Progress on identifying exercise-induced bronchoconstriction in children with asthma / 国际儿科学杂志

Asthma is one of the most common respiratory disease in children.Maintaining normal activity level(exercise ability) is the goal of treatment in children with asthma.However, when children with asthma do exercise, exercise-induced bronchoconstriction (EIB) may occur.EIB is a situation that needs urgent recognition and treatment, and its severity can be determined through exercise challenge testing.But exercise challenge testing needs the equipment that expensive and difficult to implement.And it has not been widely used in clinical practice.Therefore, we need to find a more convenient method to identify EIB in children with asthma and apply it to clinical practice.This article introduces the definition and pathogenesis of EIB in children with asthma, summarizes the diagnostic methods and the prevention and treatment of EIB, so as to help pediatricians understand EIB more deeply and instruct children with asthma to do exercise better.

Los efectos del entrenamiento físico en niños asmáticos / Effects of exercise training in children with asthma

Asthma is a chronic obstructive respiratory disease with high prevalence in children. Several factors may trigger asthma symptoms, including exercise, which can lead to exercise-induced bronchoconstriction (EIB). Although physical exercise may represent a risk factor for triggering bronchial obstruction in asthmatics, studies have also indicated several positive effects. Thus, this article aimed to summarize current evidence on the effects of exercise training in children with asthma. There is substantial available evidence on the topic. Most of the findings show that exercise induce positive effects, including the increase of aerobic fitness, decrease of EIB levels, as well as an increase in both disease control and quality of life levels in asthmatic children. As for possible influencing factors in order to obtain exercise-induced positive effects, an adequate prescription of exercise intensity highlights and should be personalized, as well as established close to the anaerobic threshold. Thus, considering the evidence showing beneficial effects and the fact that the practice of physical exercise consists of a low cost and safe non-pharmacological therapy, supervised, personalized and individual recommendation of exercise training by health professionals are indicated to asthmatic children.

El asma es una enfermedad respiratoria obstructiva crónica con alta prevalencia en niños. Varios factores pueden desencadenar síntomas de asma, incluido el ejercicio, que puede conducir a la broncoconstricción inducida por el ejercicio (BIE). Aunque el ejercicio físico puede representar un factor de riesgo para desencadenar la obstrucción bronquial en los asmáticos, estudios también han indicado varios efectos positivos. Este artículo tiene como objetivo resumir la evidencia actual sobre los efectos del entrenamiento físico en niños con asma. Hay evidencia sustancial disponible sobre el tema. La mayoría de los hallazgos muestran que el ejercicio induce efectos positivos, incluido el aumento de la aptitud aeróbica, la disminución de los niveles de la BEI, así como un aumento tanto en el control de la enfermedad como en los niveles de calidad de vida en niños asmáticos. Se destaca la importancia de una prescripción de la intensidad del ejercicio adecuada y personalizada, cerca del umbral anaeróbico, para obtener los efectos positivos inducidos por el ejercicio. Por lo tanto, considerando la evidencia que muestra efectos beneficiosos y el hecho de que la práctica del ejercicio físico consiste en una terapia no farmacológica, segura y de bajo costo, el entrenamiento físico supervisado, personalizado e individualizado por parte de profesionales de la salud es recomendado para niños asmáticos.

Exercise-Induced bronchoconstriction and therapeutic modulation in Iraqi Girls Intermediate School Students

EIB (Exercise-Induced Bronchoconstriction) describes the narrowing that accurs in the airway follow a short period of exercise. EIB is found in 8-10% of normal children population as occult bronchospasm during or after physical activities. The mecanisms of EIB are related to rapid ventilation and mouth brathing which cause beat and water loss during breathing leading to bronchoconstriction. Peak Expiratory Flow Rate (PEFR) measured pre and post-exercise in students aged 12-16 years in girl intrmediate school. Any female shows PEFR values reduction 15% after 6 minutes continuous free running considered as asthmatic patient, this give an incidence rate of asthmatic patient of 9% in female students in this age. Treatment of EIB, Zafirlukast treatment gives (85.7%) protection rate. While salbutamol inhalation gives a protection rate 88%. Only 66.6% of girls with EIB give an improvement in PEFR values after sodium cromoglycate treatment. A regular measurement of PEFR in school students appears to be a good indicator of EIB, while inhalation of salbutaol 15 minutes before exercise give a good protection against EIB attacks at least for 4 hours (AU)

