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Purpose: Exercise-induced laryngeal obstruction (EILO) is suspected when dyspnea associated with upper airway symptoms is triggered by exercise. This condition affects mainly adolescent athletes. Visualization of the obstruction, while the patient is experiencing the symptoms during continuous laryngoscopy during exercise (CLE-test) is the gold standard for diagnosing EILO. Our study aims to evaluate the prevalence of EILO in a population presenting exercise-induced inspiratory symptoms (EIIS) or uncontrolled asthma with exertional symptoms. The second objective was to evaluate the diagnostic strength of laryngology consultation (LC) and pulmonary function tests (PFTs)., Methods: All patients referred to our center for EIIS or uncontrolled asthma with exertional symptoms were included. EILO diagnosis was made if Maat score was > 2 for patients with CLE-test or if there were inspiratory anomalies on PFTs and LC. The sensitivity and specificity of LC and PFTs as diagnostic tools were calculated considering CLE-test as the gold standard., Results: Sixty two patients were referred to our center for EIIS or uncontrolled asthma with exertional symptoms. EILO was diagnosed in 28 patients (56%) with associated asthma in 9 patients (18%). The sensibility and specificity of LC for supraglottic anomalies were 75% and 60%, respectively. The sensibility and specificity of PFTs were 61% and 89%, respectively., Conclusions: There was a high prevalence of EILO among patients with EIIS and uncontrolled asthma. Some clinical characteristics might guide the diagnosis. Nevertheless, CLE-test remained the gold standard for EILO diagnosis and identification of the dysfunctional upper airway site to provide specific management., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Free running exercise test outdoors is an important method to diagnose asthma in children. However, the extent of how much exposure to pollens of outdoor air affects the results of the test is not known., Methods: We analyzed all reliable exercise challenge tests with impulse oscillometry in children (n = 799) between January 2012 and December 2014 in Tampere University Hospital. Pollen concentrations at the time of the test were collected from the register of Biodiversity Unit of the University of Turku. We compared the frequency of exercise-induced bronchoconstriction and pollen concentrations., Results: The analyses were restricted to birch and alder pollen as high counts of grass and mugwort pollen were so infrequent. The relative change in resistance at 5 Hz after exercise or the frequency of exercise-induced bronchoconstriction were not related to alder or birch pollen concentrations over 10 grains/m 3 (p = 0.125-0.398). In logistic regression analysis comparing the effects of alder or birch pollen concentrations, immunoglobulin E (IgE)-mediated alder or birch allergy and absolute humidity over 10 g/m 3 only absolute humidity was independently associated with change in airway resistance (odds ratio [OR]: 0.32, confidence interval [CI]: 0.13-0.67, p: 0.006)., Conclusions: In our large clinical sample, outdoor air pollen concentration was not associated with the probability of exercise-induced bronchoconstriction in free running test in children while low absolute humidity was the best predictor of airway obstruction., (© 2021 Wiley Periodicals LLC.)

Purpose: Relvar® (fluticasone furoate [FF]/vilanterol [VI]) is a once-daily inhaler with bronchodilator effect lasting 24 h. Our aim was to investigate the short- and long-term effects of FF/VI on exercise-induced asthma (EIA) in adolescents., Methods: Ninety-three adolescent asthmatics aged 12-18 years were referred for evaluation of EIA. Following a positive exercise challenge test (ECT), 22/44 were allocated to a single administration of salbutamol (400 μg) and 22/44 to FF/VI (92/22 μg) in a double-blind method. Thirty-five subjects were reassessed by repeat ECT 30-60 days of FF/VI., Results: Median FEV 1 change post-ECT at baseline was -22.8% predicted (interquartile range [IQR] -26.1 and -18.0) for salbutamol and -21.0 (IQR -30.7 and -16.8) for FF/VI. Following bronchodilator, FEV 1 improved similarly in both groups. Repeat ECT following 30-60 days of FF/VI resulted in negative ECT in 33/35 subjects; the median decrease in FEV 1 of these 35 subjects was 22.6% predicted (IQR 29-18) before, and 4.6% predicted (IQR 8.7-2.5) after 30-60 days of FF/VI treatment (p < 0.0001)., Conclusions: FF/VI is effective in reversing EIA after 15 min in adolescents and in protecting EIA after 30-60 days in adolescents. Larger studies are needed to assess the effect of FF/VI on EIA., (© 2021 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society). Published by John Wiley & Sons Ltd.)

Introduction: The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents., Material and Methods: We divided participants (aged 6-18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument., Results: We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV 1 z-score of -0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV 1 after the EIB test. We found a higher frequency of EIB in participants with FEV 1 z-score values of less than -1.0 compared to those with a z-score of -1.0 or greater (P = .05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (P = .41), with sensitivity of 42.1% and specificity of 57.1%., Conclusions: The item concerning physical activity in the GINA questionnaire has insufficient diagnostic power to detect EIB in children and adolescents with asthma., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Asthma is a chronic inflammatory lung disease affecting approximately 7.7% of the US population. Sex differences in the prevalence, incidence, and severity of asthma have been widely described throughout the lifespan, showing higher rates in boys than girls before puberty, but a reversed pattern in adults. Asthma is often associated with atopy, i.e. the tendency to develop allergic diseases, and can be worsened by environmental stimuli and/or exercise. While not exclusive to patients with asthma, exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. Currently, there is limited research on sex differences in EIB and its relationship with atopy and asthma in men and women. In this minireview, we summarize the available literature on this topic. Overall, the collective knowledge supports the notion that physiological changes triggered during exercise affect males and females differently, suggesting an interaction among sex, exercise, sex hormones, and atopic status in the course of EIB pathophysiology. Understanding these differences is important to provide personalized management plans to men and women who exercise regularly and suffer from underlying asthma and/or atopy.

