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Pulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Exercise-induced asthma symptoms are particularly likely to occur after exercise in a cool dry environment. This results in cooling and drying of the airway mucosa triggering mast cell degranulation and bronchoconstriction mediated by the mast cell products cysteinyl-leukotrienes (CT) and histamine. After inhaled allergen in a sensitised individual, early bronchoconstriction is mediated by degranulation of mast cells secondary to allergen-induced cross-linking of IgE on mast cells. Many patients with allergic asthma develop a late response to an inhaled allergen involving an influx of eosinophils and airflow limitation as a result of airway wall oedema, activation and sensitisation of airway smooth muscle and airway mucus plugging (Table 2.2; Figure 2.3).
Respiratory disorders
Published in Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize, Developmental and Adapted Physical Education, 2019
Michael Horvat, Ronald V. Croce, Caterina Pesce, Ashley Fallaize
Exercise-Induced Asthma: Another contributing cause of asthma is physical activity. Exercise may induce bronchospasm in children 6 to 8 minutes after maximal work of approximately 170–180 heartbeats per minute or in people of any age whose heart rate reaches about 50 beats per minute below the estimated maximum for at least 5 minutes – in other words, whenever exertion demands about 70% of the body’s aerobic power. Exercise-induced asthma may occur in approximately 75% of all individuals with asthma, beginning with the constriction of the muscles surrounding the bronchial tubes. The severity of EIA can be mild or intense and is characterized by dyspnea and wheezing. The airway increases in size during the initial stages of exercise (bronchodilation) and then contracts, restricting the passage of air. In addition, a late-phase or late-onset asthma can be noted hours later as a secondary response to the initial exercise and release of chemical mediators (Gong, 1992).
Case studies
Published in Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay, COPD in Primary Care, 2018
Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay
The differential diagnosis in this patient includes heart failure, chronic obstructive pulmonary disease and exercise-induced asthma.Perform an exercise test and check the peak expiratory flow rate before exercise and then at 10-minute intervals for 40 minutes.If the result of the exercise test shows that the patient’s peak expiratory flow rate readings are not significantly altered by exercise, exercise-induced asthma can be ruled out.Heart failure can be ruled out by performing an echocardiogram.
Vocal cord dysfunction/inducible laryngeal obstruction: novel diagnostics and therapeutics
Published in Expert Review of Respiratory Medicine, 2023
Joo Koh, Debra Phyland, Malcolm Baxter, Paul Leong, Philip G Bardin
Classic VCD/ILO is the leading phenotype first described by Christopher et al. [1]. Classic VCD/ILO is characterized by intermittent breathlessness often with complaints of a ‘tight throat’ and dysphonia. The initial diagnosis is often asthma and there can be characteristic comorbidities such as anxiety and reflux. Spirometry is often normal. The lung disease-associated VCD/ILO phenotype is characterized by coexistent lung disease, chiefly asthma and COPD [15,37]. Symptoms are concordant with the underlying lung disease but with additional VCD/ILO-like symptoms. Spirometry is often abnormal. Laryngoscopy may show inspiratory closure and often also expiratory narrowing (‘braking’). The exercise-associated VCD/ILO phenotype has been clearly identified by Halvorsen and others in the 2017 Consensus Statement [6]. Typical patients are young people and often competitive athletes who have exertional dyspnea that is sudden in onset. Lung function is normal and exercise-induced asthma is the initial diagnosis. Endoscopy during exercise can reveal inspiratory closure with frequent supraglottal movement abnormalities. Finally, incident-associated VCD/ILO phenotype is associated with stressful events. Onset is rapid with breathlessness, throat tightness, and voice changes. The provisional diagnosis is frequently anaphylaxis or an allergic reaction, but typical inspiratory closure can be visualized without edema or allergic features [45]. Additional phenotypes, such as cough-associated VCD/ILO, irritant-associated VCD/ILO, or obesity-associated VCD/ILO, are likely to be important, and there may be overlap between phenotypes.
Efficacy and safety of the combination fluticasone propionate plus salmeterol in asthmatic preschoolers: An observational study
Published in Journal of Asthma, 2019
Elpis Hatziagorou, Eleana Kouroukli, Maria Galogavrou, Dafni Papanikolaou, Dr. Despoina Terzi, Pinelopi Anagnostopoulou, Fotios Kirvassilis, Demosthenes B Panagiotakos, John Tsanakas
In an elegant, retrospective, multicenter study of 50 patients under the age of 5 years treated with FP/SA, Sekhsaria et al analysed changes in emergency room visits, hospitalization rates, frequency of wheezing and the impact on growth, by interpreting the change in height percentiles, and they were able to demonstrate that FP/SA is both efficacious and safe in this age group (4). Although the results reported in the study by Sekhsaria et al are of great interest, it is likely that their impact may be somewhat blunted by the relatively small number of patients involved. The findings of our study, involving 796 children younger than 5 years are in keeping with those previously described by Sekhsaria et al. Moreover, our study demonstrated significant improvement/reduction in the incidence of exercise-induced asthma and nocturnal asthma as well.
Exercise-induced anaphylaxis: causes, consequences, and management recommendations
Published in Expert Review of Clinical Immunology, 2019
Morten J. Christensen, Esben Eller, Henrik F. Kjaer, Sigurd Broesby-Olsen, Charlotte G. Mortz, Carsten Bindslev-Jensen
Exercise-induced asthma is characterized by asthma symptoms or cough [83] that usually occurs within 10–15 min after physical activity, rarely during exercise. Symptoms resolve in a variable time within an hour after the end of the exercise. Exercise-induced asthma is experienced by most asthmatic children and is not associated with anaphylactic symptoms or food intake. The diagnostic value of medical history in identifying individuals suffering from exercise-induced bronchoconstriction is poor [84]. Therefore, the diagnosis of exercise-induced bronchoconstriction should be based on exercise challenge test. A positive exercise test is defined as a maximum percentage fall in FEV1 ≥15% from the baseline [85]. Exercise test may be influenced by the type of exercise, environmental conditions, hour of the day, and the health (infections, allergies, drugs).