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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]

Introduction: Apart from pharmacological treatment, non-pharmacological strategies including physical activity play a significant role in the management of asthma. The aim of this paper is to examine various topics related to swimming and asthma. They include the detailed effect of swimming on asthma control,the potential role of swimming in early childhood asthma development, exercise induced asthma in swimmers as well as the relationship between asthma and cold water swimming. Review methods: This article is based on the literature found in the PubMed Database from the period of 1971-2024 with the use of keywords such as “asthma”, “swimming”, “cold water swimming”, “exercise induced asthma”, “childhood asthma” Description of the state of knowledge: Swimming is a safe form of physical activity for asthma patients.Swimming training enhances aerobic capacity, reduces exercise-induced bronchoconstriction and improves lung function in both pediatric and adult patients. However, there is a concern regarding indoor swimming pools that chlorine can potentially induce airway inflammation. There is research suggesting that early life swimming pool exposure may contribute to the asthma development in atopic children. There is some premise to the thought that cold water swimming may help alleviate asthma symptoms, but it also carries many risks.Swimming is a major cause of exercise induced asthma in professional athletes. Conclusions: Alongside appropriate pharmacological treatment, swimming is a valuable strategy in asthma management in both pediatric and adult asthma patients. The risks of chlorinating pools are still not known to outweigh the benefits of swimming for asthmatics. Further research should be carried out on safety of early swimming in atopic children. Cold water swimming should also be evaluated in terms of safety and potential benefits for asthma patients.

Background: There is increasing evidence linking infant rhinorrhea to school-age exercise-induced wheeze (EIW) via a parasympathetic nervous system pathway. The ratio of the root mean square of successive differences in heart beats (RMSSD) measured in quiet sleep versus active sleep (RMSSDQS:AS) is a novel biomarker in asthma. Objective: We tested the hypotheses that (1) neonatal rhinorrhea predicts childhood EIW independent of other neonatal respiratory symptoms, (2) neonatal RMSSDQS:AS predicts childhood EIW, and (3) RMSSDQS:AS mediates the association between neonatal rhinorrhea and childhood EIW. Methods: Participants from the Safe Passage/Environmental Influences on Child Health Outcomes (PASS/ECHO) prospective birth cohort had heart rate variability extracted from electrocardiogram traces acquired in the first month of life. Parents reported on rhinorrhea in their child at age 1 month and on EIW in their child at ages 4 to 11 years. Results: In models (N = 831) adjusted for potential confounders and covariates, including neonatal wheeze, cough and fever, neonatal rhinorrhea–predicted childhood EIW (relative risk [RR] = 2.22; P = .040), specifically, among females (RR = 3.38; P = .018) but not males (RR = 1.39; P = .61). Among participants contributing data in both active and quiet sleep (n = 231), RMSSDQS:AS predicted EIW (RR = 2.36; P = .003) and mediated the effect estimate of neonatal rhinorrhea predicting EIW among females. Half of the females with a higher RMSSDQS:AS and neonatal rhinorrhea (n = 5 of 10) developed EIW as compared with 1.8% of the other females (n = 2 of 109) (P < .001). Conclusions: Our findings support dysregulation of the parasympathetic nervous system in infancy as one of the possible underlying mechanisms for the development of EIW later in childhood among females, which could aid in the development of future interventions.

Asthma is a complex medical problem for which currently available treatment can be incompletely effective. This case report describes a 49 year old woman who had suffered from asthma since her teenage years that resolved after she took up regular open water swimming. After sharing this case report with an international open water swimming community on social media, over one hundred people with asthma commented that their symptoms had also improved after taking up this activity. The mechanism whereby open water swimming might alleviate asthma has not been established. Possibilities include benefits to mental health, anti-inflammatory effects, being more fit, improved immune function and suppression of the bronchoconstrictive component of the diving reflex. Further research might usefully confirm or refute these clinical observations.