Asthma leads to increased weight gain in nonpregnant populations, but studies have not examined this association within the context of pregnancy. The association between asthma and perinatal weight trajectories was examined in the Breathe-Wellbeing, Environment, Lifestyle, and Lung Function Study (2015-2019). Multilevel linear spline models were adjusted for age, race/ethnicity, income, marital status, education, cigarette smoking, parity, study site, and prepregnancy body mass index were used to examine differences in perinatal weight trajectories between women with (n = 299) and without (n = 101) asthma. Secondary analyses were conducted to assess whether associations differed by asthma phenotypes. At 40 weeks' gestation, women with asthma gained 16.2 kg (95% confidence interval (CI): 14.6, 17.7) and women without asthma gained 13.1 kg (95% CI: 10.9, 15.4). At 3 months postpartum, women with asthma retained 10.4 kg (95% CI: 8.9, 11.9) and women without asthma retained 8.0 kg (95% CI: 5.9, 10.2). Among women with asthma, exercise-induced asthma and step 3 asthma medications were associated with excess gestational weight gain. These study findings suggest women with asthma gain and retain more weight during pregnancy and postpartum than do women without asthma., (Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Asthma is a complex condition that affects 14% of the world's children and the approach to management includes both pharmacologic as well as non-pharmacologic strategies including attention to complex socioeconomic status phenomena. After an historical consideration of asthma, allergic and immunologic aspects of asthma in children and adolescents are presented. Concepts of socioeconomic aspects of asthma are considered along with environmental features and complications of asthma disparities. Also reviewed are links of asthma with mental health disorders, sleep disturbances and other comorbidities. A stepwise approach to asthma management is discussed that includes pharmacologic and non-pharmacologic strategies in the pediatric population. The role of immunotherapy and use of various immunomodulators are considered as well., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Exercise-induced wheeze (EIW) has been found to be associated with asthma-related urgent care in school-aged children. Despite asthma's high prevalence and morbidity among adolescents, this association has not been examined in adolescents. We tested the association of EIW and other asthma symptoms to asthma-related ED visits and hospitalizations in urban adolescents with probable asthma. We hypothesized that EIW would be associated with urgent care., Methods: In this cross-sectional study 30,467 high school students (mean age = 16.0) from 49 NYC schools completed two brief validated measures, one assessing probable asthma and the other the frequency of six asthma symptoms over the past year. Adolescents also reported if in the past year they had an asthma-related ED visit or hospitalization. Analyses presented here included students with probable asthma (n = 9149). Using logistic regression, we modeled each asthma symptom as a function of ED visits and hospitalizations adjusting for sex, age, race/ethnicity and asthma severity. Multivariable models included all symptoms to account for the potential interaction between symptoms., Results: Among adolescents with probable asthma, EIW was associated with ED visits and hospitalizations. In multivariable models wheeze without a cold, chest tightness, night wakening, but not EIW, were significantly associated with both ED visits and hospitalizations., Conclusions: Unlike findings with younger children, EIW does not appear to be associated with ED visits and hospitalizations among urban adolescents with probable asthma. Instead, symptoms, such as chest tightness and night wakening, appear to be important at identifying adolescents at risk for asthma-related urgent care., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: To determine changes in lung function following an acute bout of high intensity interval exercise (HIIE), moderate intensity interval exercise (MIIE), and moderate intensity continuous exercise (MICE) in adults with airway hyper-responsiveness (AHR)., Design: A randomized cross-over design was used., Methods: Participants completed five laboratory sessions: (1) eucapnic voluntary hyperpnea challenge (2) maximal exercise test to determine peak power output (PPO) and, (3-5) HIIE (90% PPO for 1min followed by 10% PPO for 1min, repeated 10 times), MIIE (65% PPO for 1min followed by 10% PPO for 1min, repeated 10 times) and MICE (65% PPO for 20min). Lung function was assessed pre and post-exercise., Results: Thirteen participants (age: 21.1±2.7years) with mild/moderate asthma completed all protocols. Lung function was significantly lower following the MICE (-14.8%±12.2) protocol compared to the HIIE (-7.1%±8.3) and MIIE (-4.5%±3.3)., Conclusions: It appears that MICE is associated with the greatest decline in post-exercise FEV 1 among those with AHR. Interval exercise may be better tolerated than continuous exercise among those with AHR., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Local airway water loss is the main physiological trigger for exercise-induced bronchoconstriction (EIB). Our aim was to investigate the effects of whole body water loss on airway responsiveness and pulmonary function in athletes with mild asthma and/or EIB. Ten recreational athletes with a medical diagnosis of mild asthma and/or EIB completed a randomized, crossover study. Pulmonary function tests, including spirometry, whole body plethysmography, and diffusing capacity of the lung for carbon monoxide (Dl CO ), were conducted before and after three conditions: 1 ) 2 h of exercise in the heat with no fluid intake (dehydration), 2 ) 2 h of exercise with ad libitum fluid intake (control), and 3 ) a time-matched rest period (rest). Airway responsiveness was assessed 2 h postexercise/rest via eucapnic voluntary hyperpnea (EVH) to dry air. Exercise in the heat with no fluid intake induced a state of mild dehydration, with a body mass loss of 2.3 ± 0.8% (SD). After EVH, airway narrowing was not different between conditions: median (interquartile range) maximum fall in forced expiratory volume in 1 s was 13 (7-15)%, 11 (9-24)%, and 12 (7-20)% in dehydration, control, and rest conditions, respectively. Dehydration caused a significant reduction in forced vital capacity (300 ± 190 ml, P = 0.001) and concomitant increases in residual volume (260 ± 180 ml, P = 0.001) and functional residual capacity (260 ± 250 ml, P = 0.011), with no change in Dl CO Mild exercise-induced dehydration does not exaggerate airway responsiveness to dry air in athletes with mild asthma/EIB but may affect small airway function. NEW & NOTEWORTHY This study is the first to investigate the effect of whole body dehydration on airway responsiveness. Our data suggest that the airway response to dry air hyperpnea in athletes with mild asthma and/or exercise-induced bronchoconstriction is not exacerbated in a state of mild dehydration. On the basis of alterations in lung volumes, however, exercise-induced dehydration appears to compromise small airway function., (Copyright © 2017 the American Physiological Society.)

