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.

Asma induzida pelo exercício: aspectos atuais e recomendações / Asma inducido por el ejercicio: aspectos actuales y recomendaciones

OBJETIVO: Descrever os mecanismos da asma induzida pelo exercício (AIE), bem como os efeitos de diferentes tipos de treinamento físico na função pulmonar e nas capacidades aeróbia e anaeróbia. Destaca-se a importância de um diagnóstico correto mediante o teste de exercício e, no manejo, o uso de drogas beta-adrenérgicas e anticolinérgicas. FONTE DOS DADOS: Os artigos foram criteriosamente escolhidos utilizando as bases de dados PubMed e Scielo pelo ano de publicação e dando preferência a ensaios clínicos randomizados, com critérios de seleção da amostra bem definidos. SíNTESE DOS DADOS: Os mecanismos para explicar a AIE permanecem sem conclusão, mas parece haver uma interação fisiológica entre as hipóteses aqui apresentadas. O uso de medicamentos e as freqüentes crises durante o exercício aparecem como fatores limitantes para a prática de exercícios físicos, conduzindo para um estilo de vida sedentário. CONCLUSÃO: Deve-se incentivar a prática de exercícios devidamente prescritos e minimizar as restrições aos sujeitos com AIE.

OBJECTIVE: To describe the mechanisms of Exercise-Induced Asthma (EIA) as well as the effect of different kinds of physical training on pulmonary function, anaerobic fitness, and aerobic fitness. We highlighted the importance of a correct diagnostic through exercise testing and, concerning treatment, the utilization of drugs such as beta-adrenergics and anticholinergics. DATA SOURCE: The articles were chosen using the PubMed and Scielo databases, considering the year of publication and giving preference to clinical randomized trials with well-defined inclusion criteria. SUMMARY OF THE FINDINGS: The medication used and the frequent symptoms during and after exercise appear as a limiting factor to the practice of exercises among subjects with EIA. This may result in a sedentary lifestyle. CONCLUSION: Subjects with EIA should be allowed to do exercise if well prescribed.

OBJETIVO: Describir los mecanismos del asma inducido por el ejercicio (AIE), así como los efectos de diferentes tipos de entrenamiento físico sobre la función pulmonar y las capacidades aeróbica y anaeróbica. Se destaca la importancia de un diagnóstico correcto mediante el test de ejercicio y el manejo o uso de drogas beta-adrenérgicas y anticolinérgicas. FUENTES: Los artículos fueron cuidadosamente escogidos utilizando las bases de dados de PubMed y Scielo por el año de publicación, dando preferencia a ensayos clínicos randomizados, con criterios de selección de muestra bien definidos. SíNTESES DE DATOS: Los mecanismos para explicar la AIE permanecen sin conclusión, pero parece haber una interacción fisiológica entre las hipótesis aquí presentadas. El uso de medicamentos y las frecuentes crisis durante el ejercicio aparecen como factores limitantes para la práctica de ejercicios físicos, conduciendo esto a un estilo de vida sedentario. CONCLUSION: Se debe incentivar la práctica de ejercicios debidamente prescritos y minimizar las restricciones a los individuos con AIE.

Young People and Exercise-Induced Asthma

In many developed and developing countries, asthma is thought to be the most common chronic illness in childhood and it appears to be increasing in prevalence. Bronchial hyper-responsiveness [breathlessness, fatigue, chest pain, etc] to various stimuli, including exercise, is the most specific sign of asthma. Typically exercise-induced asthma [EIA] consists of coughing, wheezing, chest tightness, chest pain or any combination of these symptoms during exercise, or more so, about eight to 15 minutes after exercise. The symptoms of EIA are usually resolved between 30 and 90 minutes. A proper warm-up before strenuous physical activity and a warm-down following exercise appear to offer some protection from EIA. Prevention is the main objective in managing EIA. Some of these precautions can include: [i] an appropriate warm up before vigorous exercise and a gradual warm down after the exercise; [ii] covering the nose and mouth with a mask or a scarf whilst exercising in cool environments; [iii] exercising only in warm and humidified environments; and [iv] improving the baseline fitness of young people who have asthma. The physical fitness and exercise performance of young people with asthma appear to be inferior to those of young people without asthma, but this could be due to their diminished levels of physical activity and unnecessary avoidance of exercise because of the disease. Young people with asthma can benefit from exercise programmes that help raise their levels of physical fitness, especially aerobic fitness. With the proper use of prescribed medication and effective asthma management, young people with asthma are capable of high levels of performance, and need not forego the health benefits that can be harvested with a regime of life-long exercise

Pulmonary function and exercise challenge test in Thai children: 10 years post respiratory syncytial virus infection.