Reversion of methacholine induced bronchoconstriction with inhaled diazepam in patients with asthma / Bloqueo de la respuesta bronco constrictora a metacolina con diazepam inhalado en pacientes con asma

Background: Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. Aim: To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. Patients and Methods: Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. Results: In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. Conclusions: Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.

Antecedentes: Las benzodiacepinas tienen un efecto broncodilatador directo. La metacolina es un agonista muscarínico que causa bronco constricción. Objetivo: Evaluar el efecto modulador de la inhalación de diazepam sobre la bronco constricción inducida por metacolina. Pacientes y Métodos: Se estudiaron 12 pacientes con asma bien controlada. En el primer día, se determinó la curva dosis respuesta de parámetros de función pulmonar a una dosis progresiva de metacolina. Después de la última dosis, cuando se consiguió un 20% de reducción en la capacidad vital forzada en el primer segundo (FEV1), se midió FEV1 y la capacidad vital (CV) a los 7, 15 y 30 min después de la provocación. En el segundo día los pacientes se inhalaron con diazepam antes de hacer la prueba con metacolina. Resultados: En el primer día, el FEV1 bajo de 2,98 a 1,69 l con 6 mg/ml de metacolina. En el segundo día, la inhalación de diazepam redujo la respuesta a metacolina con una reducción de FEV1 de 2,48 a 2,21 L. Conclusiones: La benzodiacepinas reducen la respuesta de vasoconstricción a metacolina.

The effects of daily bathing on symptoms of patients with bronchial asthma

BACKGROUND: The influence of bathing in asthma patients is not yet fully known. OBJECTIVE: We conducted an observational study to investigate changes in symptoms and their degree by bathing in asthmatic patients. METHODS: A questionnaire focusing on ever experienced bathing-induced symptom changes and their degree, as well as contributing factors, was designed and administered to asthmatic patients in the outpatient department of our institute between January 2012 and November 2013. RESULTS: Two hundred fifteen cases were recruited. In 60 cases (27.9%), asthmatic symptoms appeared, including 20 cases of chest discomfort (33.3%), 19 cases of cough (31.7%), and 21 cases of wheezing (35.0%). The triggering factors included vapor inhalation (32 cases, 53.3%), hydrostatic pressure on the thorax due to body immersion in the bathtub (26 cases, 43.3%), and sudden change of air temperature (16 cases, 26.7%). Thirty-eight cases (17.7%) experienced improvement in active asthmatic symptoms by bathing. Vapor inhalation was the most common contributing factor (34 cases, 89.5%), followed by warming of the whole body (13 cases, 34.2%). There was no relationship between asthma severity and the appearance of bathing-induced symptoms or improvement of active asthmatic symptoms by bathing. CONCLUSION: The effects of bathing in asthmatic patients widely differed from patient to patient and their etiology includes several factors. For those who suffer from bathing-induced asthma symptoms, preventive methods, such as premedication with bronchodilators before bathing, should be established. This study is registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan with the registration number UMIN000015641.