Exercise-induced bronchoconstriction (EIB) is a transient airflow obstruction, typically 5–15 min after physical activity. The pathophysiology of EIB is related to the thermal and osmotic changes of the bronchial mucosa, which cause the release of mediators and the development of bronchoconstriction in the airways. EIB in children often causes an important limitation to physical activities and sports. However, by taking appropriate precautions and through adequate pharmacological control of the condition, routine exercise is extremely safe in children. This review aims to raise awareness of EIB by proposing an update, based on the latest studies, on pathological mechanisms, diagnosis, and therapeutic approaches in children.

Airway hyperresponsiveness (AHR) is a characteristic feature of bronchial asthma and is diagnosed using direct and indirect bronchoprovocation tests. The diagnosis of AHR is a challenge in symptomatic patients with a normal baseline prebronchodilator spirometry and postbronchodilator spirometry. Exercise-induced asthma or exercise-induced bronchoconstriction (EIB) is a distinct form of AHR. There is no single test that is sufficient to exclude AHR in symptomatic military personnel with normal spirometry. This study was conducted to compare the diagnostic value of indirect bronchoprovocation test using inhaled adenosine monophosphate (AMP) and exercise challenge test (ECT) in the diagnosis of EIB. A crossover study was conducted with consecutive sampling of patients presenting with symptoms suggestive of asthma and with normal spirometry results who were subjected to both ECT and bronchoprovocation test using inhaled AMP on separate days. Forty participants were recruited (the mean age: 25 yrs, 100% male). The commonest presentation was breathlessness on exercise (55%). With exercise alone, 40% tested positive for AHR, while with AMP alone, the positivity increased to 53%, and the difference was statistically significant (p= 0.03). Exercise alone failed to detect 8 cases that tested positive for AHR by inhaled AMP challenge. Indirect bronchoprovocation test using inhaled AMP may be used to diagnose AHR in conditions in which exercise challenge testing is not available or the patient is unable to complete ECT. [ABSTRACT FROM AUTHOR]

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.

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 postrace. 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence linking infant rhinorrhea to school-age exercise-induced wheeze (EIW) via a parasympathetic nervous system pathway. The ratio of the root mean square of successive differences in heart beats (RMSSD) measured in quiet sleep versus active sleep (RMSSD QS:AS ) is a novel biomarker in asthma., Objective: We tested the hypotheses that (1) neonatal rhinorrhea predicts childhood EIW independent of other neonatal respiratory symptoms, (2) neonatal RMSSD QS:AS predicts childhood EIW, and (3) RMSSD QS:AS mediates the association between neonatal rhinorrhea and childhood EIW., Methods: Participants from the Safe Passage/Environmental Influences on Child Health Outcomes (PASS/ECHO) prospective birth cohort had heart rate variability extracted from electrocardiogram traces acquired in the first month of life. Parents reported on rhinorrhea in their child at age 1 month and on EIW in their child at ages 4 to 11 years., Results: In models (N = 831) adjusted for potential confounders and covariates, including neonatal wheeze, cough and fever, neonatal rhinorrhea-predicted childhood EIW (relative risk [RR] = 2.22; P  = .040), specifically, among females (RR = 3.38; P  = .018) but not males (RR = 1.39; P  = .61). Among participants contributing data in both active and quiet sleep (n = 231), RMSSD QS:AS predicted EIW (RR = 2.36; P  = .003) and mediated the effect estimate of neonatal rhinorrhea predicting EIW among females. Half of the females with a higher RMSSD QS:AS and neonatal rhinorrhea (n = 5 of 10) developed EIW as compared with 1.8% of the other females (n = 2 of 109) ( P  < .001)., Conclusions: Our findings support dysregulation of the parasympathetic nervous system in infancy as one of the possible underlying mechanisms for the development of EIW later in childhood among females, which could aid in the development of future interventions., (© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.)

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.