Background: Children with asthma may be less physically active than their healthy peers. We aimed to investigate whether perceived exercise limitation (EL) was associated with lung function or bronchial hyper-responsiveness (BHR), socioeconomic factors, prenatal smoking, overweight, allergic disease, asthma severity, or physical activity (PA)., Methods: The 302 children with asthma from the 10-year examination of the Environment and Childhood Asthma birth cohort study underwent a clinical examination including perceived EL (structured interview of child and parent(s)), measure of overweight (body mass index by sex and age passing through 25 kg/m 2 or above at 18 years), exercise-induced bronchoconstriction (forced expiratory volume in one-second (FEV 1 ) pre- and post-exercise), methacholine bronchial challenge (severe BHR; provocative dose causing ≥20% decrease in FEV 1 ≤ 1 μmol), and asthma severity score (dose of controller medication and exacerbations last 12 months). Multivariate logistic regression analyses were conducted to assess associations with perceived EL., Results: In the final model explaining 30.1%, asthma severity score (OR: 1.49, (1.32, 1.67)) and overweight (OR: 2.35 (1.14, 4.82)) only were significantly associated with perceived EL. Excluding asthma severity and allergic disease, severe BHR (OR: 2.82 (1.38, 5.76)) or maximal reduction in FEV 1 post-exercise (OR: 1.48 (1.10, 1.98)) and overweight (OR: 2.15 (1.13, 4.08) and 2.53 (1.27, 5.03)) explained 9.7% and 8.4% of perceived EL, respectively., Conclusions: Perceived EL in children with asthma was independently associated with asthma severity and overweight, the latter doubling the probability of perceived EL irrespectively of asthma severity, allergy status, socioeconomic factors, prenatal smoking, or PA., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Exercise-induced respiratory symptoms are often reported by professional athletes, but asthma and allergy are underdiagnosed. Few studies used standardized questionnaires combined with clinical assessment to investigate asthma and allergy among athletes., Objectives: Assessment of the prevalence of allergy and asthma symptoms among Polish professional athletes and confronting it with clinical data., Methods: Two hundred twenty-two Olympic athletes participated in the project being part of the Global Allergy and Asthma European Network (GA(2) LEN) Olympic study. Allergy and asthma status was determined using Allergy Questionnaire for Athletes (AQUA), spirometry, reversibility test, methacholine challenge and skin prick testing. Final diagnosis was established by an allergist., Results: At least one exercise-induced asthma (EIA) symptom was reported by 28.4% athletes, and finally asthma diagnosis was established in 11.3% while only 5.9% of athletes had history of asthma. Reversibility test was positive in 36% of athletes finally diagnosed with asthma. Allergic rhinitis (AR) symptoms were reported by 27%, and the diagnosis was confirmed in 21% of athletes while only 9% had previously diagnosed AR. No significant differences in frequency of asthma and AR were observed between endurance and non-endurance athletes., Conclusions: High prevalence of exercise-induced respiratory symptoms among top athletes is not reflected by asthma diagnosis. As it was expected, our data confirm that - in diagnosis of EIA - lung function testing alone is not useful, whereas reversibility tests are of limited value., (© 2014 John Wiley & Sons Ltd.)

Rationale: Few studies have examined determinants of physical activity in patients with chronic illnesses, like asthma. The aim of this study was to examine whether baseline maternal and paternal beliefs, support and parenting were associated with changes in sport participation of adolescents with asthma, and investigate the moderating effect of sex., Methods: In a population-based cohort study, during home visits in 2012 and 2013, 253 adolescents completed a questionnaire assessing their sport participation. Both parents reported their sport-specific parenting (support, general and asthma-specific beliefs, self-efficacy to encourage sport participation). The collected data was described using descriptive statistics. Path and multi-group analyses were used to examine whether baseline parental factors predicted change in adolescent sport participation, multi-group analyses examined the moderating effect of sex. For all analyses probability p value less than the accepted level of significance α = 0.05 (p < 0.05) were taken as significant effects., Results: Few parental factors associated with changes in sport participation of the adolescents, sex did not moderate the associations. In the fully adjusted models, only maternal asthma-specific beliefs about sport participation were significantly positively associated with change in adolescent sport participation., Conclusion: Sport-specific parenting does not appear to be a determinant of sport participation in adolescents with asthma. Future research should consider other individual, social and environmental determinants to inform intervention development.

Background: Dysautonomia has been independently associated with training and exercise-induced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers., Methods: Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200™ Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD20 and pupillary parameters was investigated with Spearman's correlation test., Results: No statistically significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p<0.001), percentage of constriction (r = -0.59, p = 0.011) and latency (r = 0.490, p = 0.039)., Conclusions: No significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters, but among those with relevant AHR an association was found. Although limited by the sample size, these findings support the relation between dysautonomia and AHR in asthmatic swimmers., (Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

For more than a century, clinicians have attempted to subdivide asthma into different phenotypes based on triggers that cause asthma attacks, the course of the disease, or the prognosis. The first phenotypes that were described included allergic asthma, intrinsic or nonallergic asthma, infectious asthma, and aspirin-exacerbated asthma. These phenotypes are being reviewed elsewhere in this issue of the journal. The present article focuses on developing and emerging clinical asthma phenotypes. First, asthma phenotypes that are associated with environmental exposures (occupational agents, cigarette smoke, air pollution, cold dry air); second, asthma phenotypes that are associated with specific symptoms or clinical characteristics (cough, obesity, adult onset of disease); and third, asthma phenotypes that are based on biomarkers. This latter approach is the most promising because it attempts to identify asthma phenotypes with different underlying mechanisms so that therapies can be better targeted toward disease-specific features and disease outcomes can be improved., (Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Swimming produces many psychophysiological effects, including blood, hormonal, enzymatic, pulmonary, cardiovascular and energetic adaptations. However, asthma and allergies are becoming increasingly prevalent medical issues among elite endurance-trained swimmers, where exercise-induced asthma or bronchospasm is frequently reported. Heavy endurance swimming training, especially under adverse conditions, stresses the airway mucosa, leading to inflammatory changes, as observed in induced sputum in competitive swimmers. In addition, chlorine-based disinfectants (CBDs) are commonly used in indoor pools due to their effectiveness and lower relative cost. Many of these substances have carcinogenic and genotoxic properties, and exposure to DBPs have been linked to adverse respiratory effects. The association between long-term exposure to a chlorinated swimming pool and elevated serum sIgE levels suggests a link between allergens, chlorine exposure and the development of various pulmonary dysfunctions. Thus, the combination of intense and repeated physical endurance training over extended periods, along with suboptimal environmental conditions, may contribute to the development of rhinitis, asthma and bronchial hyperresponsiveness in athletes. While occasional or low-level exposure to chlorine might not be harmful, regular swimmers, especially those at competitive levels, are at a higher risk of developing respiratory disorders. Because these potential risks of exposure to CBDs must be balanced against the benefits of swimming and the risk of microbial infections in pools, we recommend better pool management and regular health checks for swimmers. Fortunately, the reduction of bronchial symptoms in swimmers who reduce training volume and intensity suggests that the negative effects on pulmonary function may be reversible. For these reasons, it is crucial to develop effective respiratory protection strategies, including medical interventions and modifications to the pool environment. Practical steps such as reducing chlorine use, ensuring proper hygiene before swimming and using swim caps can minimise risks. Research should also explore safer alternatives to CBDs, such as ozonation, and improved ventilation to reduce air pollutants. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMaterials and methodsResultsConclusionsIt is well-known that children who suffer from obesity and asthma may also have exercise-induced bronchospasm. Exhaled nitric oxide is an indicator of airway inflammation, and could be affected by exercise. This study looked at how exercise, which is a typical cause of acute airway obstruction, affects the levels of FeNO and spirometric parameters in obese and asthmatic children.Seventy children between the ages of 6 and 18 were divided into four groups: healthy children, obese children with asthma, obese children without asthma, and normal-weight asthmatic children. FeNO and spirometric parameters were assessed before and after exercise. Their heart rate was raised to 160–170 beats per minute by walking on a flat surface.The highest mean FeNO was seen in the asthmatic-obese group, while the lowest mean FeNO was found in the healthy group. MEF25–75 increased with exercise in the obese non-asthmatic group. FEV1/FVC was the lowest in the asthmatic-obese group.FeNO and FEV1/FVC have a strong association with asthma. The highest values of FeNO found in asthma-obesity combined. It was seen that obesity increased inflammation but exercise did not affect FeNO values. FeNO and FEV1 values were found to be higher in obese patients with and without asthma than normal weight and overweight asthmatics and non-asthmatics. [ABSTRACT FROM AUTHOR]