The association of forced expiratory volume in one second and forced expiratory flow at 50% of the vital capacity, peak expiratory flow parameters, and blood eosinophil counts in exercise-induced bronchospasm in children with mild asthma

BACKGROUND: Exercise-induced bronchoconstriction (EIB), which describes acute airway narrowing that occurs as a result of exercise, is associated with eosinophilic airway inflammation, bronchial hyperresponsiveness. The forced expiratory volume in one second (FEV₁) is the most commonly used spirometric test in the diagnosis of EIB in exercise challenge in asthma. Other parameters such as forced expiratory flow at 50% of the vital capacity (FEF(50%)) and peak expiratory flow (PEF) are used less often in the diagnosis of EIB. OBJECTIVE: The purpose of this study is to evaluate the association of FEV₁ and FEF(50%), PEF parameters, blood eosinophil counts in EIB in children with mild asthma. METHODS: Sixty-seven children (male: 39, female: 28) with mild asthma were included in this study. Pulmonary functions were assessed before and at 1, 5, 10, 15, and 20 minutes after exercise. The values of spirometric FEV₁, FEF50(%), PEF, and blood eosinophil counts were evaluated in EIB in children with mild asthma. RESULTS: There was a positive correlation between FEV₁ with FEF(50%) and PEF values (p < 0.05; FEF(50%), r=0.68; PEF, r=0.65). Also, a positive correlation was found between blood eosinophil counts and the values of spirometric FEV₁, FEF(50%), and PEF (p < 0.05; FEV₁, r=0.54; FEF(50%), r=0.42; PEF, r=0.26). In addition to these correlations, in the exercise negative group for FEV₁, the FEF(50%) and PEF values decreased more than the cutoff values in 3, and 2 patients, respectively. CONCLUSION: According to the presented study, eosinophil may play a major role in the severity of EIB in mild asthma. FEF(50%) and PEF values can decrease in response to exercise without changes in FEV₁ in mild asthmatic patients.

Plasma secreted phospholipase A2 in asthmatic children: correlation with leptin levels and exercise induced bronchoconstriction

PURPOSE: Dysregulated cysteinyl leukotriene (CysLT) synthesis is prominent in exercise-induced bronchoconstriction (EIB). Secreted phospholipase A2 (sPLA2) plays a key regulatory role in the biosynthesis of CysLTs. We previously found that serum leptin levels correlate with (EIB) in children with asthma. The aim of this study was to address the relationship between plasma sPLA2/leptin levels and EIB. METHODS: Sixty-seven prepubertal children between the ages of 6 and 10 years were included in the study. They were asthmatics with EIB (n=25), asthmatics without EIB (n=21), and healthy subjects (n=21). We measured the plasma sPLA2 and leptin levels. We also performed pulmonary function tests at baseline, after bronchodilator inhalation, and after exercise. RESULTS: The sPLA2 and leptin levels were significantly higher in asthmatics with EIB than in those without and control subjects. In addition, sPLA2 levels were significantly correlated with body mass index (Speraman correlation coefficient r=0.343, P=0.023) and leptin levels (partial correlation coefficient r=318, P=0.033). The maximum decrease in % forced expiratory volume in 1 second after exercise was significantly correlated with both PLA2 levels (r=0.301, P=0.041) and leptin levels (r=0.346, P=0.018). CONCLUSION: The sPLA2 and leptin levels were significantly higher in asthmatics with EIB than in asthmatics without EIB and control subjects. In addition, sPLA2 levels were significantly correlated with leptin levels and EIB in asthmatic children.

Bronchoconstriction following instillation of phenylephrine eye drops in premature infants with bronchopulmonary dysplasia: two cases report / 대한마취과학회지

Premature infants requiring an ophthalmic examination or even surgery for retinopathy of prematurity (ROP) have a high prevalence of co-existing bronchopulmonary dysplasia (BPD). Reactive airway is one of the clinical presentations of BPD. We report two cases of bronchoconstriction following instillation of mydriatic eye drops. One occurred during induction of anesthesia for laser photocoagulation and the other before screening of ROP. The most likely cause in each case was phenylephrine eye drops. We recommend that the minimal dosage of phenylephrine needed to attain proper mydriasis should be instilled to infant patients, and the possibility of bronchoconstriction occurrence kept in mind, especially for infants with low body weight with BPD.

