Evaluación de la disnea asociada al ejercicio / Exercise-induced dyspnea evaluation

Exercise-induced dyspnea is a common pediatric question but difficult to address since usually symptoms are described ambiguously by the child or parents. Most of times dyspnea is secondary to poor training but sometimes may be due to an underlying condition like exercise-induced bronchoconstriction or vocal cord dysfunction. To provide clinicians with a practical approach about exercise-induced dyspnea we have review pathogenesis and clinical characteristics of respiratory diseases and proposed an algorithm for study.

Frecuentemente nos vemos enfrentados a evaluar un niño con síntomas vagos asociados al ejercicio que el mismo paciente o sus padres describen como ahogo o sensación de pecho apretado. La mayoría de las veces se trata de cansancio atribuible al ejercicio normal que solo refleja pobre condicionamiento físico del individuo; sin embargo, este cansancio puede ser desproporcionado al esfuerzo, lo que obliga a considerar enfermedades comunes como asma o poco comunes como disfunción de cuerdas vocales. El objetivo de esta revisión es actualizar el conocimiento aquellas enfermedades respiratorias que forman parte del diagnóstico diferencial de la disnea asociada al ejercicio y proponer un algoritmo de estudio que permita un acercamiento práctico según causas de origen.

Broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite / Exercise-induced bronchoconstriction in elite long-distance runners in Brazil

OBJETIVO: Determinar a prevalência de broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite e se há uma diferença na carga de treinamento entre atletas com e sem broncoespasmo induzido por exercício. MÉTODOS: Estudo transversal com corredores de longa distância de elite sem sintomas atuais de asma e sem diagnóstico de broncoespasmo induzido por exercício. Todos os participantes foram submetidos ao teste de hiperventilação voluntária eucápnica e ao teste cardiopulmonar de esforço máximo e responderam a questionários sobre sintomas de asma e atividade física para monitorizar sua carga de treinamento semanal. RESULTADOS: Dos 86 atletas do sexo masculino recrutados, 20 concordaram em participar do estudo, dos quais 5 (25%) foram diagnosticados com broncoespasmo induzido por exercício. Não foram evidenciadas diferenças entre os atletas com e sem broncoespasmo induzido por exercício em relação a características antropométricas, consumo de oxigênio de pico, valores basais de função pulmonar ou sintomas de asma relatados. A carga de treinamento semanal foi significativamente menor nos atletas com broncoespasmo induzido por exercício do que naqueles sem esse diagnóstico. CONCLUSÕES: Nesta amostra de corredores de longa distância brasileiros, a prevalência de broncoespasmo induzido por exercício foi alta.

OBJECTIVE: To determine the prevalence of exercise-induced bronchoconstriction among elite long-distance runners in Brazil and whether there is a difference in the training loads among athletes with and without exercise-induced bronchoconstriction. METHODS: This was a cross-sectional study involving elite long-distance runners with neither current asthma symptoms nor a diagnosis of exercise-induced bronchoconstriction. All of the participants underwent eucapnic voluntary hyperpnea challenge and maximal cardiopulmonary exercise tests, as well as completing questionnaires regarding asthma symptoms and physical activity, in order to monitor their weekly training load. RESULTS: Among the 86 male athletes recruited, participation in the study was agreed to by 20, of whom 5 (25%) were subsequently diagnosed with exercise-induced bronchoconstriction. There were no differences between the athletes with and without exercise-induced bronchoconstriction regarding anthropometric characteristics, peak oxygen consumption, baseline pulmonary function values, or reported asthma symptoms. The weekly training load was significantly lower among those with exercise-induced bronchoconstriction than among those without. CONCLUSIONS: In this sample of long-distance runners in Brazil, the prevalence of exercise-induced bronchoconstriction was high.

Is Free Running Asthma screening test still useful? / ¿Es la prueba de carrera libre para el tamizaje del asma todavía útil?

