Subjective responses to sprint interval exercise in adults with and without Exercise-induced bronchoconstriction.

OBJECTIVE: Little is known of the subjective response to exercise that involves short "all out" bursts of effort, separated by recovery periods (sprint interval exercise (SPRINT)) among adults with exercise-induced bronchoconstriction (EIBC). The purpose of this study was to compare subjective responses to SPRINT and moderate intensity continuous exercise (MOD) among adults with EIBC, and to compare these responses between adults with EIBC and those without EIBC. METHODS: Eight adults (22.3 ± 3.0 years) with EIBC, and eight adults (22.3 ± 3.0 years) without EIBC completed a SPRINT (4 × 30 second sprints separated by 4.5 minutes of active recovery) and MOD (20 minutes at 65% peak power output) session in random order. Self-reported affect, perceived breathlessness, and perceived exertion were recorded throughout exercise using validated scales. Enjoyment was assessed following exercise. RESULTS: Differences between SPRINT and MOD were observed such that affect and perceived breathlessness were worse during the initial stages of SPRINT than MOD; however, differences disappeared by the end of exercise. Enjoyment was similar for SPRINT and MOD in the EIBC group (SPRINT: 72.9 ± 20.0 vs. MOD: 79.5 ± 20.5, p = 0.25), and between groups for SPRINT and MOD. CONCLUSIONS: Perceived breathlessness may impact affect during the early stages of exercise among those with EIBC. Post-exercise enjoyment appears to be similar between SPRINT and MOD. Future research is needed to better understand the relationship between ventilation patterns, exercise intensity, and enjoyment of exercise among those with EIBC.

Exercise-induced bronchoconstriction in athletes - A qualitative assessment of symptom perception.

BACKGROUND: A poor relationship between perceived respiratory symptoms and objective evidence of exercise-induced bronchoconstriction (EIB) in athletes is often reported; however, the reasons for this disconnect remain unclear. The primary aim of this study was to utilise a qualitative-analytical approach to compare respiratory symptoms in athletes with and without objectively confirmed EIB. METHODS: Endurance athletes who had previously undergone bronchoprovocation test screening for EIB were divided into sub-groups, based on the presence or absence of EIB ± heightened self-report of dyspnoea: (i) EIB-Dys- (ii) EIB + Dys+ (iii) EIB + Dys- (iv) EIB-Dys+. All athletes underwent a detailed semi-structured interview. RESULTS: Twenty athletes completed the study with an equal distribution in each sub-group (n = 5). Thematic analysis of individual narratives resulted in four over-arching themes: 1) Factors aggravating dyspnoea, 2) Exercise limitation, 3) Strategies to control dyspnoea, 4) Diagnostic accuracy. The anatomical location of symptoms varied between EIB + Dys + athletes and EIB-Dys + athletes. All EIB-Dys + reported significantly longer recovery times following high-intensity exercise in comparison to all other sub-groups. Finally, EIB + Dys + reported symptom improvement following beta-2 agonist therapy, whereas EIB-Dys + deemed treatment ineffective. CONCLUSION: A detailed qualitative approach to the assessment of breathlessness reveals few features that distinguish between EIB and non-EIB causes of exertional dyspnoea in athletes. Important differences that may provide value in clinical work-up include (i) location of symptoms, (ii) recovery time following exercise and (iii) response to beta-2 agonist therapy. Overall these findings may inform clinical evaluation and development of future questionnaires to aid clinic-based assessment of athletes with dyspnoea.

Perception of Exercise-Induced Bronchoconstriction in College Athletes.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) can lead to long-term respiratory illness and even death. EIB prevalence rates are both high and variable in college athletes. Also, prevalence rates may be underestimated due to ineffective screening. The purpose of this study is to investigate the prevalence of EIB and the perceived impact of EIB in college athletes via a self-report questionnaire. METHODS: A self-report EIB questionnaire was administered to college athletes on 8 different sports teams. Information collected was used to identify athletes who self-reported: (1) a history of EIB and/or asthma, (2) respiratory symptoms during exercise, (3) medication use, and (4) concern about EIB. RESULTS: Results showed that 56 of 196 athletes (28.6%) self-reported a history of EIB or asthma. Over half (52%) reported a history of EIB/asthma or current EIB symptoms. Forty-six of the 140 athletes (32.9%) who did not report a history of EIB or asthma indicated symptoms of EIB during sports, training, or exercise. Fourteen of 56 athletes (25%) self-reporting a history of EIB or asthma did not report the use of a respiratory medication. Nineteen of 196 athletes (9.7%) reported being concerned that EIB was adversely affecting their sports performance. CONCLUSIONS: College athletes self-report a high prevalence of EIB or asthma. Although college athletes may not report a history of EIB or asthma, they indicate symptoms of EIB. A majority of athletes reported a history or current symptoms related to EIB or asthma. Many athletes with a history of EIB or asthma are not taking any asthma medication. Last, athletes report concern about EIB adversely affecting their sports performance. More work is needed using a combination of a screening questionnaire and standardized EIB testing to develop a validated tool for accurately screening and diagnosing EIB in college athletes.