Estenosis bronquial congénita, papel de las imágenes en el diagnóstico: presentación de un caso / The role of diagnostic imaging in congenital bronchial stenosis: A Case report

En este artículo se presenta el caso de un lactante menor de 2 meses de edad que a los 15 días de nacido presentó estridor y dificultad respiratoria, por lo que fue llevado a una clínica de primer nivel, donde se le realizó una radiografía de tórax en la cual se documentó la presencia de una hiperinflación del campo pulmonar derecho. Se le realizó una fibrobroncoscopia óptica, de resultado normal, y una gammagrafía de ventilación/perfusión que mostró una hipoplasia pulmonar derecha. Fue manejado con oxígeno suplementario y terapias respiratorias sin mejoría clínica, motivo por el cual fue trasladado a otra institución para un manejo especializado. Con el fin de obtener un mapa vascular prequirúrgico, se realizó una angiografía pulmonar por tomografía, unas reconstrucciones con mínima intensidad de proyección y una broncoscopia virtual multicorte. Con todo ello se documentó una estenosis del bronquio fuente derecho, producida por un repliegue de la pared bronquial y con efecto de válvula, que producía una hiperinsuflación secundaria del pulmón derecho. Estos hallazgos fueron confirmados en la cirugía correctiva. Este es un caso de gran interés porque, a pesar de lo inusual de la patología y la edad del paciente, fue posible establecer un diagnóstico certero mediante el uso de la TAC multidetector que permitió utilizar herramientas de reconstrucción tridimensional y navegación endoluminal, como la broncoscopia virtual.

This article reports the case of a lactating infant, 2 months old, who 15 days after birth presented gasping and respiratory difficulty. For this reason, he was taken to a first-degree clinic, where a thorax radiography was performed. This thorax radiography documented the presence of a hyper-inflation of the right lung. An optic fiber bronchoscopy was performed, with normal results, and a ventilation/perfusion scan which reported a hypoplasia of the right lung. It was treated with complementary oxygen and respiratory therapies without any clinical improvement. Therefore, the patient was sent to a different institution for more specialized treatment. A pulmonary angiography through a tomography, a minimum projection intensity reconstruction, and a multi-slice virtual bronchoscopy were performed in order to obtain a presurgical vascular map. This process showed a stenosis of the right source bronchus, caused by a fold of the bronchial wall with a valve effect, causing a secondary hyperinsuflation of the right lung. These findings were confirmed in the corrective surgery. We consider this case especially interesting because, in spite of the unusual pathology and the age of the patient, it was possible to establish a correct diagnosis through the use of the multi detector CAT scan, enabling us to use the reconstructive three-dimensional tools, as well as endoluminal navigation such as virtual bronchoscopy.

Massive Cardiomegaly due to Dilated Cardiomyopathy Causing Bronchial Obstruction in an Infant

Dilated cardiomyopathy (DCMP) remains a life threatening disease in young patients and is often difficult to differentiate from myocarditis. Early recognition and treatment of DCMP are crucial for good prognoses in this patient population. The clinical course of patients with DCMP that result in cardiogenic shock varies according to the etiology as well as patient age. The volumetric expansion of the enlarged heart can compress adjacent structures causing a number of related symptoms, especially in infants with soft cartilaginous bronchi. Therapeutic strategies for treating these issues vary according to the type of complication encountered. We report a case of severe DCMP with sudden onset of massive cardiomegaly with heart failure complicated by bronchial obstruction in an infant.