OBJECTIVE: To report the occurrence of asthma, pulmonary function and exercise challenge test abnormalities found in Thai children, who 10 years earlier had lower respiratory tract infection caused by respiratory syncytial virus (RSV-LRI). PATIENTS AND METHODS: 37 children, with RSV-LRI admitted at Ramathibodi Hospital during January 1986 through December 1987, were contacted, of whom 13 patients responded and completed history-review-questionnaires. Pulmonary function measurements at pre- and post-exercise and testing for bronchodilator response were performed. RESULTS: The occurrence of physician-diagnosed asthma in the patients with and without family history of allergic diseases was 75 per cent and 40 per cent, respectively. Of 11 patients who performed spirometry, 45 per cent had concave flow-volume curves, 36 per cent showed decreased ratio of forced expiratory flow in the first second (FEV1) to forced vital capacity (FVC) and 27 per cent showed either decreased forced expiratory flow between 25-75 per cent of FVC (FEF25-75%) or peak expiratory flow rate (PEFR). Of 8 patients who completed exercise challenge tests, 87.5 per cent showed markedly decreased PEFR at post exercise challenge tests and 37.5 per cent had markedly decreased FEV1. 62.5 per cent and 25 per cent showed markedly increased PEFR and FEV, respectively, after inhalation of bronchodilators. CONCLUSION: This study suggests that the occurrence of asthma in children, who had previous RSV-LRI, is relatively high compared with that reported in general Thai children. Baseline pulmonary function tests showed evidence of airway obstruction as demonstrated by concave-shaped flow-volume curves, decreased FEV1/FVC ratio, FEF25-75% and PEFR. The presence of bronchial hyperreactivity to exercise challenge test and positive response to bronchodilators confirms the evidence of exercise-induced bronchospasm in children with history of RSV-LRI.

Bronchoconstrictor effect of exercise in healthy Libyan children in Tripoli

To study the effects of short-term exercise on pulse rate and peak expiratory flow rate in healthy Libyan schoolchildren, 650 healthy students [330 boys, 320 girls] aged 4.5 years to 14.9 years were selected from four randomly chosen Tripoli primary schools. Pulse rate and peak expiratory flow rate were measured at rest in standing position and immediately after rhythmic short-term exercise. Exercise markedly increased pulse rate [mean differences being significantly higher in girls than boys] and markedly reduced peak expiratory flow rate [mean difference being significantly higher in boys than girls]. We found 10% of the children had a reduction in peak expiratory flow rate > or = 15% from the baseline

Etiopatogenia da asma induzida por exercício / Pathogenesis of exercise-induced asthma

O texto procura revisar a etiopatogenia da asma induzida por exercício (AIE), abordando os prováveis estímulos, as vias de transmissäo desses estímulos e a reaçäo tardia. A mudança de temperatura e osmolaridade das vias aéreas exerce importante papel como estímulo para desenvolvimento da AIE. Os mediadores químicos estäo certamente implicados na transmissäo deste estímulo, desencadeando broncoespasmo. A reaçäo tardia ainda representa um campo aberto para pesquisas, apresentando algumas semelhanças com a reçäo tardia induzida por antígenos.

Prevalence of exercise-induced asthma in schoolchildren in Kingston, St. Andrew and St. Catherine, Jamaica

A cross-sectional study was done, focusing on the prevalence of exercise-induced asthma in Jamaica and variables that may account for this rate. No previous study of this nature had been undertaken, and the investigators contend that there is a need to identify children who suffer from this condition but are unaware of it. A sample of 214 students from primary and secondary schools in the corporate area were chosen and given questionnaires to complete. Eighty-four of the children reported a history consistent with that of exercise-induced asthma and were further subjected to stress testing for a definitive diagnosis of this condition. A prevalence of 20.8 per cent [C.I ñ 5.35] was identified which reflected a rate comparable to that recorded in North America. There was a significantly higher prevalence in children of primary school ages, but all other variables considered for significance testing to determine associations between these and the prevalence of EIA proved not significant. A recomendation has been made for opportunity screening by medical practitioners