RESUMO
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.
Assuntos
Asma Induzida por Exercício/epidemiologia , Mães/psicologia , Atividade Motora , Adolescente , Asma Induzida por Exercício/fisiopatologia , Asma Induzida por Exercício/psicologia , Criança , Estudos Transversais , Progressão da Doença , Teste de Esforço , Feminino , Humanos , Masculino , Inquéritos e Questionários , Clima Tropical , Adulto JovemRESUMO
O relato de sintomas respiratórios (chiado no peito, tosse ou dispneia)associados ao exercício físico percebidos pelas crianças ou seus pais,apesar de baixa sensibilidade e especificidade, tem sido frequentementeutilizado para o diagnóstico de broncoespasmo induzido por exercício(BIE) em detrimento da realização do teste formal de broncoprovocaçãocom exercício, o que pode resultar em número excessivo de pacientescom este diagnóstico. Paralelamente a isso, a preocupação com o poucotempo dedicado à realização de atividades físicas (AF) por criançase adolescentes asmáticos tem aumentado e o BIE tem sido apontadocomo um dos fatores limitantes para a prática de AF nesta população. Ospossíveis prejuízos advindos da redução das AF nessa faixa etária alertapara a necessidade de um cuidadoso diagnóstico do BIE e da corretaidentificação daqueles que realmente sofrem limitações pela doença,permitindo a instituição de medidas de controle e a prática segura de AF.Este artigo apresenta uma revisão narrativa da literatura sobre o BIE,fatores limitantes das atividades físicas em crianças e adolescentes asmáticos,o papel da história clínica no diagnóstico do BIE e a importânciade um diagnóstico confiável.
Respiratory symptoms complaints (wheezing, cough, dyspnea)associated with exercise, despite low sensitivity and specificity, hasoften been used as a reliable proxy for the diagnosis of exercise-inducedbronchospasm (EIB) instead of formal exercise bronchial provocationtest, which can result in over diagnosis. Parallel to this, concerns abouta reduction in time devoted to physical activities (PA) by asthmaticchildren and adolescents are increasing and the diagnosis of EIB has beensuggested as one of the limiting factors associated with lower PA levelsin this population. The possible physical, developmental e psychologicalconsequences of PA reduction in this age group warns about the needfor an accurate EIB diagnosis, allowing the institution of effective controlmeasures and encouragement of a safe PA practice. In this narrativeliterature review the authors discuss EIB, factors associated with PAlimitation in asthmatic children and adolescents, the role of dyspneacomplaints in relation to EIB diagnosis and the importance of a reliablediagnosis.