The impact of discussing exercise test results of young asthmatic children on adherence to maintenance medication.

OBJECTIVE: Parents' awareness of their child's asthma may improve by discussing an exercise challenge test (ECT) result with them. We investigated the influence of discussing an ECT result with parents on adherence to inhaled maintenance medication, parental illness perceptions and medication beliefs in young asthmatic children. METHODS: A total of 79 children, 4-7 years old and enrolled in our standard comprehensive asthma care program, performed an ECT to assess exercise induced bronchoconstriction (EIB). The result of the ECT was immediately discussed with the parents. Median medication adherence level was measured with electronic medication loggers from six weeks before the ECT till six weeks afterwards. Parental beliefs about medicines and illness perceptions were measured with the Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perceptions Questionnaire (B-IPQ). RESULTS: The median baseline adherence level was high (83%) and showed a small significant decline after the ECT. There was no significant difference in the decrease in median adherence level between the children with or without EIB. Most parents (82.1%) showed a positive necessity-concern ratio at baseline, as measured with the BMQ. There was no clinical relevant change in medication concerns and necessity scores or in illness perceptions. CONCLUSION: Discussing ECT results with parents does not modify median adherence levels to inhaled maintenance medication nor medication beliefs of highly adherent young asthmatic children who are already enrolled in a comprehensive asthma care program.

Effect of exercise-induced bronchospasm and parental beliefs on physical activity of asthmatic adolescents from a tropical region.

BACKGROUND: Physical activity (PA) is an essential health promotion factor. In asthmatic children and adolescents, exercise-induced bronchospasm (EIB) and parental beliefs and attitudes toward PA may be limiting issues. OBJECTIVE: To compare PA levels in asthmatic adolescents with and without EIB and the influence of mothers' beliefs of asthma worsening due to PA and attitudes in restraining their children's PA, asthma severity, severe EIB, or bronchospasm perception. METHODS: We performed a cross-sectional, hypothesis-testing study from December 1, 2008, through August 31, 2009, using the International Physical Activity Questionnaire to assesses PA levels in 134 asthmatic adolescents (10-19 years of age, 60% male) from an underprivileged community. EIB was defined as a decrease in forced expiratory volume in 1 second greater than 10% from basal 5, 15, or 30 minutes after treadmill running for 8 minutes. Subjective factors were evaluated through specific questionnaires. RESULTS: EIB was diagnosed in 46% of patients and was not associated with lower PA levels (odds ratio, 1.62; 95% confidence interval, 0.75-3.52). The other factors evaluated were also not associated with lower PA levels, although 78% of the mothers said they believe asthmatic children cannot participate in PA as much as nonasthmatic children, 44% that exercise can be harmful, and 52% that they restrained their children's PA. CONCLUSION: We found no association between EIB and low PA levels, although EIB was a frequent event that should be addressed by health care professionals, along with mother's beliefs and attitudes toward PA.

Exercise-induced asthma is associated with impaired quality of life among children with asthma in Japan.

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.

Perceptions and pathophysiology of dyspnea and exercise intolerance.

Dyspnea is a complex psychophysiologic sensation that requires intact afferent and efferent pathways for the full perception of the neuromechanical dissociation between the respiratory effort attempted and the work actually accomplished. The sensation is triggered or accentuated by a variety of receptors located in the chest wall, respiratory muscles, lung parenchyma, carotid body, and brain stem. The sensation of dyspnea is stronger in patients with higher scores for anxiety and has been reported in patients with anxiety disorders with no cardiopulmonary disease. These observations demonstrate the importance of cerebral cognition in this complex symptom. Ten cases are presented that illustrate different clinical manifestations of dyspnea.

Perception of exercise induced asthma by children and their parents.