Summary Exercise-induced asthma is seen following vigorous or prolonged exercise or physical exertion. It has been suggested that climatic conditions have an influence on exercise-induced asthma. Therefore, the aim of the present study was to examine the effect of two climatic conditions on exercise-induced deterioration of pulmonary function tests in 10–12 year old students. Two hundred and fifty six students were randomly chosen from two cities namely Kerman and Gorgan (128 subjects in each who were equally from both cities) including 62 girls and 66 boys of 10–12 years old. A questionnaire was used to obtain demographic information and to identify the prevalence of asthma symptoms. Each subject performed a seven-minute free run exercise with maximum effort and sufficient motivation until they reached 70–75% heart rate. Pulmonary function tests (PFT) including, forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), peak expiratory flow (PEF), and maximum expiratory flow at 50% of vital capacity (MEF 50 ) were measured before, at the beginning, and 7 and 20 min after physical activity. The prevalence of both asthma (28.12%) and exercise-induced asthma (20.31%) in Kerman students was higher than those of Gorgan students (21.09% and 17%, respectively). All PFT values declined 7 and 20 min post-exercise in both groups. Although all baselines PFT in Kerman students were higher than those of Gorgan students, the decline in PFT values in Kerman students was greater than those of Gorgan students. At 20 min post exercise, the decline in FEV 1 , PEF and MEF 50 in Kerman students was significantly higher than those of Gorgan students (p < 0.05 to p < 0.01). The results of the present study showed that prevalence of both asthma and exercise-induced asthma in a city with dry and cool climate such as Kerman was higher than in a city with humid climate such as Gorgan. In addition, the results showed that in a humid climate, post-exercise decline in PFT values was less than in a dry climate. [ABSTRACT FROM AUTHOR]

Zusammenfassung Belastungsinduzierte asthmatische Symptome und Asthma werden häufig bei hochtrainierten Athleten diagnostiziert. Ein belastungsinduziertes Asthma (EIA) und eine belastungsinduzierte Bronchokonstriktion (EIB) treten, je nach Sportart, in 15-45% aller Hochleistungssportler auf. Das EIA tritt nicht selten auch zusammen mit einer Vocal Cord Dysfunktion (VCD) in Erscheinung, die auch eigenständig als Differentialdiagnose in Betracht gezogen werden muss. Die Therapie basiert auf antiinflammatorischer Medikation (inhalative Glukokortikosteroide) und inhalativen Bronchodilatatoren (z.B. ß2-Agonisten). Im Allgemeinen dürfen, gemäß der Verbotsliste der Welt-Anti-Doping-Agentur (WADA), ß2-Agonisten bei Sportlern nicht zur Anwendung gelangen. Allerdings enthält die WADA-Liste spezifische ß2-agonistische Substanzen, die zur inhalativen Therapie verwendet werden dürfen. Summary Exercise induced asthma- like symptoms and asthma are frequently seen in highly trained athletes. Exercise induced asthma (EIA) and exercise induced bronchoconstriction (EIB) are estimated to be found in 15-45% of elite athletes. EIA is often experienced concurrently with vocal cord dysfunction (VCD), which needs to be considered as a differential diagnosis, in combination as well as a stand-alone diagnosis. The therapy is based on anti-inflammatory drugs (e.g. inhaled glucocorticosteroids) and inhaled bronchodilators (e.g. ß2-agonists). Generally, athletes may not use ß2-agonists according to the Prohibited List of the World Anti-Doping Agency (WADA). However, the WADA-List contains specific ß2-agonistic substances which are permitted to be used by inhalation. [ABSTRACT FROM AUTHOR]

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The prevalence of exercise induced asthma (EIA) in Iran is not known. In the present study the prevalence of EIA among female students of guidance school in the city of Mashhad was evaluated. A total of 1690 female students aged 12-14 years in ten randomly selected schools in north east of Iran (Mashhad) completed an asthma symptoms- specific questionnaire. One hundred forty four randomly selected students including 49 symptomatic and 95 asymptomatic cases participated in a 6 minutes free run test (until reaching 70-75% of MHR (maximum heart rate) for evaluating EIA. Pulmonary function tests (PFT) were measured before (baseline), immediately, 5 minutes and 15 minutes after exercise. The prevalence of asthma symptoms among the studied students was 12.54%. There was not significant difference in any of PFT values between asymptomatic and symptomatic students. The results of exercise test showed that totally 61.22% of symptomatic students responded to exercise test (their post-exercise PFT values decline more than 15%) while only 16.82% of asymptomatic students were responders to exercise (p