Ratio of Leukotriene E4 to Exhaled Nitric Oxide and the Therapeutic Response in Children With Exercise-Induced Bronchoconstriction

PURPOSE: This study assessed the association between the ratio of leukotriene E4 (LTE4) to fractional exhaled nitric oxide (FENO) in the response of children with exercise-induced bronchoconstriction (EIB) enrolled in a therapeutic trial with montelukast or inhaled corticosteroid (fluticasone propionate [FP]). METHODS: Children aged 6 to 18 years with EIB were randomized in a 4-week, placebo-controlled, double-blinded trial with montelukast or FP. Before and after treatment, treadmill exercise challenges were performed. The LTE4 levels in the induced sputum and urine and the FENO levels were measured in subjects before and 30 minutes after the exercise challenges. The same tests were conducted after treatment. RESULTS: A total of 24 patients completed the study: 12 in the montelukast group and 12 in FP group. Both study groups displayed a similar postexercise maximum decrease in forced expiratory volume in one second (FEV1) before treatment as well as after treatment. However, there were significant differences in the magnitude of change between the two (Delta; -18.38+/-14.53% vs. -4.67+/-8.12% for the montelukast and FP groups, respectively; P=0.021). The Delta logarithmic sputum baseline and postexercise LTE4/FENO ratio were significantly lower in the montelukast group than in the FP group (baseline; -0.09+/-0.21 vs. -0.024+/-0.03, P=0.045; postexercise, -0.61+/-0.33 vs. -0.11+/-0.28, P=0.023). CONCLUSIONS: These data indicate that the efficacy of montelukast for preventing a maximum decrease in FEV1 after exercise is significantly higher than that of FP, and the high LTE4/FENO ratio is associated with a greater response to montelukast than to FP for EIB therapy. These results suggest that LTE4 may play an important role in EIB.

Seasonal Factors Influencing Exercise-Induced Asthma

PURPOSE: Exercise-induced bronchoconstriction (EIB) in patients with asthma occurs more frequently in winter than in summer. The concentration of house dust mite (HDM) allergens in beds also shows seasonal variation. This study examined the relationship between seasonal differences in the prevalence of EIB and sensitization to HDMs in patients with asthma. METHODS: The medical records of 74 young adult male patients with asthma-like symptoms who underwent bronchial challenge with methacholine, 4.5% saline and exercise, and allergen skin prick tests, were reviewed. The subjects were divided into summer (n=27), spring/fall (n=26) and winter (n=21) groups according to the season during which they underwent testing. RESULTS: The positive responses to exercise differed according to season (48.1% in summer, 73.1% in spring/fall, and 90.5% in winter; P0.05). CONCLUSIONS: Positive skin test reactions to HDMs and EIB occurred in winter, spring/fall, and summer in decreasing order of frequency. Seasonal variation in the prevalence of EIB may be related to seasonal variation in sensitization to HDMs, accompanied by differences in indirect, but not direct, AHR.

Exercise-induced bronchoconstriction in rhinitis children without asthma.

Background: Exercise-induced bronchoconstric-tion (EIB) is a condition that leads to limited participation in sports. Prevalence of EIB ranges from 5-20% in general population to 40 - 90% in asthmatic patients. But the prevalence among rhinitis children with EIB remains debatable. We aimed to determine the prevalence of EIB in non-asthmatic children with rhinitis. Methods: A cross-sectional study was performed on 53 rhinitis patients without known asthma who attended the Pediatric Allergy Clinic between March 2009 and February 2010.They all underwent physical examination, skin prick test, pulmonary function tests and an exercise challenge test (ECT) on a treadmill. A positive ECT was defined as a decrease in FEV1 > 10% after exercise. baseline pulmonary function and the decline in FEV1 after exercise. Results: The patients’ mean age was 12.3±2.6 years. Most of them (60.4%) had moderate to severe persistent rhinitis. Eleven out of 53 patients (20.7%) had EIB. The peak time for occurrence of EIB was 10 minutes after exercise. Most of the EIB episodes observed were of mild degree. Patients who had persistent symptoms and a short duration of rhinitis treatment prior to the ECT day had more positive ECT results (72.7% vs. 28.6%, p 0.013, 0.2 years vs.1.9 years, p 0.012, respectively). The history (Hx) was not a reliable means of identifying children who had EIB (ECT+/Hx+ 54.6%, ECT-/Hx+ 54.8%). There was no significant relationship between Conclusion: The prevalence of EIB in rhinitis children without asthma is 20.7%. History, physical examination and pulmonary function are insufficient to diagnose EIB.