OBJECTIVE: The aim of this study is to evaluate the usefulness of Free Running Asthma Screening Test (FRAST) as a method that may help the diagnosis of exercise-induced bronchospasm (EIB) in children from a rural area and to compare the results with their history of asthma. METHODS: A FRAST challenge took place at 9 schools. It lasted for 6 minutes and pupils performed it properly with the help of an athlete. The best out of three Peak Expiratory Flow Rate (PEFR) efforts was recorded before and after challenge, using a mini-Wright peak-flow-meter. A more than 15% drop in PEFR was considered an indication of EIB. A questionnaire defining asthmatic symptoms had been distributed and already completed by their parents. RESULTS: The exercise was successfully performed by 268 children. Eleven children presented a fall of PEFR of at least 15%, five or ten minutes after the exercise; among these, only three boys had a history of asthma, while the remaining 8 children were undiagnosed. No difference regarding age, gender or locations' altitude was found. CONCLUSION: FRAST can be of great use in the diagnosis of EIB in areas that lack proper tools and specialized personnel. A poor correlation between self-reported symptoms and the results of exercise challenges was confirmed.

OBJETIVO: El objetivo de este estudio fue evaluar la utilidad de la prueba de la carrera libre para el tamizaje del asma (PCLTA) como método que puede ayudar al diagnóstico del broncoespasmo inducido por ejercicio (BEI) en los niños de un área rural, y comparar los resultados con su historia de asma. MÉTODOS: Una prueba de reto PCLTA tuvo lugar en 9 escuelas. La prueba tuvo una duración de 6 minutos, y los alumnos la realizaron correctamente con la ayuda de un atleta. El mejor de tres esfuerzos de la tasa de flujo espiratorio máximo (TFEM) fue registrado antes y después de la prueba, usando un medidor Mini-Wright de flujo espiratorio máximo. Una caída de más del 15% en la TFEM fue considerada una indicación de BEI. Un cuestionario que define los síntomas asmáticos había sido distribuido y respondido por sus padres. RESULTADOS: El ejercicio se realizó con éxito por 268 niños. Once niños presentaron una caída de TFEM de por lo menos 15%, cinco o diez minutos después del ejercicio. De ellos, tres varones tenían una historia de asma, mientras los otros 8 niños restantes no tenían diagnóstico. No se halló diferencia con respecto a edad, género o altitud de las localizaciones. CONCLUSIÓN: La prueba PCLTA puede ser de gran utilidad en el diagnóstico de BEI en áreas en las que faltan las herramientas apropiadas y el personal especializado. Se confirmó la existencia de una pobre correlación entre los síntomas auto-reportados y los resultados de los ejercicios de reto.

Exercise induced asthma in school children of south Punjab, Pakistan

To find the prevalence of exercise induced asthma, in school children of South Punjab, Pakistan. It was a cross sectional, questionnaire based, descriptive survey of the children aged 3-18 years, in randomly selected primary and secondary schools, from October 2002 to March 2003. The data then was analyzed by the statistician with Statistical Analysis System [SAS]. Of 6120 questionnaire sent to the parents/guardians, we received 3180 back [52%]. Of the 3180 respondents, 1767[56%] were for boys and 1413[44%] were for girls. The median age was 8.25 years. Around 71% of children were between 4 to 11 years of age. The parents reported exercise induced asthma in 306[10%] of their children with an equal prevalence in boys and girls i.e. [5% each, when figures were rounded off to the nearest whole number]. Of this 306 children with exercise induced asthma, 159 [51%] were boys and 147[49%] were girls. Of the 1767 boys and 1413 girls, the exercise induced asthma reported by parents was 9% in boys and 10% in girls, [159 and 147 respectively]. The exercise induced asthma was not reported in 14-18 years age group of males. The asthma is taken as a stigma in our society and as such is not reported or disclosed rather denied. An extensive educational media campaign is required for awareness of the masses

Asma inducida por ejercicio: Diferencias en la percepciónde síntomas entre pacientes pediátricos y sus padres / Exercise-induced asthma as perceived by pediatric patients and their parents