Summary: 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 (R2: 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 < 0.001, 99% CI: 2.3–9.5 min). In conclusion, this study shows that an exercise challenge in asthmatic children can give rise to inspiratory airflow limitation, which may give rise to asthma like symptoms. [ABSTRACT FROM AUTHOR]

The prevalence of exercise induced asthma (EIA) in Iran is not known. In the present study the prevalence of EIA among female students of guidance school in the city of Mashhad was evaluated. A total of 1690 female students aged 12-14 years in ten randomly selected schools in north east of Iran (Mashhad) completed an asthma symptoms- specific questionnaire. One hundred forty four randomly selected students including 49 symptomatic and 95 asymptomatic cases participated in a 6 minutes free run test (until reaching 70-75% of MHR (maximum heart rate) for evaluating EIA. Pulmonary function tests (PFT) were measured before (baseline), immediately, 5 minutes and 15 minutes after exercise. The prevalence of asthma symptoms among the studied students was 12.54%. There was not significant difference in any of PFT values between asymptomatic and symptomatic students. The results of exercise test showed that totally 61.22% of symptomatic students responded to exercise test (their post-exercise PFT values decline more than 15%) while only 16.82% of asymptomatic students were responders to exercise (p<0.001). However, in both asymptomatic and symptomatic responder students, all PFT values declined significantly after exercise compared to baseline values (p<0.05 to p<0.001) and there was not any significant difference between two groups. The results showed that although higher number of symptomatic students showed EIA, some asymptomatic students also sowed EIA. [ABSTRACT FROM AUTHOR]

Summary: Although montelukast is claimed to be preferable to inhaled corticosteroids in children with asthma and allergic rhinitis, virus-induced exacerbations, exercise induced asthma, and in those experiencing difficulties with inhalation therapy, there is no scientific evidence to support any of these claims. In comparative trials and systematic reviews, inhaled corticosteroids are clearly more effective than montelukast in reducing asthma exacerbations, improving lung function, symptom scores, and rescue medication use. The effects on exercise induced bronchoconstriction appear to be similar. Because of their superior efficacy and excellent long-term efficacy and safety profile, inhaled corticosteroids are the treatment of first choice for the maintenance therapy of childhood asthma, irrespective of age or clinical phenotype. [Copyright &y& Elsevier]

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. [Copyright &y& Elsevier]

Summary: Exercise is an important aspect of health and development in children. By placing the pulmonary system under stress, exercise testing may reveal subtle dynamic abnormalities that are not apparent on conventional static pulmonary function tests. Furthermore, exercise testing assesses the functional impact of respiratory disease on children. Exercise testing has been used in children with a variety of respiratory diseases such as exercise induced bronchoconstriction, asthma, cystic fibrosis and bronchopulmonary dysplasia to assess the severity of disease as well as response to various interventions. Furthermore, there is good evidence that exercise testing is a useful tool to help determine prognosis in patients with cystic fibrosis. In addition to the clinical utility, exercise testing is also becoming an increasingly important outcome measure in research studies. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Many patients complain about hyperreactivity of the skin or mucosal membranes, whereby rather harmless «triggers» lead to exaggerated reactions like running nose, bronchospasm, urticaria, etc. Most of these hyperreactivities have an underlying inflammation. It is important not to focus only on the triggers, but to look for the agent causing the inflammation and to avoid/treat it: elimination of the cause also eliminates the hyperreactivity. Four examples are presented where this cause -- trigger model of hyperreactivity is illustrated (exercise induced asthma, pollen associated food allergy, flare-up reactions in drug allergy and hyperreactivity in chronic urticaria). [ABSTRACT FROM AUTHOR]

