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VO2 max is a measure of athletic performance and is generally considered an excellent health parameter for athletic performance testing. Various methods are used to generate such a result generally using a treadmill or cycle ergometer. Improvements have been shown through training. The upper limit of such improvement has been difficult to find in the literature in part because testing often starts with individuals already at a superior level of performance. As genetics may play a significant role in an individual's VO2 max, training can only contribute a portion of the result. Humans have a range of maximal oxygen utilization with upper limits approaching 100 mL/kg. This case report demonstrates a 96% improvement over time secondary to selective intense training. The intent was to document objectively amelioration of the VO2 max using a defined protocol on standardized testing equipment. This may lead to more efficient training of individuals desiring performance improvement.

Background Diagnosing Airway hyper-responsiveness (AHR) requires bronchial provocation tests that are performed at rest and after exercise or hyperventilation in either a lab or field setting. Presently, it is unclear whether the proposed AHR field test for swimming induces sufficient provocation due to lack of intensity. Thus we aimed to examine how the 8 minute field swim test compared to all out racing and a lower intensity practice exposure affected AHR. We hypothesized that the race would affect AHR the most thereby highlighting the importance of maximal effort in swim AHR. Methods 10 female and 15 male swimmers completed three conditions (sanctioned race of different distances, 8 min field swim challenge and swim practice). Forced vital capacity (FVC), forced expired volume in 1 second (FEV1) and forced expiratory flow (FEF25-75) were measured at rest and after each exercise condition (at 6 and 10 min) in accordance with standard protocols. AHR was defined as a decrease in FEV1 of ≥10% post exercise. Results A significant increase in FEV1 and FEF25-75 was observed for both post swim field test and post-race. The practice condition reduced FEV1 in 44% of swimmers although the magnitude of change was small. There was a wide variability in the individual responses to the 3 conditions and AHR was diagnosed in one swimmer (race condition). Conclusion All conditions have poor sensitivity to diagnose EIB and total accumulated ventilation (distance swum) did not influence AHR. These results also indicate that elite swimmers, despite many risk factors, are not limited by respiratory function in race conditions. It is proposed that the swim field test not be used for AHR assessment in swimmers due to too high relative humidity.

Pediatric asthma is one of the most common chronic diseases in childhood. Symptoms, such as chest tightness, shortness of breath, coughing and wheezing, make it difficult for asthmatic children to keep up with their peers during sports and play. Healthy children recover quickly to baseline heart and respiratory rate after exercise. This physiological mechanism enables them to perform their typical frequent but short bursts of intense activity. In children with exercise induced bronchoconstriction the recovery of respiratory rate after exercise may be slower, as bronchoconstriction compromises ventilation. Therefore, this research focused on assessing the respiratory rate recovery time (RRRT) of asthmatic children in both the home setting and during the controlled setting of the exercise challenge test (ECT).

Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine. publishedVersion

Methacholine and histamine can lead to inspiratory flow limitation in asthmatic children and adults. This has not been analyzed after indirect airway stimuli, such as exercise. The aim of the study was to analyze airflow limitation after exercise in cold, dry air. 72 asthmatic children with mild to moderate asthma (mean age 13.2 +/- 2.2 yrs) performed a treadmill exercise challenge. A fall of >10% in FEV1 was the threshold for expiratory flow limitation and a fall of >25% of MIF50 was the threshold for inspiratory flow limitation. The occurrence of wheeze, stridor and cough were quantified before and after exercise. After exercise, the mean fall in FEV1 was 17.7 +/- 14.6%, while the mean fall in MIF50 was 25.4 +/- 15.8%; no correlation was found between fall in FEV1 and MIF50 (R-2: 0.04; p = 0.717). 53 of the 72 children showed an inspiratory and/or expiratory airflow limitation. 38% (20/53) of these children showed an isolated expiratory flow limitation, 45% (24/53) showed both expiratory and inspiratory flow limitation and 17% (9/53) showed an isolated inspiratory flow limitation. The fall in FEV1 peaked 9 min after exercise and correlated to expiratory wheeze. The fall in MIF50 peaked 15 min after exercise and correlated to inspiratory stridor. The time difference in peak fall between FEV1 and MIF50 was statistically significant (5.9 min; p

