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Asthma is a chronic inflammatory disorder characterized by airflow obstruction. The development of leukotriene receptor antagonists and synthesis inhibitors in briefly described; and acute exercise, allergen, and aspirin challenge, studies with these agents are reviewed. Clinical studies with leukotriene antagonists and inhibitors have confirmed the central role leukotrienes of in asthma. The new generation of leukotriene receptor antagonist may be suitable as first-line therapy in patients with mild to moderate asthma. 23 3 305 312

Introduction: Exercise-induced bronchial obstruction is one of the most important features in the asthmatics. Simultaneously induced nasal obstruction is less frequent phenomenon. Patient: 16-year-old female has suffered asthmatic symptoms (episodic breathlessness, wheezing, chest tightness and cough) and rhinitic symptoms (nasal obstruction, sneezing, rhinorrhea) since early childhood. Symptoms are present during winter and spring, worsened at night and provoked by exercise. Sometimes she can not perform school gymnastics. Recently she reported symptoms of conjuctivitis. Because of moderately persistant asthma she was receiving salmeterol and fluticasone inhalation twice a day. SPT: positive for dust mites Dermatophagoides pteronyssinus (DP), Dermatophagoides farinae (DF), Lepidoglyphus destructor (LD), Tyrophagus putrescientiae (TP) and grass pollen. Specific IgE: increased for Dactylis glom (class 4), DP, DF, LD (class 3), and TP (class 2). Lung function tests: FVC and FEV1 within normal values, MEF50 and MEF25. bellow 40% of reference values. Non-specific bronchial reactivity to histamine: PC20FEV1 = 0.125 mg/mL. Exercise challenge test (EC): Without salmeterol for 12 hours before EC. Maximal expiratory flow-volume curve (MEFV) and nasal patency (Rocc) were measured by Flowscreen (Jaeger, Germany). Baseline FEV1 was 2, 64 L/s (85% reference values), baseline Rocc was 0, 63 kPa*s/L (121% reference values). Submaximal incremental EC on treadmill was performed. FEV1 and Rocc were measured immediately after the exercise and at 3, 5, 7, 10, 15, 20 and 30 min after cessation of exercise. The peak decrease in FEV1 (26% of baseline value) developed 3 min after EC and peak increase in Rocc (250% of baseline value) developed 20 min after EC. These changes spontaneously returned to normal after 30 min. She also reported breathlessness, watery rhinorrhea, sneezing and nasal obstruction. Conclusion: Exercise can induce bronchial and nasal obstruction, suggesting the unique response of the respiratory system to EC. Therefore in patient with asthmatic and rhinitic symptoms we recommend measurements of bronchial and nasal patency.

Objetivo: Verificar a ocorrência de broncoconstrição induzida por exercício e verificar a resposta cardiorrespiratória durante o exercício máximo em pacientes asmáticos. Pacientes e métodos: Quatorze asmáticos (VEF1 basal de 86,3%), conforme os critérios da American Thoracic Society, foram submetidos a teste de exercício máximo. Foram realizadas curvas fluxo-volume antes, sete e 15 minutos após esforço progressivo máximo. Seis indivíduos (43%) apresentaram queda do VEF1 igual ou maior que 15% após esforço máximo (grupo I). Os demais constituíram o grupo II. No grupo I, observou-se redução no VEF1 de 40,9% e 26,7% sete e 15min após o exercício, enquanto no grupo II ocorreu diminuição de 2,6% e aumento de 1,2%. No pico do exercício, os dois grupos atingiram FCmax acima de 91% do valor de referência; a carga máxima foi de 82,7% e 62,5%, o O2max (mL/kg/min) de 93,5% e 58,9% e a VEmax de 91,5% e 63,8%, respectivamente, nos grupos I e II. Essas diferenças foram estatisticamente significativas. A correlação da queda percentual do VEF1 (7min pós-exercício) com a VEmax (%predito) mostrou um coeficiente r = 0,8989 para o grupo I e um r = 0,3629 para o grupo II. Não se observou correlação estatisticamente significativa entre o delta VEF1 e o O2max (% predito). Conclusão: Nos pacientes com asma induzida pelo exercício, a ocorrência de broncoconstrição correlacionou-se com o nível de ventilação máxima, mas não com a aptidão física (O2 máximo). Objective: To determine the occurrence of exercise-induced bronchoconstriction and analyze cardiorespiratory response during maximal exercise in asthmatic patients. Patients and methods: Fourteen subjects with asthma (FEV1 of 86.3% predicted), as defined by the American Thoracic Society criteria were submitted to a maximal exercise test. Volume-flow curves were performed prior to progressive maximal exercise and seven and 15 minutes after it. Six patients (43%) showed a decline in FEV1 equal or greater than 15% after exercise (group I). The remaining patients constituted group II. Group I showed a FEV1 fall of 40.9% and 26.7%, seven and 15 minutes after exercise, respectively. In group II, there was a decrease of 2.6%, after 7 min and an increase of 1.2% after 15 min. At peak exercise, both groups reached heart rate above 91% of reference values; peak work was 82.7% and 62.5%, O2max (mL/kg/min) 93.5% and 58,9% and VEmax 91.5% and 63.8%, respectively, in groups I and II. These differences were statistically significant. The correlation between the FEV1 fall rate (7 min post-exercise) and VEmax (% predicted) has showed a coefficient r = 0.8989 in group I and r = 0.3629 in group II. There was no correlation between delta VEF1 and O2max (% predicted) in both groups. These findings showed that, in exercise-induced asthma patients, the occurrence of bronchoconstriction correlated with the level of maximal ventilation, but not with physical fitness (O2max).

Since asthma is the most common chronic illness in childhood, many of the problems associated with this condition will impact on the child's education. Because of widespread concerns regarding the management of asthma in schools, a subcommittee of the Thoracic Society of Australia and New Zealand, Asthma Special Interest Group, was convened to draw up national guidelines for school staff in order to provide optimal management of asthma in the school setting. We used current medical literature and the clinical experience of the authors who have dealt with children and adolescents suffering from asthma in the hospital, community and school environment. A number of issues had been identified, including: the availability of an asthma first aid kit; correct use of bronchodilator aerosols by puffer and spacer devices; and clear instructions as to when to notify parents and when to call an ambulance to the school. To provide optimal care of asthma in the school setting, the committee made the following recommendations: (i) improved guidance and training of school teachers and ancillary staff in appropriate asthma care; (ii) improved recognition by schools of those students with asthma; (iii) schools should encourage a policy of exercise for all students with asthma; (iv) asthma medication should be readily available at all times to those students with asthma; (v) the safety of school excursions and school camps should be improved by having available personnel competent in acute asthma management; a mobile asthma first aid kit: and by ensuring the student continues taking their usual asthma medications throughout the excursion; (vi) the early introduction of a 'lung health' education programme for all students, with particular emphasis on asthma being encouraged. We believe that asthma management in schools would be optimized if this national policy were adopted throughout Australian schools.