BACKGROUND: Exercise induced asthma (EIA) plays an important role in clinical evaluation. There has been little previous work validating EIA as reported directly by children and indirectly by their parents. AIMS: (1) To determine the strength of the association between children's symptoms of EIA and their physiological response to exercise in a laboratory setting. (2) To compare parents' perception of EIA with that of their children. (3) To seek factors influencing the perception of EIA. METHODS: Forty three asthmatic children and their parents answered a questionnaire, which included measures of symptom perception in EIA using visual analogue (VAS) and Likert scales. The children underwent a standardised treadmill exercise challenge, using spirometry to measure the physiological outcome, after which they and their parents independently completed the symptom scores. Twenty four subjects agreed to return for a second visit, in order to assess repeatability. RESULTS: The VAS and Likert scales were highly correlated. Children's symptom perception as measured by change in VAS scores related weakly to change in FEV(1) after exercise, and was unaffected by confounding factors such as age, gender, medication, and habitual exercise. Parents' perception of symptoms was unrelated to any physiological measure. There was no significant relation between parent and child VAS scores after exercise, and there was poor agreement between the Likert scale scores after exercise. The repeatability of the perception of change in FEV(1) after exercise was poor for both parents and children. CONCLUSION: Physicians should obtain reports of EIA from children rather than parents, but be aware of their limited accuracy and repeatability.

The influence of lung function information on self-reports of dyspnea by children with asthma.

Studied the influence of actual and false peak flow (PEF) information on dyspnea (breathlessness) in two experiments, each with 30 children with and 30 without asthma (7-17 years). Dyspnea, PEF, and lung function were measured before and after standardized physical exercise. Dyspnea was measured with a visual analog scale. PEF was measured with a peak flow meter and used for manipulation of dyspnea. The first experiment showed that the relationship between dyspnea and lung function was not stronger when children had knowledge of PEF values. The second experiment revealed that asthmatic children who received false feedback of 30% below the actual PEF reported significantly more dyspnea. Implications for the management of asthma are discussed.

The impact of asthma in an inner city general practice.

This study was undertaken to find out the problems which children with asthma experience at school and at home. Patient interviews with 32 asthmatic children aged between 6 and 16 years using a semi-structured questionnaire were carried out in an inner city practice in Bristol. Twenty-three (71.8%) children experienced exercise-induced bronchospasm which particularly upset them at school. Eleven of 14 (78.5%) secondary schoolchildren said not being able to participate in sport was the worst thing about having asthma. Children seemed to accept that their inability to participate in sport was normal. Fourteen primary schoolchildren (77.7%) had restricted access to their inhalers. Primary schoolchildren were upset most by coughing or wheezing. Of 21 children who said smoke made their asthma worse, 18 lived in households where someone smoked. Children were more distressed by how their asthma affected them at school than at home. Thirty-one (96.8%) of the children viewed their asthma negatively, although 26 (81.2%) felt they were in control of their asthma. School age children may have undiagnosed, exercise-induced bronchospasm causing considerable physical and psychological morbidity and are therefore being inadequately treated. Children's negative views of their asthma may be missed by conventional questioning and asthma clinics should ensure that children are encouraged to reveal the issues that concern them. Children should have easy access to their medication at school. Locally agreed management of asthma in schools may improve morbidity from asthma.

Prevention of asthma induced by cold air by cellulose-fabric face mask.

We have tested the effect of a porous cellulose fabric face mask. Nine asthmatic patients, anamnestically sensitive to cold, took part in exercise tests on an ergometer bicycle at a temperature of approximately -10 degrees C, with and without a face mask. For comparison, exercise tests were also performed with breathing taking place through a woolen scarf. Three minutes after finishing the exercise test, there was an average fall in FEV1 of 32% in the group without a face mask. The corresponding fall in FEV1 was 6% with a face mask and 17% with a scarf. In order to get some idea of the patients' attitudes to the face mask, it was used by 25 asthma patients during a period of 2 weeks in winter, after which they were asked to answer a simple questionnaire. Eighty-eight percent of the patients stated that the face mask had provided satisfactory protection against asthma complaints induced by cold air, and 72% reported that they had been able to spend more time out-of-doors. The results show that porous cellulose fabric designed as a face mask offers effective protection against asthma complaints induced by cold air and exercise, and that the patients appear to appreciate this protective aid highly despite the cosmetic disadvantages.

Development of child-centered disease-specific questionnaires for living with asthma.

Contemporary developments in the management of chronic diseases such as diabetes and asthma offer possibilities for optimal control, but patients increasingly need to take on responsibilities for self care. Health professionals require comprehensive assessments of outcome that include data reflecting patients' perceptions of their disorder and its management. Disease-specific, patient-centered questionnaires for evaluation of adults' health-related quality of life are available for diabetes and asthma. Little progress is evident in relation to pediatric instruments. This paper describes the development of such an instrument for measurement of 8- to 11-year-olds' perceptions of their asthma--the CAQ-B Psychometric characteristics of the CAQ-B are reported: principal axis factor analysis resulted in the derivation of four subscales reflecting children's perceptions of both active and passive aspects of living with asthma, together with their perceptions of its severity and any associated distress. Preliminary explorations with CAQ-B included comparisons of parents', doctors', and children's ratings of severity; comparisons of data from asthmatic and nonasthmatic children; comparisons of data from boys and girls.