Background Asthma is the most common chronic diseases in school-aged children in Japan. It is important to consider health-related quality of life (QoL) among children with chronic diseases when treatment decisions are made. Methods A school-based survey was conducted in randomly selected public schools in Tokyo by using a KINDL® questionnaire for evaluating QoL and the international study of asthma and allergy on childhood (ISAAC) questionnaire, which is designed for comparing the asthma prevalence in various countries, from May to June in 2005. We recruited approximately 10% of the total children 6–7-years-old and 13–14-years-old living in Tokyo for sampling. Results Response rate of this questionnaire was 86% (22,645 children) in the 6–7-year-old group and 64% (12,879 children) in the 13–14-year-old group. Comparing asthmatics with non-asthmatics in the same age, QoL of children with asthma was significantly impaired. The severity of QoL of children with asthma was significantly impaired. QoL of children with exercise-induced asthma (EIA) were more significantly impaired than ones without EIA and showed lower scores in the categories of physical functioning, emotional and school activities than those without EIA. Of note, QoL was more impaired in the EIA-positive group among severe asthmatics, suggesting that QoL of children with even severe asthma could be improved when EIA is appropriately controlled. Conclusions Existence of EIA among asthmatic children most strongly impairs their QoL. We should be more cautious about the management of EIA.

Rationale Allergic rhinitis and exercise induced bronchoconstriction (EIB) are common in asthmatic children. The aim of this study was to investigate whether treatment of allergic rhinitis with an intranasal corticosteroid protects against EIB in asthmatic children. Methods: This was a double-blind, randomized, placebo-controlled, parallel group study. Subjects aged 12-17 years, with mild-to-moderate asthma, intermittent allergic rhinitis and >= 10% fall in FEV1 at a screening exercise challenge were randomized to 22 +/- 3 days treatment with intranasal fluticasone furoate or placebo. The primary outcome was change in exercise induced fall in FEV1. Secondary outcomes were changes in the area under the curve (AUC), asthma control questionnaire (ACQ), pediatric asthma quality of life questionnaire (PAQLQ), and exhaled nitric oxide (FeNO). Results: Twenty-five children completed the study. Mean exercise induced fall in FEV1 (+/- SD) decreased significantly (95% CI: 0.7-18.2%, P = 0.04) in the fluticasone furoate group from 28.4 +/- 15.8% to 19.0 +/- 13.8%, compared to the placebo group (27.4 +/- 16.0% to 27.4 +/- 19.2%). The change in AUC was not significantly different between treatment groups. However, within the fluticasone furoate group the AUC decreased significantly (P = 0.01). Although total PAQLQ score did not improve, the activity limitation domain score improved significantly within the fluticasone furoate group (P = 0.03). No significant changes were observed in FeNO and ACQ. Conclusion: Treatment of allergic rhinitis in asthmatic children with an intranasal corticosteroid reduces EIB and tends to improve quality of life. Pediatr Pulmonol. 2012; 47: 27-35. (C) 2011 Wiley Periodicals, Inc.

Summary Background Exercise induced asthma may symptomatically be difficult to differentiate from exercise related obstruction in the upper airways, sometimes leading to diagnostic confusion and inappropriate treatment. Larynx accounts for a significant fraction of total airway resistance, but its role as a limiting factor for airflow during exercise has been hampered by lack of diagnostic tools. We aimed to study laryngeal function in exercising humans by transnasal laryngoscopy. Methods Continuous video recording of the larynx was performed in parallel with continuous film recording of the upper part of the body and recording of breath sounds in subjects running to respiratory distress or exhaustion on a treadmill. Results A successful examination was obtained in 20 asymptomatic volunteers and 151 (91%) of 166 young patients with a history of inspiratory distress or stridor during exercise. At rest, six patients had abnormal laryngeal findings. During exercise, a moderate or severe adduction of laryngeal structures was observed in parallel with increasing inspiratory distress in 113 (75%) patients. In 109 of these, adduction started within supraglottic structures, followed by adduction of the vocal cords in 88. In four patients, laryngeal adduction started in the vocal cords, involving supraglottic structures secondarily in three. Conclusion Larynx can safely be studied throughout a maximum intensity exercise treadmill test. A characteristic laryngeal response pattern to exercise was visualised in a large proportion of patients with suspected upper airway obstruction. Laryngoscopy during ongoing symptoms is recommended for proper assessment of these patients.