Background: Exercise-induced bronchoconstriction (EIB) is common in children with asthma but can be present also in children without asthma, especially athletes. Differential diagnosis includes several conditions such as exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history, clinical examination and specific tests are mandatory to exclude alternative diagnoses. Given the high prevalence of EIB in children and its potential impact on health, sport performance, and daily levels of physical activity, health care professionals should be aware of this condition and able to provide a specific work-up for its identification. The aims of the present study were: (a) to assess the agreement among hospital pediatricians and primary care pediatricians of Emilia-Romagna Region (Italy) about the management of EIB in children and (b) formulate statements in a consensus document to help clinicians in daily clinical practice. Methods: According to Delphi method, a panel of specialists scored 40 statements that were then revised and discussed during online meetings to reach full consensus. Statements were then formulated. Results: To obtain full consensus, the questionnaire was administered in two rounds after full discussion of the uncertain topics on the basis of the latest evidence on EIB published over the last 10 years. Despite an overall agreement on EIB management, some gaps emerged in the sections dedicated to diagnosis and treatment. Nine summary statements on definition, pathogenesis, diagnostic work-up, treatment, and follow-up were eventually formulated. Conclusions: This study describes the knowledge of EIB in a group of pediatricians and highlights gaps and uncertainties in diagnosis and treatment. The creation of statements shared by the specialists of the same area may improve the management of EIB in children. However, more research and evidence are needed to better clarify the best treatment and to standardize the best diagnostic protocol limiting useless examinations but at the same time assuring the best management. [ABSTRACT FROM AUTHOR]

AbstractObjective: Physical exercise in treatment of asthma is scarcely studied with no clear exercise guidelines for asthmatics. We aimed to investigate the associations between physical exercise frequency, systemic inflammation and asthma control. This has not been previously studied in adult-onset asthma.Methods: This study is part of Seinäjoki Adult Asthma Study (SAAS), where 203 patients with adult-onset asthma were evaluated in 2012–2013. Exercise frequency was recorded with a structured lifestyle questionnaire. Study population was divided into two categories by exercise frequency: Low-frequency group exercised ≤2 times/week and high frequency group >2 times/week. Blood inflammatory markers were measured and IL-6 > 1.55 pg/ml and hs-CRP > 4.12 mg/l indicated systemic inflammation.Results: High-exercise frequency group had lower levels of hs-CRP (p = 0.007), IL-6 (p = 0.015), suPAR (p = 0.008) and adipsin (p = 0.031) and higher levels of adiponectin (p = 0.010) than low-exercise frequency group. In logistic multivariate regression models, higher-exercise frequency lowered odds for elevated hs-CRP (OR = 0.37, 95% CI 0.15–0.94) and IL-6 levels (OR = 0.43, 95% CI 0.20–0.91), after adjusting for possible confounding factors. There was no difference in lung function tests, asthma control test or airways questionnaire 20 scores between the exercise frequency groups. However, differences were found in single symptom questions; high-exercise frequency group had less symptoms during light housework and laughing but experienced more limitation of activity in self-reports.Conclusions: Higher-exercise frequency is associated with lower level of systemic inflammation in patients with adult-onset asthma but no clear association was found to asthma outcomes. Exercise frequency may be associated with lesser amount of some individual asthma symptoms. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThe prevalence of asthma is increasing gradually worldwide. The pathophysiological process of asthma causes some alterations in the respiratory system and decreases oxygen-carbon dioxide exchange and respiration volume. These alterations may affect maximal exercise capacity, peripheral muscle strength, sleep quality, and disease-specific quality of life but have yet to be comprehensively investigated. To compare maximal exercise capacity, pulmonary function, peripheral muscle strength, dyspnea, sleep quality, and quality of life in adult patients with asthma, healthy controls were aimed.Forty-one adult stable asthmatic patients (GINA I–III) and 41 healthy subjects were compared. Exercise capacity (cardiopulmonary exercise test [CPET]), pulmonary function (spirometry), peripheral muscle strength (dynamometer), dyspnea (modified Medical Research Council [mMRC] dyspnea scale), quality of life (Asthma Quality of Life Questionnaire [AQLQ]) and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were evaluated.Peak VO2, VO2kg, MET, VE, HR, %VE, %HR, VCO2 parameters of CPET, FVC, FEV1, FEF25–75%, and FEV1/FVC and quadriceps femoris, shoulder abductors, and hand grip muscle strength were significantly decreased in patients with asthma (p < 0.05). MMRC dyspnea scale score was increased, and AQLQ and PSQI scores decreased in asthma patients (p < 0.05).Cardiac and pulmonary system responses to peak exercise worsened, and maximal exercise capacity and peripheral muscle strength decreased in adult patients with stable asthma. In addition, dyspnea during daily activities increases, and quality of life and sleep quality are impaired. A variety of exercise training that would benefit asthmatic patients’ outcomes should be investigated. [ABSTRACT FROM AUTHOR]

