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OBJECTIVE: To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH). MATERIALS AND METHODS: Cross-sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise-induced bronchospasm compatible response (EIB-cr) and 24 asthmatics with EIB-cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH. RESULTS: Twenty-four (52.1%) of asthmatics had EIB-cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB-cr compared to nonasthmatics in the rectus abdominis area (p < 0.05). CONCLUSION: There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB-cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography.
Assuntos
Valor Preditivo dos Testes , Músculos Respiratórios , Termografia , Humanos , Masculino , Feminino , Estudos Transversais , Criança , Adolescente , Músculos Respiratórios/fisiopatologia , Volume Expiratório Forçado , Termografia/métodos , Estudos de Casos e Controles , Fatores de Tempo , Asma Induzida por Exercício/fisiopatologia , Asma Induzida por Exercício/diagnóstico , Pulmão/fisiopatologia , Fatores Etários , Asma/fisiopatologia , Asma/complicações , Asma/diagnóstico , Hiperventilação/fisiopatologia , Espasmo Brônquico/fisiopatologia , Espasmo Brônquico/etiologiaRESUMO
OBJECTIVE: The aim of this study was to analyze whether physical exercise can contribute to improving the control and severity of exercise-induced bronchospasm (EIB) in children and adolescents. METHOD: This is a systematic review that used PubMed/Medline and Scopus databases as a search source, and using descriptors indexed to DeCS/Mesh. The articles were analyzed in three stages in the selection process. Methodological quality was assessed using the TESTEX scale. RESULT AND DISCUSSION: A total of 5867 articles were filtered in the initial search; however, only eight of these were included after the eligibility criteria. All presented improvements in cardiorespiratory fitness. Only two followed the international EIB diagnostic guidelines. Of these, only one described a reduction in FEV1 and considered that this improvement may influence the EIB response in children and adolescent athletes with a non-asthmatic sample. CONCLUSION: The studies analyzed in this review did not enable drawing a conclusion regarding the influence of physical exercise on EIB in asthmatics. The lack of clinical trials on EIB and physical exercise, as well as the difficulty in methodological standardization for EIB diagnosis evidence the lack of scientific knowledge in this area, serving as a stimulus for researchers to find more consolidated answers.
Assuntos
Asma Induzida por Exercício , Asma , Humanos , Adolescente , Criança , Asma Induzida por Exercício/diagnóstico , Exercício Físico/fisiologia , Teste de Esforço , AtletasRESUMO
Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow-up at their primary healthcare provider's office, or directly to the closest emergency department [ED] via Emergency Medical Services [EMS]). This article specifically describes the initial assessment and management of shortness of breath in an adolescent athlete during a track event.
Assuntos
Traumatismos em Atletas , Serviços de Enfermagem Escolar , Adolescente , Atletas , Criança , Atenção à Saúde , Dispneia/etiologia , Emergências , Exercício Físico , Humanos , Estados UnidosRESUMO
Este estudo objetivou, por meio de um delineamento transversal, associar broncoespasmo induzido pelo exercício (BIE), perfil antropométrico, qualidade de vida e aptidão cardiorrespiratória de adolescentes. Para tanto, 202 sujeitos com idades entre 13 e 18 anos participaram da pesquisa. Eles foram submetidos a medidas antropométricas, teste de broncoprovocação, teste de aptidão cardiorrespiratória e responderam a um questionário de percepção de qualidade de vida. A análise dos dados ocorreu mediante análise descritiva, comparação entre grupos (Teste-T de Student) e Correlação de Pearson. O nível de significância foi p < 0,05. Os participantes que não apresentaram BIE obtiveram valores significativamente maiores para circunferência da cintura (72,02 ± 7,89 vs. 68,71 ± 6,65; p = 0,002). Observaram-se correlações significativas negativas entre percentual de queda do volume expiratório forçado no primeiro segundo (VEF1) e IMC (r = -0,138), circunferência da cintura (r = -0,225), VO2máx (r = -0,144) e qualidade de vida (r = -0,189).
The aim of the present study was to associate, using a cross-sectional design, exercise-induced bronchospasm (EIB), anthropometric profile, quality of life and cardiorespiratory fitness of adolescents. In order to do so, 202 subjects, aged 13 to 18 years, participated in the study. They underwent anthropometric measurements, a test to induce EIB, a cardiorespiratory test, and answered a questionnaire regarding their perception of quality of life. Data analysis was performed using descriptive statistics, group comparison (Student's T-test) and Pearson's Correlation. The level of significance was p < 0.05. Participants who did not present EIB showed significantly higher waist circumference values (72.02 ± 7.89 vs. 68.71 ± 6.65; p = 0.002). In addition, significant negative correlations were found between the percentage of decrease of the forced expiratory volume in the first second (FEV1), BMI (r = -0.138), waist circumference (r = -0.225), VO2max (r = -0.144) and quality of life (r = -0.189).