Objective: Exercise-induced bronchospasm (EIB) is a common condition in elite athletes. The purpose of this study was to evaluate the diagnostic value of self-reported EIB symptoms in children. Methods: In a cross sectional study in 2005, all soccer player boys of 3 football schools of Shahr Rey a town in the south of Tehran, enrolled in this study. All subjects were asked for the presence of four cardinal symptoms of EIB (cough, wheeze, shortness of breath, chest pain/discomfort) during and after exercise. Self reported symptom-based EIB was defined as having at least two out of four symptoms. Findings were compared to spirometric criteria as a gold standard test. Findings: A total of 371 boys were enrolled in this study. The mean age of children was 11.67 ± 1.53 years (range 7-16 years). According to spirometric findings, 74 (19.9 %) subjects had EIB. The sensitivity and specificity of self-reported symptoms for EIB diagnosis were 13.0 % and 89.9 %, respectively. Conclusion: Self-reported symptoms of EIB in children can be useful for epidemiological study. Our results in Iran are comparable with studies in other countries and point to a relatively high prevalence of EIB among athlete children. [ABSTRACT FROM AUTHOR]

Abstract: Asthma in children is not the most important indication for an exercise test. However, one might recommend a cardiopulmonary exercise test systematically in the follow-up of patients with severe asthma when there is persistent bronchial obstruction, when an asthmatic child complains of dyspnoea on exertion, or when the child''s physical activity is limited. This test could be used to assess exercise tolerance, ventilatory adaptations, and the need for exercise training. Follow-up and evaluation of this training could be through a field exercise test (shuttle test or walk test). Moreover, the diagnosis of childhood asthma is frequently based only on symptoms suggestive of exercise-induced asthma. When the clinical features or a bronchodilatator test are not diagnostic, analysis of symptoms occurring during an exercise test can establish the diagnosis. The exercise test is thus a method that provides the time and intensity necessary to trigger exercise-induced bronchospasm. [Copyright &y& Elsevier]

Abstract: Asthma in children is not the most important indication for an exercise test. However, one might recommend a cardiopulmonary exercise test systematically in the follow-up of patients with severe asthma when there is persistent bronchial obstruction, when an asthmatic child complains of dyspnoea on exertion, or when the child`s physical activity is limited. This test could be used to assess exercise tolerance, ventilatory adaptations, and the need for exercise training. Follow-up and evaluation of this training could be through a field exercise test (shuttle test or walk test). Moreover, the diagnosis of childhood asthma is frequently based only on symptoms suggestive of exercise-induced asthma. When the clinical features or a bronchodilatator test are not diagnostic, analysis of symptoms occurring during an exercise test can establish the diagnosis. The exercise test is thus a method that provides the time and intensity necessary to trigger exercise-induced bronchospasm. [Copyright &y& Elsevier]

Highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many inhalant irritants and allergens all year round. Asthma occurs most commonly in athletes engaging in endurance events such as cross-country skiing, swimming, or long-distance running. As well as the type of training, a major risk factor is atopic disposition. A mixed type of eosinophilic and neutrophilic airway inflammation has been shown to affect elite swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a form of repeated thermal, mechanical, or osmotic airway trauma resulting in a healing or remodelling process. Elite athletes commonly use antiasthma drugs to treat exercise-induced bronchial symptoms. Only a few controlled studies have been conducted on the effects of antiasthma drugs on asthma symptoms, bronchial hyperresponsiveness and airway inflammation in elite athletes. Inhaled β2-adrenoceptor agonists are effective against exercise-induced bronchospasm. In contrast, airway inflammation, bronchial hyperresponsiveness and symptoms have responded poorly to inhaled corticosteroids and leukotriene antagonists. As discontinuing high-level exercise has proved effective in reducing eosinophilic airway inflammation, exercise or training should be restricted in athletes having troublesome symptoms and sputum eosinophilia. Switching training to less irritating environments should be considered whenever possible. It appears to be difficult to change the ‘natural course’ of asthma in athletes by anti-inflammatory treatment. [ABSTRACT FROM AUTHOR]