Previous studies based on animal models have raised concerns about salbutamol use in ozone air pollution with regard to ozone related lung injury. We conducted a double‐blind, randomized, placebo‐controlled crossover study including 18 subjects diagnosed with EIB by a eucapnic voluntary hyperpnea (EVH) test. Participants completed 30 min of standardized moderate to vigorous exercise in four conditions: ozone plus salbutamol; room air plus salbutamol; ozone plus placebo medication; and room air plus placebo medication. Spirometry, fraction of exhaled nitric oxide, and symptoms were measured before, immediately after, 30 min after and 1 h after exercise. Measurements between the four conditions were compared using percent change from pre to post exercise. There was a statistically significant difference between the salbutamol and placebo medication groups for spirometric variables including FEV1 (Estimate = 6.3, 95% CI: 4.23–8.37, p < 0.001). No differences were observed between ozone and room air exposures. There were no significant differences in FeNO response between experimental conditions. We found that salbutamol improved pulmonary function in individuals with EIB when exercising in ozone and did not increase eosinophilic airway inflammation as indicated by FeNO. This evidence suggests that it is safe for people with EIB to continue to use salbutamol as proscribed when ozone levels are elevated. [ABSTRACT FROM AUTHOR]

Exercise-induced bronchospasm (EIB) is a problem encountered by many people, and although it can be controlled, it is often overlooked or attributed to deconditioning. Children and elite athletes tend to have an increased incidence of EIB, but this condition is also encountered in others. Unfortunately, many who must deal with this disease tend to limit the level of exercise that provokes symptoms or avoid exercise altogether. EIB can occur alone or in association with underlying asthma. This article discusses EIB, its management, and strategies for nurses when caring for patients with EIB. [ABSTRACT FROM AUTHOR]

Asthma is one of the most prevalent chronic respiratory diseases in childhood and adolescence. It is characterized by inflammation and bronchial hyperreactivity, which trigger bronchoconstriction and airway obstructions. This condition represents a significant public health issue due to its impact on emergency services, hospitalizations, and school absenteeism. In Ecuador, previous studies have revealed a prevalence of asthma symptoms in adolescents but a low rate of diagnosis, suggesting possible underdiagnosis and insufficient control of the condition. Exercise-induced bronchoconstriction (EIB) is a common manifestation in patients with uncontrolled asthma and can be assessed through provocation tests, such as the Exercise-Induced Bronchial Provocation Test (EIBPT). This study aims to evaluate the bronchial response to the EIBPT in Ecuadorian children and adolescents to contribute to a better understanding of asthma in this population. This nonexperimental, descriptive, observational study was conducted on 25 students aged 8 to 17 years without a prior asthma diagnosis. Participants underwent the EIBPT on a treadmill. The criterion for a positive result was set at a decrease in VEF1 %, observed in only 4% of the 25 participants. The low prevalence of EIB in this sample suggests that, in Ecuadorian children and adolescents without a prior asthma diagnosis, exercise does not induce significant bronchoconstriction, ruling out the existence of an asthma underdiagnosis. [ABSTRACT FROM AUTHOR]

Winter sports athletes training are more predisposed to the development of asthma and exercise-induced bronchoconstriction (EIB) than athletes training in milder ambient conditions. An increased incidence of asthma symptoms has been demonstrated, among others, in competitive cross-country skiers. Winter sports training in an indoor ice rink also contributes to an increase in the occurrence of asthma and EIB symptoms and to the influx of inflammatory cells into the respiratory tract. Hyperventilation with dry, cold air may predispose to development of bronchospasm. The frequency of symptoms varies depending on the discipline trained. The latest research highlights the involvement of neurogenic (excessive stimulation of the vegetative system) and inflammatory component (increased number of eosinophils, T lymphocytes and mast cells) in the development of asthma symptoms in athletes. The air quality at the indoor ice rinks has been significantly deteriorating for a long time due to exhaust emissions (increase in NO2, CO and PM1 particles) from ice cleaning machines. Switching to electric devices has drastically reduced the amount of harmful particles. Despite the changes introduced, athletes training on indoor ice rinks are still a group predisposed to exerciseinduced bronchospasm. [ABSTRACT FROM AUTHOR]

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Exercise-induced bronchoconstriction (EIB) is a common condition among athletes, particularly those involved in endurance sports, and can significantly impact their performance and quality of life. The underlying mechanisms of EIB remain complex and are influenced by various factors, including airway cooling, dehydration, increased exposure to allergens and pollutants, and intense physical exertion. The inflammatory responses in the airways of athletes with asthma are often unique, with increased airway sensitivity and reactivity. Factors such as increased ventilation, pollutants, allergens, and airway remodeling contribute to the high incidence of EIB in athletes. The diagnosis of asthma and EIB relies on clinical symptoms, peak expiratory flow measurements, and bronchoprovocation tests, including exercise challenge testing and methacholine challenges. These methods help establish airway hyperresponsiveness and assess the severity of bronchoconstriction. Diagnosis can be complicated by the need for multiple tests, as symptoms and airway responsiveness may fluctuate with training intensity. Treatment and management strategies for EIB in athletes are multifaceted and include both pharmacological and non-pharmacological approaches. Non-pharmacological strategies emphasize asthma education, environmental control, and exercise modification. Pharmacological interventions commonly include inhaled glucocorticoids, β2-agonists, leukotriene modifiers, and mast cell stabilizers. These treatments aim to manage symptoms, improve lung function, and reduce the occurrence of bronchoconstriction. Successful management requires a coordinated approach, involving healthcare providers, sports medicine professionals, and coaches, to ensure proper diagnosis, treatment adherence, and the continued participation of athletes in their chosen sports.

Airway hyperresponsiveness, a key feature of asthma, is associated with exercise-induced asthma. Tezepelumab was reported to reduce airway hyperresponsiveness. Tezepelumab was confirmed through 3-dimensional bronchial tree visualization to be effective for exercise-induced asthma, reducing the need for a short-acting β2 agonist.