RESUMO
BACKGROUND: Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ventilation on exercise capacity in individuals with severe therapy-resistant asthma (STRA) are unknown. This study aimed to evaluate the immediate effect of continuous positive airway pressure (CPAP) on exercise tolerance in children with STRA. METHODS: We performed a controlled, randomized, crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA. Clinical, anthropometric and lung function data were collected. The participants in the intervention group (IG) used CPAP (PEEP 10cmH2O and FiO2 0.21) for a period of 40 min. Subjects in the control group (CG) used CPAP with minimum PEEP at 1 cmH20 also for 40 min. Afterwards, subjects from both groups underwent cardiopulmonary exercise testing (CPET). After a 15-day washout period, on a subsequent visit, subjects participated in the opposite group to the initial one. RESULTS: Thirteen subjects with a mean age of 12.30 ± 1.7 years were included. The variables of peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) before using CPAP and after performing CPET did not show significant differences. Regarding CPET results, there was no significant difference (P = 0.59) between groups at peak exercise for oxygen consumption-VO2 (CG: 33.4 ± 6.3 and IG: 34.5 ± 5.9, mL kg-1 min-1). However, the IG (12.4 ± 2.1) presented a total test time (min) significantly (P = 0.01) longer than the CG (11.5 ± 1.3). CONCLUSION: The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.
Assuntos
Asma/fisiopatologia , Asma/terapia , Pressão Positiva Contínua nas Vias Aéreas , Tolerância ao Exercício/fisiologia , Adolescente , Criança , Estudos Cross-Over , Teste de Esforço , Feminino , Humanos , Masculino , Testes de Função RespiratóriaRESUMO
BACKGROUND: Respiratory complaints after exercise are common in patients with rhinitis. Exercise-induced bronchospasm (EIB) may be one of the causes. OBJECTIVES: To evaluate EIB prevalence in a group of children and adolescents with allergic rhinitis, to compare the treadmill running (TR) and eucapnic voluntary hyperventilation (EVH) challenge methods as diagnostic tools and to assess the association between respiratory complaints on exercise and EIB. METHODS: Patients aged between 10 and 20 years were studied at the Pulmonology Department of the Hospital das Clínicas -UFPE- Recife, Brazil. The severity of symptoms of rhinitis and exercise-related respiratory complaints in the past year were evaluated. Challenges were performed in random sequence, no more than 72â¯h apart and followed international guidelines. Forced expiratory volume in the first second (FEV1) was determined before and 3, 5, 7, 10, 15 and 30â¯min after each challenge. A >10% reduction in FEV1 from baseline at two points after the challenge was considered sufficient to diagnose EIB. RESULTS: Of the thirty-five subjects evaluated, thirteen (37%) showed EIB, six by both methods, three only after TR and four only after EVH (Coens' Kappaâ¯=â¯0.489). There was no association between respiratory complaints after exercise and EIB (pâ¯=â¯0.74). CONCLUSION: A high prevalence of EIB was found in this population but only moderate agreement between the challenges used to diagnose EIB. Caution should be adopted when comparing these methods or interpreting their results interchangeably. There was no association between reported respiratory symptoms after exercise and EIB.
Assuntos
Asma Induzida por Exercício/diagnóstico , Asma Induzida por Exercício/etiologia , Exercício Físico/fisiologia , Hiperventilação/complicações , Rinite Alérgica/complicações , Adolescente , Asma Induzida por Exercício/fisiopatologia , Testes de Provocação Brônquica/métodos , Criança , Estudos Transversais , Teste de Esforço/métodos , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Hiperventilação/fisiopatologia , Masculino , Rinite Alérgica/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: Exercise-induced bronchospasm (EIB) is the bronchial narrowing that occurs after intense exercise in a significant number of asthmatics and in some non-asthmatics. This study aims to evaluate the occurrence of EIB in adolescents with asthma, rhinitis and respiratory asymptomatics in a hot and dry climate. RESEARCH DESIGN AND METHODS: This is a cross-sectional study based on an epidemiological study that evaluated the prevalence of asthma in schoolchildren in a semi-arid zone of Brazil. The EIB was defined as a reduction in forced expiratory volume in first second (FEV1) greater than 10%. RESULTS: A total of 114 individuals participated in the study (36.8% male), of whom 54 were asymptomatic, 30 asthmatic and 30 with rhinitis. Asthmatics presented a higher proportion of EIB in comparison to rhinitis and asymptomatics (46.7% vs. 13.3% and 7.4%, p = 0.001) and none of the individuals had severe EIB (ΔFEV1 ≥ 50%). CONCLUSIONS: A large proportion of the asthmatics selected from the community for the clinical study had EIB. Among participants with rhinitis, EIB was found in slightly more than 10%, while in the asymptomatics the frequency was slightly more than 5%. This study presents an important aspect in individuals living in hot and dry climates.