Perception of breathlessness during bronchoconstriction induced by antigen, exercise, and histamine challenges.

Perception of breathlessness was studied in eight patients with mild, stable asthma after a histamine and exercise challenge performed before and 24 and 48 hours respectively after an antigen challenge. FEV1 and perception of breathlessness, evaluated by Borg's 10 point category scale, were measured after each administration of doubling antigen or histamine concentrations to achieve a greater than 20% fall in FEV1, and after six minutes of steady state exercise at 80% of maximal oxygen consumption (VO2max). The geometric mean provocative concentration of histamine causing a 20% fall in FEV1 (PC20) fell from 1.67 mg/ml before antigen challenge to 0.52 mg/ml 24 hours after the challenge. The median maximal % fall in FEV1 with exercise was 24.9% (range 10.5-40.5%) before and 30.6% (range 13.8-52.3%) 48 hours after antigen challenge. The median maximum % fall in FEV1 after antigen inhalation was 20.1% (range 13.3-35.2%) within the first hour; only two subjects had a late fall in FEV1 (23% and 58%). The median (range) of Borg scores obtained when FEV1 was reduced by 20% did not differ significantly for the three types of acute challenges: 1.25 (0.5-2.5) and 1.0 (0.5-3.0) after histamine tests, 1.0 (0.5-4.1) and 1.55 (0.5-2.0) after exercise, and 1.5 (0-3.0) after antigen challenge. In the two subjects who had a late response to antigen the Borg score was reduced for the same % fall in FEV1 as with the early response. It is concluded that the perception of breathlessness does not differ appreciably during the early response to histamine, antigen exposure, or exercise, but that it is reduced during the late asthmatic response. It was not influenced by previous antigen exposure, despite an increase in airway responsiveness.

[Childhood asthma and sports in school: a survey of teachers of sports and physical education]. / L'enfant asthmatique et le sport au collège: enquête aupr+5Es des professeur d'éducation physique et sportive.

Exercise induced bronchial obstruction is very common in asthmatic children who represent at least 5% of the general paediatric population. 89 teachers of physical education at school replied to a questionnaire on asthma: 82% knew the existence of exercise induced asthma, all thought that asthmatics can do sport at school; however their knowledge of this disorder seemed insufficient to offer sporting activities in a satisfactory manner; the idea of asthma as a psychological disorder is well ingrained (61.6%), they felt that necessarily the bronchial obstruction should be noticed by the asthmatic (58%) and finally a significant proportion (29%) thought that they had never seen a child in an asthmatic crisis during their lessons. The majority (88%) were favourable to information on asthma given by an information film followed by a discussion.

The effect of exercise and induced expectations on visceral perception in asthmatic patients.

It is assumed that visceral perception of the asthmatic patient is not only influenced by the physiological response itself but also by cognitions, i.e. specific illness related attitudes and expectations. Thirty-two adult asthmatics were studied in a 2 X 2-factorial design to examine the effect of physical exercise due to an ergometer capacity test (set at a load of 40 and 80 watt respectively) and induced expectations about the consequences of this task on broncho-constriction. Two sets of instructions were used to induce anticipations of harmful and non-harmful consequences respectively. The following dependent variables were registered: airways resistance, skin resistance and visceral perception (rating of physiological changes). Before the experiment the habitual way of reacting to asthma-relevant cues in each subject was assessed. Only small effects of the different ergometer loads on physiological responding and no effects of the experimental variables on visceral perception were found using an analysis of variance approach. A covariance analysis, however, using the trait variable as covariate, demonstrated that the induced 'harmful' anticipation significantly intensified the perception of visceral changes and even had some influence on asthma-relevant physiological responding.

Attitude toward physical education and self-concepts of asthmatic and nonasthmatic children taught by physical education specialists.

50 asthmatic and 741 nonasthmatic children in Grades 4 to 6 were compared on attitudes toward physical education and self-concept. Data were collected using the Children's Attitude Inventory Toward Physical Education, a paired-comparison inventory for indicating preferences among 10 school subjects, and the Children's Self-concept Scale. Analysis of variance and X2 indicated no significant differences between asthmatic and nonasthmatic children on the three measures.

A short exercise and living course for asthmatics.

A 5-day, non-residential exercise and living course for children with asthma is described as a feature of a programme of outpatient physiotherapy. Eleven children undertaking such a course were compared with 10 asthmatic children in a control group. The subject group showed, in the short term at least, an improvement in bronchial lability, peak flow rates, nocturnal and daytime wheeze, and activity compared with the controls. These findings were statistically significant. There was no difference between the groups in the number of days on which extra medication was taken. A short, sharp course is of benefit physically, socially and psychologically to children with asthma.