Aim: Exercise test outdoors is widely used to diagnose asthma in children, but it is unclear how much outdoor air factors affect the results. Methods: We analysed 321 outdoor exercise challenge tests with spirometry in children 6–16 years conducted due to suspicion of asthma or for assessing the effect of medication on asthma. We studied the association of FEV1 decrease and incidence of exercise‐induced bronchoconstriction (EIB) with temperature, relative humidity (RH) and absolute humidity (AH). Results: Asthma was diagnosed in 57% of the subjects. AH ≥5 g/m3, but not RH or temperature, was associated with the EIB incidence (p = 0.035). In multivariable logistic regression, AH ≥5 g/m3 was negatively associated (OR = 0.51, 95% CI [0.28─0.92], p = 0.026) while obstruction before exercise (OR = 2.11, 95% CI [1.16─3.86], p = 0.015) and IgE‐mediated sensitisation were positively associated with EIB (OR = 2.24, 95% CI [1.11─4.51], p = 0.025). AH (r = −0.12, p = 0.028) and temperature (r = −0.13, p = 0.023) correlated with decrease in FEV1. In multivariable linear regression, only AH was associated with FEV1 decrease (coefficient = −0.044, 95% CI [−0.085 to −0.004], p = 0.033). Conclusion: AH of outdoor air associates with occurrence and severity of EIB in outdoor exercise tests in children. Care should be taken when interpreting negative outdoor exercise test results if AH of air is high. [ABSTRACT FROM AUTHOR]

Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. "Osmotic theory" and "thermal or vascular theory" have been proposed. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. Treatment options include both pharmacological and behavioral approaches. Considering medications, the use of short-acting beta-agonists (SABA) just before exercise is the commonest option strategy, but daily inhaled corticosteroids (ICS) can also be considered, especially when EIB is not controlled with SABA only or when the patients practice physical activity very often. Among the behavioral approaches, warm-up before exercise, breathing through the nose or face mask, and avoiding polluted environments are all recommended strategies to reduce EIB risk. This review summarizes the latest evidence published over the last 10 years on the pathogenesis, diagnosis using spirometry and indirect bronchoprovocation tests, and treatment strategies, including SABA and ICS, of EIB. A specific focus has been placed on EIB management in young athletes, since this condition can not only prevent them from practicing regular physical activity but also competitive sports. [ABSTRACT FROM AUTHOR]

Aquatic exercises are among the types of exercise most tolerated by people with asthma. Therefore, the objective of this study was to synthesize the evidence on the effects of aquatic exercise on lung function and quality of life in asthmatic patients. A systematic search encompassing the Medline, CINAHL, Cochrane Library, Embase, AMED, SPORTDiscus, and Physiotherapy Evidence Database databases was conducted to identify randomized controlled trials assessing the impact of aquatic exercise in comparison to control conditions or land-based exercise on lung function and quality of life in individuals diagnosed with asthma. The stages of selection, data extraction and methodological evaluation, and level of evidence of the manuscripts were carried out independently by two authors. Ten studies, comprising a total of 393 participants, were incorporated into this systematic review. Very low-quality evidence was found in favor of aquatic exercise in asthmatic patients for forced expiratory volume in 1 s (MD: 0.20 L, 95% CI: 0.02 L–0.38L N: 91) and for forced vital capacity (MD: 0.32 L, 95% CI: 0.08 L–0.56L N: 80). No effect of aquatic exercise was observed on the FEV1/FVC ratio (MD:1.11L, 95% CI: −1.28 L–3.49L N:80) compared with control. Only one study evaluated the effect of aquatic exercise on patients' quality of life. Improvements in lung function and quality of life in asthmatic patients undergoing aquatic exercise are not supported by high-quality evidence. The present findings will need to be confirmed by new, methodologically more rigorous clinical trials. The effect of aquatic exercise on pulmonary function and quality of life in asthma patients is still uncertain. The current quality of evidence for aquatic exercise in asthma patients is low. There is an urgent need for higher-quality studies investigating the effects of aquatic exercise among asthma patients. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic respiratory disease in children. It has a serious impact on children's physical and mental health. Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory disease, whose major components include breathing training, inspiratory muscle training and exercise training. Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, the main components of which are breathing training, inspiratory muscle training and exercise training. Pulmonary rehabilitation can improve the physical and mental condition of patients with chronic respiratory diseases and promote healthy behaviors. However, there is little research on pulmonary rehabilitation in children with asthma. This review comprehensively evaluated the effect of pulmonary rehabilitation in children with asthma at home and abroad, aiming to provide reference for clinical research on pulmonary rehabilitation in children with asthma. [ABSTRACT FROM AUTHOR]

Objective: To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH). Materials and Methods: Cross‐sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise‐induced bronchospasm compatible response (EIB‐cr) and 24 asthmatics with EIB‐cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH. Results: Twenty‐four (52.1%) of asthmatics had EIB‐cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB‐cr compared to nonasthmatics in the rectus abdominis area (p < 0.05). Conclusion: There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB‐cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Respiratory, Critical Care, & Sleep Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses the prevalence of exercise-induced bronchoconstriction (EIB) in athletes, particularly in the context of the Paris 2024 Olympic Games. It highlights the importance of treating EIB with daily inhaled corticosteroids to inhibit its effects and potentially achieve remission. The text also explores the similarities between EIB and asthma, emphasizing the need for objective monitoring and optimal treatment to improve respiratory health in athletes. The discussion on achieving 'remission' in severe asthma patients and the potential long-term benefits of inhibiting EIB with daily corticosteroids adds depth to the understanding of airway diseases in elite athletes. [Extracted from the article]

Swimming is a widely practiced exercise in modern society, where there is a heightened interest in health. The exceptional benefits of swimming are well-known, yet the issue of water quality management inevitably arises due to its nature as an aquatic exercise. Several studies reported that chlorine disinfectants commonly used in swimming pool water disinfection could degrade into toxic disinfection by-products (DBPs) and suggested that the DBPs might induce respiratory disorders, including asthma. Conversely, there were also reports that the DBPs had no significant effects on respiratory conditions. In this study, we investigated the influence of swimming exercise and DBPs on asthma. The decomposition products had little effect on the number of T cells in various immune organs. However, swimming exercise was found to increase the cell count in proportion to the exercise duration. Nevertheless, there were no significant changes in other immune cells and the secretion of asthma-related cytokines. These findings indicate that the effects of swimming pool DBPs on respiratory conditions during swimming exercise are either negligible or absent, and instead, the immunological benefits gained through consistent swimming exercise outweigh any potential drawbacks. [ABSTRACT FROM AUTHOR]