Assuntos
Asma Induzida por Exercício/epidemiologia , Espasmo Brônquico/epidemiologia , Rinite/epidemiologia , Adolescente , Asma Induzida por Exercício/fisiopatologia , Brasil/epidemiologia , Espasmo Brônquico/fisiopatologia , Estudos Transversais , Teste de Esforço , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Prevalência , Testes de Função Respiratória , Rinite/fisiopatologiaRESUMO
Abstract Introduction: Despite the prevalence of prescribed asthma, there is uncertainty about the incidence of exercise-induced bronchospasm (EIB). Objective: Compare the frequency of EIB between swimmers and sedentary individuals, and observe heart rate variability during bronchial activity. Methods: In total, 18 swimmers (group 1) and 18 sedentary individuals (group 2) were included. The participants rested for 30 minutes for evaluation of HRV. Blood pressure (PA), respiratory rate (RR), and pulse oxygen saturation (SpO2) were measured. The volunteers remained seated for the spirometry test (maneuver of forced vital capacity - FVC). This was repeated 5, 10, 15, 20, and 30 minutes after the exercise test. The statistical analysis used the Student t, Mann Whitney, and Shapiro-Wilks tests. The significance level was p <0.05. Results: The spirometry findings showed 3 sedentary individuals and 10 swimmers with obstructive ventilatory disorder (OVD). Only 2 of the sedentary and none of the swimmer group demonstrated positive bronchial provocation. A key criterion for diagnosing OVD, the relationship between forced expiratory volume in one second and FVC (FEV1/FVC), was statistically lower in the swimmer group. The measures of the root mean square of the successive differences between adjacent normal RR intervals, in a time interval (RMSSD), and the standard deviation of all normal RR intervals recorded in a time interval (SDNN) were significantly higher among the athletes. Conclusion: The bronchial provocation test identified a higher prevalence of bronchospasm among sedentary individuals. However, there was a reduction in the FEV1/FVC ratio and higher HRV in the group of swimmers.
Resumo Introdução: Apesar da prevalência da asma definida, há imprecisão sobre incidência de broncoespasmo induzido por exercício (BIE). Objetivo: Comparar a freqüência de BIE entre nadadores e sedentários, e observar a variabilidade da freqüência cardíaca durante a atividade de broncoprovocação. Métodos: Incluídos 18 nadadores (grupo 1) e 18 sedentários (grupo 2). Permaneceram por 30 minutos de repouso para a avaliação da VFC. Foi aferida a pressão arterial (PA), frequência respiratória (f) e a saturação de pulso de oxigênio (SpO2). Permaneceram sentados, para o teste de espirometria (manobra da capacidade vital forçada - CVF). Essa foi repetida em 5, 10, 15, 20 e 30 minutos após o teste de esforço. A análise estatística usou os testes t de Student, Mann Whitney de Shapiro-Wilk, com nível de significância p<0,05. Resultados: A espirometria evidenciou 3 sedentários e 10 nadadores com distúrbio ventilatório obstrutivo (DVO). Apenas 2 do grupo sedentário apresentaram broncoprovocação positiva e nenhum do grupo de nadadores. Um critério fundamental para diagnosticar DVO, a relação entre o volume expiratório no primeiro segundo e a CVF (VEF1/CVF) foi estatisticamente menor no grupo de nadadores. As médias da raiz quadrada da média do quadrado das diferenças entre intervalos RR normais adjacentes, em um intervalo de tempo (RMSSD) e no desvio padrão de todos os intervalos RR normais gravados em um intervalo de tempo (SDNN), foram estatisticamente maiores entre os atletas. Conclusão: O teste de broncoprovocação identificou maior prevalência de broncoespasmo entre os sedentários. Entretanto, houve redução na relação VEF1/CVF e maior VFC no grupo de nadadores.