Background: Exercise is a frequent trigger of symptoms in asthmatic children and it worsens their quality of life. Aim: To compare the perception about exercise among asthmatic pediatric patients and their parents. Material and methods: Asthmatic patients with symptoms related to exercise, were tested with an exercise challenge test following the Tal protocol. Before testing, a questionnaire about symptoms triggered by exercise was answered by children and their parents. The data was analyzed with a Kappa correlation test. Results: Seventy five patients, aged 6 to 15 years, were studied. Forty one percent exercised less than one hour per week. Although 64% reported to experience respiratory difficulty and 80% cough during exertion, 87% were willing to perform more exercise. Forty percent of all patients had a positive challenge test for exercise-induced asthma. Correlation between patient's and parent's answers about the effect of physical activity exercise was low, with a kappa of 0.53. There was no correlation between exercise test and the answers to the questionnaire. Conclusions: Children with asthma frequently have exercise-associated symptoms and parental perception about this problem is very low.

Testes de broncoprovocação com metacolina e com exercício em bicicleta e corrida livre em crianças com asma intermitente / Bronchial provocation tests using methacholine, cycle ergometer exercise and free running in children with intermittent asthma

OBJETIVO: Comparar a responsividade de vias aéreas à metacolina e ao teste de exercício na bicicleta ergométrica e corrida livre em crianças com asma intermitente. MÉTODOS: Estudo randomizado. Trinta crianças de ambos os sexos com asma intermitente participaram do estudo. Cada teste foi realizado em 3 dias diferentes, através de randomização: a) broncoprovocação com metacolina, método do dosímetro; b) teste de exercício: corrida livre em um corredor de 50 m; c) teste de exercício: bicicleta ergométrica com ar seco. A freqüência cardíaca atingida foi 80 a 90 por cento da freqüência cardíaca máxima. A espirometria foi realizada aos 3, 6, 10, 15, 20 e 30 minutos após o exercício. Broncoespasmo induzido por exercício foi definido como a queda de volume expiratório forçado no primeiro segundo (VEF1) > 10 por cento em relação aos valores pré-teste. RESULTADOS: A média de idade foi 11±3 anos. O VEF1 e VEF1/CVF (capacidade vital forçada) foram normais e similares antes dos três testes de broncoprovocação. A freqüência cardíaca máxima foi de 178±7 bpm durante o exercício na bicicleta e 181±6 bpm na corrida livre (p > 0,05). Broncoespasmo significante foi visto em 23 crianças após o teste com metacolina, em 19 após a corrida livre e em 14 crianças após exercício em bicicleta (p < 0,05, metacolina versus testes de exercício). Levando-se em conta todas as medidas de VEF1 após o exercício, a corrida livre resultou em maior broncoespasmo em relação à bicicleta ergométrica (p = 0,003, chi2 = 8,948). Houve significante porém fraca correlação entre a queda máxima de VEF1 após a corrida livre e bicicleta (r = 0,46, p < 0,01). CONCLUSÕES: A broncoprovocação com metacolina identifica um maior número de asmáticos quando comparada aos testes de exercício. Quando a broncoprovocação com metacolina não estiver disponível, a corrida livre deve ser o teste de escolha, devido à sua simplicidade e maior capacidade de induzir broncoespasmo.

Airway Hyperresponsiveness to Hypertonic Saline as a Predictive Index of Exercise-Induced Bronchoconstriction