Background: Asthma is a very common respiratory disorder, affecting more than 360 million people worldwide. It is a chronic inflammatory disorder of the airways with the symptoms of shortness of breath, coughing, chest tightness, wheezing, and sometimes chest pain. Leukotrienes play an important role in bronchoconstriction during the allergen or exercise-induced acute asthma attack. Aim: The study aims to predict the interactions between leukotriene antagonist drugs and CysLT receptor-1 (CysLTR1), P2Y12 and peroxisome proliferator-activated receptor gamma (PPAR-γ) on a competitive basis. The study also has the objective of understanding the cardioprotective roles of the drugs. Introduction: Asthma is strongly linked to the development of acute coronary syndrome by the leukotriene-induced activation of CysLTR1, platelet aggregation and thrombosis by activating P2Y12. PPAR-γ is considered to show benefits against atherosclerosis, diabetes, hypertension, obesity and dyslipidaemia, which are risk factors for the development of cardiovascular disorders. Leukotriene receptor inhibitors act with these three types of receptors to show therapeutic effects. Materials and Methods: To predict the possible interactions between the drugs and the receptors, the study has used in silico methods. Results and Discussion: Montelukast, Zafirlukast and Gemilukast are potential antagonists of CysLTR1 and P2Y12. They are also responsible for the upregulation of PPAR-γ. Thus, these drugs show a cardioprotective role in asthma-induced cardiac disorders. Conclusion: A competitive in silico study of Montelukast, Zafirlukast and Gemilukast to predict their binding to CysLTR1, P2Y12 & PPAR-γ revealed that Montelukast is more effective than the other two drugs for showing a cardioprotective role. [ABSTRACT FROM AUTHOR]

Asthma is a complex respiratory condition characterized by chronic airway inflammation and variable expiratory airflow limitation, affecting millions globally. Among athletes, particularly those competing at elite levels, the prevalence of respiratory conditions is notably heightened, varying between 20% and 70% across specific sports. Exercise-induced bronchoconstriction (EIB) is a common issue among athletes, impacting their performance and well-being. The prevalence rates vary based on the sport, training environment, and genetics. Exercise is a known trigger for asthma, but paradoxically, it can also improve pulmonary function and alleviate EIB severity. However, athletes' asthma phenotypes differ, leading to varied responses to medications and challenges in management. The unique aspects in athletes include heightened airway sensitivity, allergen, pollutant exposure, and temperature variations. This review addresses EIB in athletes, focusing on pathogenesis, diagnosis, and treatment. The pathogenesis of EIB involves complex interactions between physiological and environmental factors. Airway dehydration and cooling are key mechanisms, leading to osmotic and thermal theories. Airway inflammation and hyper-responsiveness are common factors. Elite athletes often exhibit distinct inflammatory responses and heightened airway sensitivity, influenced by sport type, training, and environment. Swimming and certain sports pose higher EIB risks, with chlorine exposure in pools being a notable factor. Immune responses, lung function changes, and individual variations contribute to EIB in athletes. Diagnosing EIB in athletes requires objective testing, as baseline lung function tests can yield normal results. Both EIB with asthma (EIBA) and without asthma (EIBwA) must be considered. Exercise and indirect bronchoprovocation tests provide reliable diagnoses. In athletes, exercise tests offer effectiveness in diagnosing EIB. Spirometry and bronchodilation tests are standard approaches, but the diagnostic emphasis is shifting toward provocation tests. Despite its challenges, achieving an optimal diagnosis of EIA constitutes the cornerstone for effective management, leading to improved performance, reduced risk of complications, and enhanced quality of life. The management of EIB in athletes aligns with the general principles for symptom control, prevention, and reducing complications. Non-pharmacological approaches, including trigger avoidance and warming up, are essential. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy in athletes. Short-acting beta agonists (SABA) are discouraged as sole treatments. Leukotriene receptor antagonists (LTRA) and mast cell stabilizing agents (MCSA) are potential options. Optimal management improves the athletes' quality of life and allows them to pursue competitive sports effectively. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence. [ABSTRACT FROM AUTHOR]

Athletes often experience lower airway dysfunction, such as asthma and exercise‐induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti‐doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti‐doping regulations. [ABSTRACT FROM AUTHOR]

Exercise‐induced bronchoconstriction (EIB) is usually assessed by changes in forced expiratory volume in 1 s (FEV1) which is effort dependent. The purpose of this study was to determine whether the diaphragm electromyogram (EMGdi) recorded from chest wall surface electrodes could be used to reflect changes in airway resistance during an exercise challenge test and to distinguish patients with EIB from those without EIB. Ninety participants with or without asthma history were included in the study. FEV1 was recorded before and 5, 10, 15, and 20 min after exercise. EIB was defined as an FEV1 decline greater than 10% after exercise. A ratio of root mean square of EMGdi to tidal volume (EMGdi/VT) was used to assess changes in airway resistance. Based on changes in FEV1, 25 of 90 participants exhibited EIB; the remainder were defined as non‐EIB participants. EMGdi/VT in EIB increased by 124% (19%–478%) which was significantly higher than that of 21% (−39% to 134%) in non‐EIB participants (p < 0.001). At the optimal cutoff point (54% in EMGdi/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.92 (p < 0.001) with sensitivity 92% and specificity 88%. EMGdi/VT can be used to assess changes in airway resistance after exercise and could be used to distinguish participants with EIB from those without EIB. [ABSTRACT FROM AUTHOR]

Combined exposure to the alarmins TSLP, IL-33 and IL-25 enhances mast cell-dependent contractions of human bronchi Keywords: airway hyperresponsiveness; anti-IgE; asthma; histamine; IL-33; prostaglandin D2; TSLP EN airway hyperresponsiveness anti-IgE asthma histamine IL-33 prostaglandin D2 TSLP 1062 1066 5 10/09/23 20231001 NES 231001 Key Messages Combined pretreatment with TSLP, IL-33 and IL-25 (epithelial alarmins) enhanced IgE-triggered contraction in isolated human bronchi. The release of histamine in response to IgE-mediated stimulation increased only in the alarmin mix pretreated group, indicating that, as shown for PGD SB 2, sb the alarmin mix enhanced the IgE-triggered release of histamine, presumably by increasing mast cell reactivity. Airway hyperresponsiveness, asthma, histamine, IL-33, anti-IgE, TSLP, prostaglandin D2. [Extracted from the article]