RESUMO
To determine the influence of polymorphisms of the beta-2 adrenergic receptor (ADRB2) in triggering exercise-induced bronchospasm (EIB) in adolescents. Methods: The subjects were divided into two groups: present EIB (EIB+) (n=45) and absent EIB (EIB−) (n=115). The bronchial provocation test with exercise was performed with a protocol that consisted of walking/running for at least eight minutes at high intensity, i.e., >85% of maximum heart rate, considering EIB+ as a 10% decrease in forced expiratory volume in one second (FEV1). The genotyping of the ADRB2 gene was performed by the Taqman method, using the Step One Plus system. Independent t-test, MannWhitney and Chi-square tests, as well as Spearman's correlation coefficient were used for the statistical analysis. Results: Age, body weight, height, FEV1, FVC and FEV1/FVC ratio were lower in the EIB+ group when compared to EIB− (p<0.05). There were no significant differences in the proportion of the allele at position 27 and Arg16Gly and Gln27Glu genotypes between the EIB+ and EIB− groups (p=0.26; p=0.97 and p=0.43, respectively). However, there was a trend toward statistical significance regarding the greater proportion of the Gly16 allele for the EIB+ when compared to the EIB− group (p=0.08). Conclusions: The presence of polymorphisms associated with the Glu27 allele and Arg16Gly and Gln27Glu genotypes had no influence on EIB. However, the statistical trend toward greater frequency of the Gly16 allele in individuals with EIB+ can be considered evidence of the influence of polymorphisms of the ADBR2 gene on EIB in adolescents.
Determinar a influência dos polimorfismos dos receptores adrenérgicos beta 2 (ADRB2) no desencadeamento de broncoespasmo induzido pelo exercício (BIE) em adolescentes. Métodos: Os sujeitos foram divididos em dois grupos: BIE presente (BIE+) (n=45) e BIE ausente (BIE−) (n=115). O teste de broncoprovocação com exercício foi feito com protocolo que consistiu em caminhar/correr durante no mínimo oito minutos em intensidade superior a 85% da frequência cardíaca máxima, considerando como BIE presente uma queda de 10% do volume expiratório forçado no primeiro segundo (VEF1). A genotipagem do gene ADRB2 foi feita pelo método Taqman por meio do aparelho Step One Plus. Para análise estatística usaram-se os testes t independente, U de Mann-Whitney, qui-quadrado e coeficiente de correlação de Spearman. Resultados: Idade, massa corporal, estatura, VEF1, CVF e relação VEF1/CVF foram menores no grupo BIE+ em comparação com o BIE− (p<0,05). Não houve diferenças significativas na proporção do alelo na posição 27 e dos genótipos Arg16Gly e Gln27Glu entre os grupos BIE+ e BIE− (p=0,26; p=0,97 e p=0,43, respectivamente). Entretanto, verificou-se uma tendência à significância estatística na maior proporção do alelo Gly16 para o grupo BIE+ comparado com o BIE− (p=0,08). Conclusões: A presença de polimorfismos associados ao alelo Glu27 e os genótipos Arg16Gly e Gln27Glu não influenciam no BIE. Porém, a tendência estatística observada para uma maior frequência do alelo Gly16 nos indivíduos com a presença de BIE pode ser considerado indício da influência de polimorfismos no gene ADBR2 no BIE em adolescentes.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Asma Induzida por Exercício/genética , Polimorfismo GenéticoRESUMO
OBJECTIVE: To determine the influence of polymorphisms of the beta-2 adrenergic receptor (ADRB2) in triggering exercise-induced bronchospasm (EIB) in adolescents. METHODS: The subjects were divided into two groups: present EIB (EIB+) (n=45) and absent EIB (EIB-) (n=115). The bronchial provocation test with exercise was performed with a protocol that consisted of walking/running for at least eight minutes at high intensity, i.e., >85% of maximum heart rate, considering EIB+ as a 10% decrease in forced expiratory volume in one second (FEV1). The genotyping of the ADRB2 gene was performed by the Taqman method, using the Step One Plus system. Independent t-test, Mann-Whitney and Chi-square tests, as well as Spearman's correlation coefficient were used for the statistical analysis. RESULTS: Age, body weight, height, FEV1, FVC and FEV1/FVC ratio were lower in the EIB+ group when compared to EIB- (p<0.05). There were no significant differences in the proportion of the allele at position 27 and Arg16Gly and Gln27Glu genotypes between the EIB+ and EIB- groups (p=0.26; p=0.97 and p=0.43, respectively). However, there was a trend towards statistical significance regarding the greater proportion of the Gly16 allele for the EIB+ when compared to the EIB- group (p=0.08). CONCLUSIONS: The presence of polymorphisms associated with the Glu27 allele and Arg16Gly and Gln27Glu genotypes had no influence on EIB. However, the statistical trend towards greater frequency of the Gly16 allele in individuals with EIB+ can be considered evidence of the influence of polymorphisms of the ADBR2 gene on EIB in adolescents.
Assuntos
Asma Induzida por Exercício/genética , Polimorfismo Genético , Receptores Adrenérgicos beta 2/genética , Adolescente , Testes de Provocação Brônquica/métodos , Volume Expiratório Forçado , Genótipo , HumanosRESUMO
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.