BACKGROUND: Changes in airway mucosal osmolarity are an underlying mechanism of bronchoconstrictive responses to exercise and hypertonic saline (HS). The purpose of this study was to examine whether an osmotic challenge test using HS can predict exercise-induced bronchospasm (EIB) in asthma patients. METHODS: Thirty-six young male asthmatic patients underwent bronchial challenge tests based on 4.5% HS, exercise (> 24h later), and methacholine (MCh) at the Chonnam National University Hospital. The relationships between responses to HS and exercise, and between MCh and exercise were evaluated. RESULTS: The maximal fall in forced expiratory volume in one second following exercise was significantly higher in the HS-responders (n=19) than in the HS-nonresponders (n=17, 35.9+/-4.1% vs. 17.9+/-2.7%, p< 0.001), and there was a significant correlation between the severity of EIB and HS-airway hyperresponsiveness (AHR). When compared with the MCh-AHR test in terms of predicting EIB, the HS-AHR test showed higher specificity (71.4% vs. 42.9%), but a lower sensitivity (58.6% vs. 89.7%) and negative predictive value (29.4% vs. 50.0%). At the moderate AHR cutoff value, the MCh-AHR test had a specificity that was comparable with and predictive values that were higher than those of the HS-AHR test. CONCLUSIONS: The HS-AHR test was more specific than the MCh-AHR test, but was less sensitive and had a poorer negative predictive value, which in combination preclude the use of the HS-AHR test as a screening tool for EIB. The MCh-AHR test had a cutoff value for moderate AHR that may be more useful for predicting EIB in asthmatic patients.

The prevalence of exercise-induced bronchoconstriction among symptomatic sportsmen.

Exercise-induced bronchoconstriction (EIB) is a transient airflow obstruction that usually occurs 5 to 15 minutes after physical exertion. Although this condition is preventable, it is still underrecognized and affects the quality of life. The purpose of this study was to evaluate the prevalence of EIB, to find out whether self-reported symptoms were enough to establish the diagnosis of EIB and to define related symptoms and risk factors among symptomatic students of a Sports Academy in our city, which is situated at about 2,000 meters altitude and experiences a long winter period. A questionnaire was sent to students of the Sports Academy. After its evaluation, symptomatic students were invited to perform a pulmonary function test (PFT) before and after a six minute exercise test. Two hundred and seventy-seven students (205 males and 72 females, mean age: 20+/-4) from 12 different types of sport replied to the questionnaire. Of these subjects, 43% were symptomatic. Out of the 119 symptomatic students, 63 accepted our invitation. Three of them were excluded. After performing a six-minute exercise test, EIB was observed in 5 (8%) of them, whose symptoms were aggravated by cold weather. Our results suggest that EIB may be common among symptomatic sportsmen. Screening is important, since EIB could be prevented with appropriate diagnosis and treatment. Although respiratory symptoms during exercise may give important clues, only these symptoms are not sufficient to establish the diagnosis of EIB. Symptomatic patients should undergo further tests for EIB.

Prevalence of exercise-induced bronchospasm in national Hockey players of Pakistan

To determine prevalence of Exercise-induced Bronchospasm [EIB] in hockey players, who had represented or were aspiring to represent Pakistan at international level. An observational, cross-sectional study was done on the prevalence of EIB in national hockey players of Pakistan. All participants of the training camp [n=27] players were included in this study, after obtaining permission from the Pakistan Hockey Federation. An acquaintance session was conducted to introduce the study, and for the correct recording of Peak Expiratory Flow [PEF] rate. On field-testing day, pulse and PEF rates were measured first without any exercise and warm up [pre-exercise PEF rate]. After competitive 6 minute [6-min] field free running, pulse rate was measured to ensure that players heart rate has reached 70% of the predicted maximum heart rate. PEF and pulse rates were measured at 5-min, 15-min and 30-min post exercise. A player was considered EIB positive based on a post exercise decrement in PEF rate

Exercise-induced asthma among Thai asthmatic children.