Bronchial provocation tests in clinical practice / Teste de broncoprovocação na prática clínica

Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.

Hiperresponsividade brônquica, caracterizada por uma resposta exagerada das vias aéreas a um estímulo broncoconstritor, é uma das principais características da asma, presente em praticamente todos pacientes asmáticos. A hiperresponsividade brônquica pode estar presente também em outras doenças, como rinite alérgica, doença pulmonar obstrutiva crônica, fibrose cística, insuficiência cardíaca, infecção respiratória e com o uso de algumas medicações, como β-bloqueadores. Os testes de broncoprovocação são utilizados para determinação da responsividade brônquica, e têm sido cada vez mais utilizados nos últimos 20 anos com o desenvolvimento e validação de testes acurados, seguros e reprodutíveis e com a publicação de protocolos bem detalhados. Diversos estímulos podem ser utilizados em um teste de broncoprovocação, sendo classificados em estímulos diretos e indiretos. Existem inúmeras indicações para um teste de broncoprovocação. Nesta revisão, nós discutimos as principais diferenças dos estímulos diretos e indiretos e o uso desses testes na prática clínica, especialmente para a confirmação de asma, broncoconstrição induzida por exercício, tosse variante de asma e em atletas de elite.

Exercise-Induced Bronchoconstriction / 대한내과학회지

Exercise-induced bronchoconstriction (EIB) is defined as transient, reversible bronchoconstriction that develops after strenuous exercise. If exercise is the only identified trigger for bronchoconstriction, it is called EIB. However, when it is associated with known asthma, then it is defined as EIB with asthma. The role of atopy in the pathogenesis of EIB has not been determined. In this issue of the journal, Kim et al. reported that atopy was a risk factor for EIB in young adult male patients, and sensitization to house dust mites was associated with EIB. This report shed a new light on the pathogenesis of EIB. However, additional large and confirmatory studies should be required to determine the possible association between atopy and EIB.

Exercise-Induced Bronchoconstriction / 대한내과학회지

Exercise-induced bronchoconstriction (EIB) is defined as transient, reversible bronchoconstriction that develops after strenuous exercise. If exercise is the only identified trigger for bronchoconstriction, it is called EIB. However, when it is associated with known asthma, then it is defined as EIB with asthma. The role of atopy in the pathogenesis of EIB has not been determined. In this issue of the journal, Kim et al. reported that atopy was a risk factor for EIB in young adult male patients, and sensitization to house dust mites was associated with EIB. This report shed a new light on the pathogenesis of EIB. However, additional large and confirmatory studies should be required to determine the possible association between atopy and EIB.

Nitric Oxide Correlates with Exercise-Induced Bronchoconstriction in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Exercise-induced bronchoconstriction (EIB) affects daily activities as well as school performance in children. Exhaled nitric oxide (eNO) is a noninvasive test that measures airway inflammation in asthmatics. The aim of this study was to address the relationship between eNO and childhood EIB. METHODS: Our study consisted of 101 children aged 6 to 18 years belonging to one of three groups, asthmatic children with EIB (n=31), asthmatic children without EIB (n=28), or healthy controls (n=42). After children were taken off drugs that treated their asthma, baseline (pre-exercise) eNO and biomarkers of inflammation were measured. All subjects underwent spirometry and the bronchial challenge by methacholine inhalation and outdoor free running. RESULTS: eNO levels in asthmatic children with EIB were significantly greater than those in both asthmatic children without EIB (P=0.012) and controls (P<0.001). The median eNO (interquartile range) levels were 26.0 (15.0 to 46.0) parts per billion (ppb) in asthmatic children with EIB, 16.0 (12.5 to 28.0) ppb in asthmatic children without EIB, and 12.0 (10.0 to 15.3) ppb in controls. Post-exercise decrease of forced expiratory volume in 1 second correlated positively with eNO (r=0.637, P<0.001; r, partial correlation coefficient adjusted for age and height). The cutoff value for prediction of significant EIB was 20 ppb, and the overall sensitivity, specificity, positive predictive value, and negative predictive values were 61.3%, 80.0%, 57.6%, and 82.4%, respectively. The area under the receiver operating characteristic curve was 0.767 (95% confidence interval, 0.661 to 0.874). CONCLUSION: Baseline eNO levels correlate with the post-exercise decrease of forced expiratory volume in 1 second, suggesting that eNO may be a tool in the prediction of EIB.