Exercise-induced asthma, or more appropriately, exercise-induced bronchoconstriction (EIB), occurs in 80 to 90% of individuals with asthma and in approximately 11% of the general population without asthma. EIB is characterised by post-exercise airways obstruction resulting in reductions in forced expiratory volume in 1 second (FEV[sub 1]) of greater than 10% compared with pre-exercise values. The mechanism of EIB remains elusive, although both cooling and drying of airways play prominent roles. Cold, dry inhaled air during exercise or voluntary hyperventilation is the most potent stimulus for EIB. Inflammatory mediators play central roles in causing the post-exercise airways obstruction. Diagnosis of EIB requires the use of an exercise test. The exercise can be a field or laboratory based test, but should be of relatively high intensity (80 to 90% of maximal heart rate) and duration (at lest 5 to 8 minutes). Pre- and post-exercise pulmonary function should be compared, and post exercise pulmonary function determined over 20 to 30 minutes for characterisation of EIB. A pre- to post-exercise drop in FEV[sub 1] of greater than 10% is abnormal. Approaches to treatment of EIB include both nonpharmacological and pharmacological strategies. A light exercise warm up prior to moderate to heavy exercise reduces the severity of EIB. More recently, studies have supported a role for dietary salt as a modifier of the severity of EIB, suggesting that salt restrictive diets should reduce symptoms of EIB. Short acting, inhaled β[sub 2]-agonists constitute the most used prophylactic treatment for EIB. However, antileukotriene agents are emerging as effective, well tolerated, long-term treatments for EIB. [ABSTRACT FROM AUTHOR]

Exercise-induced bronchoconstriction (EIB) is a transient airflow obstruction, typically 5-15 min after physical activity. The pathophysiology of EIB is related to the thermal and osmotic changes of the bronchial mucosa, which cause the release of mediators and the development of bronchoconstriction in the airways. EIB in children often causes an important limitation to physical activities and sports. However, by taking appropriate precautions and through adequate pharmacological control of the condition, routine exercise is extremely safe in children. This review aims to raise awareness of EIB by proposing an update, based on the latest studies, on pathological mechanisms, diagnosis, and therapeutic approaches in children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Klain, Indolfi, Dinardo, Contieri, Decimo and Miraglia Del Giudice.)

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Drug therapy provides a safe and effective way of controlling asthma in children. The appropriate medications combined with advice regarding modification of trigger factors where possible should allow the asthmatic child a normal lifestyle. The child and the parents need to understand the rationale for treatment, particularly with regard to preventive medications, and education is an important aspect of management. As many children improve with increasing age, treatment should be continually re-assessed with the aim of maintaining the patient on the minimal amount of medication that will keep the asthma under good control. [ABSTRACT FROM AUTHOR]

• The eucapnic voluntary hyperpnoea test is not sensitive in cold weather athletes. • Cold air exercise induces exercise induced bronchoconstriction in winter athletes. • It takes longer to recover respiratory function after cold air exercise in athletes. • The agreement between atopy and exercise induced bronchoconstriction is low. • A FEV1/FVC ratio of <0.75 is predictive of exercise induced bronchoconstriction. Exercise Induced Bronchoconstriction (EIB) prevalence in cold weather athletes is high. Currently, no standardized cold air exercise provocation test exists. Thus we aimed to determine EIB prevalence using a Cold Air Test (CAT; 5 km outdoor running; −15 °C) compared to the most common EIB screen the Eucapnic Voluntary Hyperpnea (EVH) test in cold weather athletes. Sixteen (9 male; 20–35 years old) cold weather athletes completed EVH 72 h before CAT. Spirometry, Fractional Expired Nitric Oxide (FENO), respiratory symptoms were measured and atopy status was determined. Five and 7 participants were EIB + on the EVH and CAT, respectively. Level of agreement was 50% between tests. FEV 1 recovery was significantly prolonged and Peak Expiratory Flow was decreased after CAT compared to EVH. Predictive characteristics of EIB + included FENO >12 ppb, FEV 1 /FVC ratio (<0.75) and BMI < 20. EVH does not always reflect EIB triggered by cold weather exercise. More research is required to understand the best EIB screens for cold weather athletes. [ABSTRACT FROM AUTHOR]