BACKGROUND: Approximately seventy per cent of asthmatic children from temperate climates, with normal lung function, have exercise-induced asthma (EIA). There is certain evidence to suggest that EIA may be less frequently encountered among children who live in tropical climates. Prevalence of EIA in Asian asthmatic children has never been thoroughly studied. OBJECTIVE: To study the prevalence of EIA among Thai asthmatic children. METHOD: A prospective study was performed to determine the prevalence of EIA in 44 Thai asthmatic children who were able to perform the spirometric maneuver. Subjects were randomly selected asthmatic children from the Pediatric Allergy Clinic, Department of Pediatrics, Siriraj Hospital. They were subjected to exercise testing on a steady state, motor-driven treadmill for 6 minutes (mean speed +/- SD = 3.7 +/- 0.4 km/h, mean level of inclination + SD = 15.0 +/- 5.2 degrees). The testing was conducted in a temperature-controlled (mean temperature +/- SD = 24.4 +/- 0.8 degrees C) and humidity-controlled environment (mean relative humidity +/- SD = 41.7 +/- 2.1%). Lung function tests were performed before exercise, immediately after and at 3, 5, 10, 15, 20 and 30 minutes after exercise. Results of the lung function test were calculated as per cent falls of forced expiratory volume in 1 sec (FEV1), peak expiratory flow rate (PEFR), and forced expiratory flow at 25 per cent-75 per cent (FEF50) from baselines. EIAs were diagnosed when drops of FEV1, PEFR and FEF50 were greater than 20 per cent, 25 per cent and 25 per cent from baseline values, respectively. RESULTS: Of the 44 patients studied (31 boys and 13 girls; mean age 11.9 years), 34 per cent had mild asthma. Fifty-nine per cent had moderate asthma and 7 per cent had severe asthma. Eleven patients (25%) had EIA diagnosed by significant falls of FEV1's (26 +/- 12.6%), whereas, 13 patients (30%) and 20 patients (45%) had EIA defined by significant drops of PEFR's and FEF50's, respectively. A total of 23 patients (52%) had EIA by one or more diagnostic criteria. Peak times for EIA as diagnosed by FEV1, PEFR and FEF50 occurred at 3, 10, and 10 minutes respectively, after exercise. Most EIA episodes observed were of mild degree. CONCLUSIONS: The prevalence of EIA in Thai children is much lower than figures reported in studies from Western countries. By using a significant fall of FEV1's as the diagnostic criteria, only 25 per cent were diagnosed as having EIA. By PEFR and FEF50 criteria, percentages of EIA increased to 30 per cent and 45 per cent respectively. Screening for EIA, therefore, may not be an appropriate diagnostic tool for the diagnosis of childhood asthma in tropical climates.

Exercise - induced bronchospasm in soccer players

Exercise is one of the most prevalent predisposing factors of bronchospasm. Its symptoms may be merely due to physical activities. Clear understanding of exercise-induced bronchospasm is essential to eliminate complications and achieve more effective treatment. The study population consisted of Tehran soccer-players. In this clinical trial, four soccer clubs were selected by cluster random sampling. The means of data collecting included history taking, physical examination, and the performance of spirometry tests at rests as well as 5 and 12 minutes after exercise. One hundred soccer players were enrolled in this study with the mean age [ +/- SD] of 20 +/- 4.26 years old. The mean values of FEV1 +/- SD measured at 5 minutes before as well as 5 and 12 minutes after a ten-minute continuos exercise were 4.15 +/- 0.44, 4.13 +/- 0.5, and 4.12 +/- 0.49 liter respectively. These differences seem to be age related.12 minutes after exercise, 6 players have shown reduced FEV1 [15-17%] in respect of resting value [4.78 +/- 0.52 vs. 3.57 +/- 0.33]. The prevalence of exercise-induced bronchospasm was 6% in our study, comparable to 3-11% reported of others. The lower prevalence of exercise- induced bronchospasm in our study may be due to older study group, negative history of allergy and pulmonary diseases in our cases