Gender and perception of dyspnea: The role of the variation in the forced expiratory volume in one second / Género y percepción de disnea: el rol de la variación del volumen espiratorio forzado en un segundo

During bronchoconstriction women perceive more breathlessness than men. The aims of study were 1) to evaluate if quality of dyspnea in bronchoconstriction was different in women and men 2) to assess if gender difference in the perception of dyspnea could be related to the level of bronchoconstriction. 457 subjects (257 women) inhaled methacholine to a 20% decrease in FEV1, or 32 mg/ml. Dyspnea was evaluated using the modified Borg scale and a list of expressions of dyspnea. Borg scores were recorded immediately before the challenge test baseline and at the maximum FEV1 decrease. The prevalence of descriptors of dyspnea reported by women and men was similar. Dyspnea was related to the level of FEV1 (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095), females (OR 2.90, 95%CI 1.33-6.33, p 0.0072), younger subjects (OR 0.93, 95%CI 0.89- 0.97, p 0.0013) and body mass index (BMI) (OR 1.11, 95%CI 1.01-1.23, p 0.023). As the FEV1 fell less than 20% from baseline, only the ΔFEV1 was significantly associated with dyspnea (ΔFEV1:OR 1.15, 95%CI 1.07- 1.24, p 0.0002). Instead, if the FEV1 fell higher ≥ 20%, the presence of dyspnea was related to the degree of bronchoconstriction (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187), females (OR 3.02, 95%CI 1.36-6.72, p 0.0067), younger subjects (OR 0.92, 95%CI 0.88-0.96, p 0.0007) and BMI (OR 1.12, 95%CI 1.01-1.23, p 0.023). The quality of dyspnea during the bronchoconstriction was similar in women and men; women showed a higher perception of dyspnea than men only when the FEV1 fell more than 20% from baseline.

Durante la broncoconstricción las mujeres perciben más disnea que los hombres. Los objetivos del estudio fueron evaluar: 1) si la calidad de la disnea durante la broncoconstricción fue diferente en mujeres y hombres, 2) si la diferencia entre sexos en la percepción de disnea podría relacionarse al nivel de broncoconstricción. 457 sujetos (257 mujeres) inhalaron metacolina hasta un descenso del FEV1 ≥ 20% o 32 mg/ml. La disnea fue evaluada mediante escala de Borg y una lista de expresiones de disnea. El Borg fue registrado en forma basal y con el máximo descenso del FEV1. La frecuencia de descriptores de disnea informados por mujeres y hombres fue similar. La disnea estuvo relacionada al grado de broncoconstricción (ΔFEV1: OR 1.05, 95%CI 1.01-1.09, p 0.0095), sexo femenino (OR 2.90, 95%CI 1.33-6.33, p 0.0072), edad (OR 0.93, 95%CI 0.89-0.97, p0.0013) e índice de masa corporal (IMC) (OR 1.11, 95%CI 1.01-1.23, p 0.023). Cuando el FEV1 cayó menos del 20%, solo el ΔFEV1 se asoció con disnea (ΔFEV1: OR 1.15, 95%CI 1.07-1.24, p 0.0002). En tanto que si el FEV1 cayó ≥ del 20%, la disnea estuvo relacionada al grado de broncoconstricción (ΔFEV1: OR 1.04, 95%CI 1.01-1.09, p 0.0187), sexo femenino (OR 3.02, 95%CI 1.36-6.72, p 0.0067), edad (OR 0.92, 95%CI 0.88-0.96, p 0.0007) e IMC (OR 1.12, 95%CI 1.01-1.23, p 0.023). La calidad de la disnea durante la broncoconstricción fue similar en hombres y mujeres; las mujeres tuvieron mayor percepción de disnea que los hombres solo cuando el FEV1 descendió más del 20%.

