyperresponsiveness (EIBH), allergy skin testing, a questionnaire for parents regarding details or the home environment as well as the child’s history of respiratory symptoms, and collection of dust samples from the bedroom floor and mattress for the presence of house dust mite.RESULTS: The prevalence or EIBH (defincd as a decline of 15% or more between pre-exercise forced expiratory volume in 1 s [FEV1] and that at 5 or 10 mins postexercise) was 19.5% (23 of 118) among the Inuit children, compared with 8.8% (87 of 989) among the Montreal children. In contrast. only 8.6% of the Inuit children had a positive allergy skin test compared with 34% in Montreal.CONCLUSIONS: A higher prevalence of EIBH was found in Inuit schoolchildren compared with children of similar age in Montreal, although the prevalence of atopy was considerably lower.

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