Broncoespasmo induzido por exercício (BIE) / Bronchospasm caused by exercise

Objetivo: O autor apresenta uma revisão a respeito do broncoespasmo induzido por exercício com ênfase na sua prevalência e sintomas respiratórios. Métodos: Foram selecionados os artigos mais significativos e de maior destaque acerca da doença desde a sua descrição em 1946. Resultados: O broncoespasmo, induzido por exercício, representa um exemplo de responsividade brônquica anormal a estímulo não imunológico. A hiper-responsividade brônquica é uma condição básica para que haja o desenvolvimento do broncoespasmo induzido por exercício. É importante ressaltar que esta condição é reversível, principalmente se o tratamento é estabelecido no início da doença. Conclusão: O broncoespasmo, induzido por exercício, é uma patologia ainda pouco conhecida no que se refere ao seu tratamento, diagnóstico e prognóstico. A maioria necessita de um tratamento completo da asma, pois os sinais e sintomas relacionados ao exercício, na verdade são manifestações de um processo inflamatório mais acentuado e hiper-responsividade brônquica subjacente.

Objective: The author presents a review about exercise induced bronchospasm, with particular emphasis on prevalence and respiratory symptoms. Methods: The most relevant articles concerning the disorder were selected, from the inicial description of the disease, in 1946. Results: Exercise induce bronchospasm represents an abnormal bronchial responsiveness to a non immunological stimulus. Bronchial responsiveness in necessary to have exercise induce bronchospasm. It is important to emphasise that this condition is reversible particularly if the treatment is started in the beginning of the disease. Conclusions: Exercise induce bronchospasm is still a condition scarcely known among paediatricians, particularly regarding treatment, diagnosis and prognosis. The majority needs a complete treatment of asthma particularly because the respiratory symptoms related to exercise represents a great inflammatory process.

Efecto del calentamiento sobre el VEF-1 en niños con asma sometidos a reto por ejercicio / The effect of a heating routine in children with asthma

Antecedentes: el broncoespasmo inducido por ejercicio, también llamado asma por ejercicio, es una afección frecuente que acompaña comúnmente al paciente asmático. Su frecuencia es de alrededor del 80 al 90 por ciento para los pacientes con asma; se presenta en 40 al 50 por ciento de los niños con rinitis alérgica, en 14 por ciento de los atletas y en 12 por ciento de la población en general. Objetivo: determinar la eficacia de una rutina de calentamiento como agente preventivo del broncoespasmo inducido por ejercicio. Método: se incluyeron 30 pacientes de entre 10 y 16 años de edad, asmáticos y con broncoespasmo inducido por ejercicio diagnosticado mediante prueba de reto al ejercicio. Todos los pacientes realizaron una rutina de ejercicio con duración de 20 minutos durante los cuales se efectuaron movimientos de elasticidad, calistenia y actividad leve dirigida al ejercicio a desarrollar, tomando como parámetro objetivo el 60 por ciento de la frecuencia cardiaca submáxima. Enseguida, todos los pacientes realizaron nuevamente reto al ejercicio, en la que se utilizó una banda sinfín, con velocidades que se incrementaron progresivamente de 1 a 8 km/h y con inclinación de 0 - 10 0. Los registros espirométricos se efectuaron antes del reto y a los 2, 5, 10, 15, 20, 25, 30 y 60 minutos después del mismo. Resultados: el promedio de edad de los pacientes fue de 12.8 ñ 2 años con talla de 157 ñ 10 cm. Conclusión: el calentamiento en niños con broncoespasmo inducido por ejercicio actúa como un agente protector contra el decremento del VEF-1. Si bien el calentamiento puede ser un buen método de control en el paciente asmático, es necesario tener en cuenta que no todos los pacientes tienen un beneficio con dicha protección.Éste sólo puede utilizarse en pacientes con actividad física programada, ya que en los preescolares no es posible implantar una rutina de calentamiento por las características propias de su actividad.