Parálisis recurrencial y reflujo laringofaríngeo: Presentación de caso / Recurrent paralysis and laryngopharyngeal reflux: Presentation of a case

The current work describes the case of a male, 45-years-old, asthmatic patient, who begins with a picture of repeated asphyxia. For that reason, he visited several times the family physician, and when there was no improving, he assisted the otolaryngologic consultation, where a recurrent paralysis was detected. He entered the ospital and a tracheotomy was made. The possible etiologic causes were investigated. During the investigation it was detected that the patient had a gastroesophageal reflux. The reflux was treated, and the paralysis improved. Then, a surgical treatment was practiced against the disease for gastroesophageal reflux.

A Ação do Cissampelos Sympodialis Eichl: uma Perspectiva para o Tratamento da Asma / The Action of Cissampelos Sympodialis Eich: a Perspective in the Asthma’s Treatment

A espécie Cissampelos sympodialis (Menispermaceae) éutilizada na medicina popular e indígena para o tratamento dedesordens inflamatórias, incluindo a asma. O objetivo dopresente estudo foi revisar a literatura sobre os estudoscom a espécie Cissampelos sympodialis (Menispermaceae).A pesquisa bibliográfica deste trabalho foi realizada nosbancos de dados eletrônicos: Pubmed, Bireme, Portal Capes-Periódicos, Scielo. A asma tem como principal característicafisiopatogênica a inflamação e o broncoespasmo. Estudosfitoquímicos com espécies vegetais utilizadas no tratamentodessa patologia têm sido realizados com o objetivo deencontrar novas perspectivas terapêuticas que apresentemmenos efeitos adversos em relação aos tratamentos atuais.Estudos comprovaram que a planta é capaz de inibir tanto oinfluxo de eosinófilos quanto a produção de leucotrienoscisteínicos desencadeados pelo processo alérgico da asma.Com isso, de acordo com a literatura revisada, os estudospré-clínicos com as folhas de C. sympodialis viabilizamensaios clínicos que possam comprovar a segurança e aeficácia do C. sympodialis em seres humanos, tornandoprovável a liberação do registro como um fitomedicamento epossibilitando uma ampliação das opções terapêuticas depacientes portadores de patologias crônicas, como a asma,que cursam com broncoespasmo e inflamação...

The species Cissampelos sympodialis (Menispermaceae)is used in the popular and indigenous medicine for the treatmentof inflammatory disorders, including the asthma. The aim ofthe present study was to revise the literature about thespecies Cissampelos sympodialis (Menispermaceae). Thebibliographical research of this study was accomplished inthe electronic databases: Pubmed, Bireme, Portal Capes-Periódicos, Scielo. The asthma has as main physiopathogeniccharacteristic the inflammation and the bronchoconstriction.Phytochemical studies with vegetable species used in thetreatment of that pathology have been accomplished withthe objective of finding new therapeutic perspectives thatpresent less adverse effects in relation to the currenttreatments. Studies showed that the plant is able to inhibitboth the eosinophilic influx and the production of cysteinylleukotrienes unchained by the allergic process of the asthma.Therefore, in agreement with the revised literature, preclinicalstudies with the leaves of C. sympodialis make possible theconduction of clinical rehearsals that can prove safety andeffectiveness of the C. sympodialis in human beings, makingprobable the liberation of its registration as a phytomedicationas well as enlarging the therapeutic options of patientsaffected by chronic pathologies, like asthma, that coursewith bronchoconstriction and inflammation...