Exercise-induced bronchospasm (EIB) is a respiratory condition that causes temporary airflow obstruction during or after physical exercise. It is important to note that not everyone with EIB has asthma. Symptoms of EIB include difficulty breathing, coughing, wheezing, shortness of breath, and chest pain. The severity of bronchospasm depends on factors such as the air's ventilation, temperature, and humidity. Diagnosis of EIB can be done through challenge tests, and treatment options include preventive therapy and regular asthma treatment. It is crucial to differentiate EIB from other conditions like vocal cord dysfunction and gastroesophageal reflux disease (GERD). The article also discusses digestive symptoms associated with GERD, such as postprandial regurgitation and rumination syndrome. GERD can also cause respiratory disorders like otitis media, asthma, and chronic cough. The article provides information on non-pharmacological and pharmacological treatments for these conditions, including the use of short-acting ß2 agonists and leukotriene inhibitors. It emphasizes the importance of proper diagnosis and management, especially in athletes and teenagers who may be hesitant to use medication. [Extracted from the article]

Introduction: Exercise‐induced bronchoconstriction (EIB) is not only highly prevalent in people with asthma, but can also occur independently, particularly in athletes. Fractional exhaled nitric oxide (FeNO) is an indirect biomarker of type 2 airway inflammation that has an established role in the assessment and management of asthma. The aim was to evaluate the value of FeNO in the assessment of EIB in athletes. Method: Multicenter retrospective analysis. In total, 488 athletes (male: 76%) performed baseline FeNO, and spirometry pre‐ and post‐indirect bronchial provocation via eucapnic voluntary hyperpnea (EVH). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for established FeNO thresholds—that is, intermediate (≥25 ppb) and high FeNO (≥40 ppb and ≥ 50 ppb)—and were evaluated against objective evidence of EIB (≥10% fall in FEV1). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC‐AUC). Results: Thirty‐nine percent of the athletes had a post‐EVH fall in FEV1 consistent with EIB. FeNO values ≥25 ppb, ≥40 ppb, and ≥ 50 ppb were observed in 42%, 23%, and 17% of the cohort, respectively. The sensitivity of FeNO ≥25 ppb was 55%, which decreased to 37% and 27% at ≥40 ppb and ≥ 50 ppb, respectively. The specificity of FeNO ≥25 ppb, ≥40 ppb, and ≥ 50 ppb was 66%, 86%, and 89%, respectively. The ROC‐AUC for FeNO was 0.656. Conclusions: FeNO ≥40 ppb provides good specificity, that is, the ability to rule‐in a diagnosis of EIB. However, due to the poor sensitivity and predictive values, FeNO should not be employed as a replacement for indirect bronchial provocation in athletes. [ABSTRACT FROM AUTHOR]

Rationale: Indirect airway hyperresponsiveness (AHR) is a highly specific feature of asthma, but the underlying mechanisms responsible for driving indirect AHR remain incompletely understood. Objectives: To identify differences in gene expression in epithelial brushings obtained from individuals with asthma who were characterized for indirect AHR in the form of exercise-induced bronchoconstriction (EIB). Methods: RNA-sequencing analysis was performed on epithelial brushings obtained from individuals with asthma with EIB (n = 11) and without EIB (n = 9). Differentially expressed genes (DEGs) between the groups were correlated with measures of airway physiology, sputum inflammatory markers, and airway wall immunopathology. On the basis of these relationships, we examined the effects of primary airway epithelial cells (AECs) and specific epithelial cell–derived cytokines on both mast cells (MCs) and eosinophils (EOS). Measurements and Main Results: We identified 120 DEGs in individuals with and without EIB. Network analyses suggested critical roles for IL-33–, IL-18–, and IFN-γ–related signaling among these DEGs. IL1RL1 expression was positively correlated with the density of MCs in the epithelial compartment, and IL1RL1, IL18R1, and IFNG were positively correlated with the density of intraepithelial EOS. Subsequent ex vivo modeling demonstrated that AECs promote sustained type 2 (T2) inflammation in MCs and enhance IL-33–induced T2 gene expression. Furthermore, EOS increase the expression of IFNG and IL13 in response to both IL-18 and IL-33 as well as exposure to AECs. Conclusions: Circuits involving epithelial interactions with MCs and EOS are closely associated with indirect AHR. Ex vivo modeling indicates that epithelial-dependent regulation of these innate cells may be critical in indirect AHR and modulating T2 and non-T2 inflammation in asthma. [ABSTRACT FROM AUTHOR]

Longitudinal studies are needed to increase our knowledge of the natural history of asthma in athletes. Our aims were to estimate the incidence, remission, and relapse, of self‐reported asthma among endurance athletes. A postal questionnaire on self‐reported physician‐diagnosed asthma, asthma medication, allergy, and respiratory symptoms was sent annually 2011–2015 to 666 Swedish elite athletes competing in cross‐country skiing, biathlon, ski orienteering, or orienteering. Athletes at risk for (1) incident asthma were those without previous self‐reported asthma, use of asthma medication, or asthma‐like symptoms, (2) remission those who discontinued asthma medication usage and (3) relapse those who resumed asthma medication usage during the observation period. The population at risk was used as denominator in the calculations of subsequent event rate. At baseline, 89% responded, the median age was 17 years and 47% were females. Of the 373 athletes with never asthma nor use of asthma medication/asthma‐like symptoms at baseline, 31 (8%) reported physician‐diagnosed asthma during follow‐up, giving an adjusted incidence rate of asthma of 42/1000 person years. Among the 110 athletes with self‐reported asthma and use of asthma medication at baseline, 26 (24%) discontinued use of asthma medication during the follow‐up, giving a remission rate of 142/1000 person years. Of the 31 athletes with previous asthma and no use of asthma medication at baseline, 9 (29%) resumed use of asthma medication during follow‐up, giving a relapse rate was 148/1000 person years. Elite endurance athletes have a high incidence of self‐reported physician‐diagnosed asthma. The remission and relapse of self‐reported asthma medication usage in endurance athletes appear similar to that of the general population. [ABSTRACT FROM AUTHOR]

Moderate evidence exists for pulmonary rehabilitation improving quality of life and functional exercise capacity. For example, asthmatic patients who are obese have improved asthma control symptoms through exercise training in conjunction with weight-loss programmes[7] or older patients are more likely to engage with programmes during working hours. A feasibility study of a randomized controlled trial of asthma-tailored pulmonary rehabilitation compared with usual Care in Adults with severe asthma. [Extracted from the article]