Asma por ejercicio: utilidad de marcadores en orina / Exercise induced asthma: utility of urinaria markers

Antecedentes: los metabolitos estables de la Prostaglandina D2 (PGD2) mastocitaria 9 Ó11ß Prostaglandina F2 (9 Ó11ßPGF2) y de los cis-leucotrienos (LTE4) medidos en orina reflejan la producción de estos mediadores. Objetivos: determinar el rol de los leucotrienos y de la Prostaglandina D2 a través de la relación existente entre la provocación del asma por ejercicio (AIE) y los niveles urinarios de Laucotrieno E4 (LTE4) y 9 Ó11ßPGF2. Materiales y métodos: fueron estudiados 24 niños con asma (6-14 años) y 9 niños sanos como control. En todos los asmáticos y en 5 controles se evaluó la presencia de AIE mediante prueba de carrera libre durante 7 min, alcanzando el 80 por ciento de frecuencia cardíaca máxima para la edad. Se realizaron espirometrías basales y post prueba (secuenciales) y se colectó orina inmediatamente antes y 45 minutos despues de la prueba. LTE4 y 9 Ó11ßPGF2 fue evaluada por enzimainmunoensayos específicos. Resultados: Los 5 controles normales no presentaron asma por ejercicio, de los 24 pacientes asmáticos 12 no presentaron AIE y en 12 la prueba fue posititva (VEF1s cae > 15 por ciento). Las medias de los valores basales y post ejercicio de LTE4 y 9 Ó11ßPGF2 en pg/mg creatinina se tabulan a continuación: Asma por ejercicio: 9 Ó11ßPGF2: Basal: 3,39; Post: 7,95; p=0,001; LTE4: Basal: 4,00; Post: 9,39; p=0,002. Asma sin ejercicio: 9 Ó11ßPGF2: Basal: 3,98; Post: 6,28; p=0,02; LTE4: Basal: 5,91; Post: 7,04; p=0,242. Los niveles de 9 Ó11ßPGF2 y LTE4 de los controles normales no variaron significativamente post ejercicio. Conclusión: en los pacientes con asma por ejercicio se verifica activación mastocitaria con liberación de PGD2 que se demuestra como aumento de 9 Ó11ßPGF2 urinaria, y de los leucotrienos aumento del LTE4. El aumento de LTE4 es específico para asma por ejercicio en tanto que la 9 Ó11ßPGF2 aumenta en ambos grupos

Efecto del ejercicio dinámico y estático sobre la función cardiorespiratoria en el paciente asmático / Effect of static and dynamic exercise on the cardiorespiratory function in the asthmatic

El ejercicio constituye un factor desencadenante del asma bronquial, pues representa un estímulo no farmacológico y no inmunológico, que puede producir episodios agudos de obstrucción de las vías aéreas en los pacientes asmáticos. El objetivo del presente estudio fue el de evaluar el efecto del ejercicio dinámico y estático, sobre la función respiratoria y cardiovascular en pacientes asmáticos adolescentes y adultos jóvenes, por ser este grupo etario, el que más frecuentemente se ve sometido a un alto nivel de actividad física. Se estudiaron 30 pacientes asmáticos leves a moderados (F=16; M=14) entre 10 y 30 años (E.P.=18,7), en condiciones estables al menos durante 14 días; sin recibir tratamiento con drogas broncodilatadoras durante 24 horas ni drogas preventivas por lo menos un mes antes. A los pacientes seleccionados se les evaluaban los parámetros espirométricos (VEF-lseg; CVF; PEFR), presión arterial y frecuencia cardíaca en condiciones basales y a los 3,5,10,15,30,60 y 120 minutos posterior a la realización de un ejercicio dinámico (15 minutos pedaleando en un engómetro) o ejercicio estático (elevar una columna de mercurió a 140 mmHg y mantener por 10 minutos). El ejercicio dinámico produjo un descenso de los tres parámetros respiratorios, siendo la respuesta mayor a los 3 minutos para el PEFR y CVF (11,49 por ciento y 6,93 por ciento respectivamente) y a los 10 minutos para el VEF-1seg de 6,29 por ciento (p mayor e igual 0.005) con relación al valor basal. El ejercicio estático produjo una disminución de los parámetros estudiados, pero en menor porcentaje que el ejercicio dinámico, pero estadísticamente significativos (p mayor e igual 0.05) en relación a los valores previos. La presión arterial sistólica se elevó con los dos tipos de ejercicio (p mayor e igual 0.001), la presión arterial diastólica ascendió más con el ejercicio estático que con el ejercicio dinámico y la frecuencia cardíaca se elevó con ambos tipos de ejercicio. En conclusión, ambos ejercicios tanto dinámico como estático lograron descender los parámetros de funcionalismo pulmonar, siendo la disminución más acentuada con el ejercicio dinámico y la presión arterial diastólica se eleva considerablemente con el ejercicio estático

Respuestas cardiorrespiratorias en niños asmáticos / Cardiorespiratory answer in asthmatic children

El objetivo de este trabajo fue hallar un patrón que identifique los cuadros de alto riesgo desde el punto de vista cardiovascular. Fueron estudiados 132 asmáticos que concurren al Programa de Rehabilitación, a quienes se les efectuó espirometría preejercicio-posejercico, ECG, ergometría y ecocardiograma. Como conclusiones podemos establecer que: a)La mayoria de los niños asmáticos con ECG anormales (29,55 por ciento) correspondian al grupo con asma leve. b)La ergometría fue útil como elemento provocador de broncopasmo y aparición de arritmia. c)El ecocardiograma no aportó elementos en la valoración del asmático

Valoración y respuesta del niño asmático ante la indicación de ejercicios / Voloration and answer of the asthmatic child in the presence of physical excersices

The purpose of this work is to clarify and to establish rules about the worth of the asthmatic child in the presence of phisycal excercises. Forty one children between 6 and 14 years old have been studied the aerobics and sports lessons for asthmatic children in the Children Hospital in Paraná, whose level of asthma ranges from light to rigorous. The air hiperreactivity with the excercise was inducted in the ergonometric tape getting to the 85% of cardiac maximum the spirometric was tested before and 7 minutes after the excercise. Considering as positive the decrease of FEV, below the 15% the study has been done with temperatura and wetnese between 22-C and 40-50% wet providing the patient didn't take any drug 12 hours before the experiment. There is direct correlation between the level of severity of the asthma and the clinical worse. At of those 41 tested children the symptons were intensified in 23 children (56%) in 17 children they were not changed (42%) and in 1 case it was better (2%). That clinical was correlated with spirometric changes noticing that the children suffering from light asthma represent the highest porcentage that didn't change their spirometric. The ergometric usuful to standardize the effort, to measure cardiologically and to detect subclinical cardiac alterations. The fact of standard the methods that have been praactised take us to campare the response of severiry obstruction among the different groups and it can determine the preventive therapy. The doctor must instruct the patient, the parents and the trainers about which kinds of sports to practise the benefits offered by the physical activity. Fulfilling this methodology allows us to organize an aerobic and sports

Espirometría y Servicio Militar / Spirometry and Military Service

El estudio de la función pulmonar por medio de la Espirometrías, a través de la metología empleada es una prueba válida para evaluar a los pacientes con antecedentes de enfermedad pulmonar obstructiva, en particular Asma Bronquial, que deben realizar el Servicio Militar o en su defecto, cualquier otra actividad donde el esfuerzo físico sea un desencadenante de crisis asmáticas o de hiperreactividad bronquial. En pacientes que al momento de la primera consulta no manifestaron sintomatología clínica (disnea, roncus, sibilancias, etc) se le efectuaron Espirometrías pre y pos-ejercicio además de evaluar su respuesta a un broncodilatador nebulizado. Del total de pacientes estudiados pudo determinarse que 65,33%evidenciaron una disminución porcentual del Flujo Espiratorio Medio Forzado (FEMF 25%-75%) por debajo del 80%, situación determinante para considerar que el individuo en estudio, además de los antecedentes clínicos, inmunológicos y de laboratorio que pudiera presentar, NO ES APTO para realizar el Servicio Militar. El Grupo Testigo tuvo respuestas normales en todos los casos