RESUMO
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
INTRODUCTION: Exercise-induced bronchospasm (EIB) is common in young asthmatics and obesity is becoming an epidemic in this population. Both conditions can give rise to or worsen respiratory symptoms upon exercise and may interfere with recreational and sports activities. OBJECTIVE: To investigate the association between obesity and the risk and severity of EIB in asthmatic children and adolescents. METHODS: This study included data from asthmatic patients aged between 7 and 19 years undergoing treadmill running tests to evaluate EIB, defined as a reduction greater than or equal to 10% in forced expiratory volume in the first second (FEV1 ) compared to baseline. Eutrophic, obese, and overweight individuals were categorized according to body mass index z-score (eutrophic, -0.5 < z ≤ 1; overweight, 1 < z < 2; and obese, z ≥ 2). RESULTS: Of the 156 individuals studied (42% female), 58% were eutrophic, 22% overweight, and 19% obese. Seventy-three individuals (47%) presented with EIB, with higher risk among obese (OR, 2.86; 95% CI, 1.00-8.14; P = .05). Asthma severity was another independent risk factor for EIB (OR, 2.95; 95% CI, 1.36-6.42; P = .006). The number of patients in whom FEV1 returned to baseline values (difference less than 10% from baseline) at the 13th minute after challenge was lower in obese individuals compared to eutrophic and overweight ones (P = .04). Baseline FEV1 , gender, or age were not found to be risk factors for EIB in any of the groups. CONCLUSION: Obese youngsters with asthma present a greater risk for EIB with slower recovery than their nonobese peers. Clinicians should be aware of this association, especially in those with more severe disease, for adequate recognition and treatment.
Assuntos
Asma/epidemiologia , Espasmo Brônquico/epidemiologia , Exercício Físico , Obesidade/epidemiologia , Adolescente , Adulto , Asma/fisiopatologia , Índice de Massa Corporal , Espasmo Brônquico/fisiopatologia , Criança , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Obesidade/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test. METHODS: A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ ClinicalTrials.gov identifier: NCT02939625]. RESULTS: A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height ( z score: -2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group. CONCLUSION: Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.
Assuntos
Asma Induzida por Exercício/terapia , Exercícios Respiratórios , Espasmo Brônquico/terapia , Broncoconstrição , Pressão Positiva Contínua nas Vias Aéreas , Pulmão/fisiopatologia , Ventilação não Invasiva , Pneumonia/terapia , Terapia Respiratória/métodos , Adolescente , Fatores Etários , Asma Induzida por Exercício/diagnóstico , Asma Induzida por Exercício/fisiopatologia , Brasil , Exercícios Respiratórios/efeitos adversos , Espasmo Brônquico/diagnóstico , Espasmo Brônquico/fisiopatologia , Criança , Pré-Escolar , Terapia Combinada , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Feminino , Humanos , Masculino , Ventilação não Invasiva/efeitos adversos , Pneumonia/diagnóstico , Pneumonia/fisiopatologia , Terapia Respiratória/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
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
There is an increase in the prevalence of asthma and obesity, constituting a public health problem at national and global levels. The association between the two pathologies has not been clearly determined; however, a certain synergy has been proposed, which leads to more severe bronchospasms, longer recovery time, and more prolonged use of medications in obese asthmatic patients. The discovery of leptin, an adipokine that is directly related to the amount of total body fat and the production of proinflammatory cytokines, has generated greater interest in white adipose tissue. Our objective was to describe the possible mechanisms involved and the association between obesity and asthma. A bibliographic search was conducted in the scientific literature using the National Biotechnology Information Center (NCBI) database of the USA as a search tool; keywords used were: asthma, leptin, obesity and inflammation. There are numerous clinical and experimental studies that explore the role of obesity as an inflammatory entity in asthma, some of which have evaluated the role of "shared" genetic polymorphisms in both pathologies. Apparently, the interaction between asthma and obesity is complex, there are mechanisms that link both pathologies, these can influence the improvement or exacerbation of symptoms.
El incremento en la prevalencia de asma y obesidad constituye un problema de salud pública en los ámbitos nacional y mundial. Se ha propuesto una sinergia entre estas patologías que genera broncoespasmos más severos, mayor tiempo de recuperación y uso de medicamentos por un lapso más prolongado en los pacientes asmáticos con obesidad. El descubrimiento de la leptina, relacionada directamente con la cantidad de grasa corporal total y la producción de citocinas proinflamatorias ha generado mayor interés en el tejido adiposo blanco. El objetivo de esta investigación fue describir la asociación entre obesidad, asma y los mecanismos fisiopatológicos involucrados. Se realizó una búsqueda bibliográfica en la literatura científica empleando el Centro Nacional de Información sobre Biotecnología (NCBI) de Estados Unidos como herramienta de búsqueda; las palabras claves utilizadas fueron asma, leptina, obesidad e inflamación. Numerosos estudios clínicos y experimentales exploran la participación de la obesidad como una entidad inflamatoria en el asma; algunos han evaluado el papel de polimorfismos genéticos "compartidos" por ambas patologías. Al parecer, existen mecanismos comunes a ambas patologías que pueden influir en la exacerbación de los síntomas del asma en pacientes con obesidad.
Assuntos
Asma/imunologia , Mediadores da Inflamação/fisiologia , Inflamação/imunologia , Obesidade/imunologia , Tecido Adiposo/fisiopatologia , Asma/epidemiologia , Asma/genética , Asma/fisiopatologia , Espasmo Brônquico/etiologia , Espasmo Brônquico/fisiopatologia , Comorbidade , Citocinas/fisiologia , Dieta , Predisposição Genética para Doença , Humanos , Inflamação/epidemiologia , Leptina/sangue , Obesidade/epidemiologia , Obesidade/genética , Mecânica RespiratóriaRESUMO
The response of asthmatic children to exercise has usually been evaluated by forced expiratory volume in 1 sec (FEV(1)). We reasoned that other respiratory indexes derived from the forced vital capacity maneuver such as forced expiratory flow between 25-75% of vital capacity (FEF(25-75%)) would add significant information in the evaluation of the relationship between asthma severity and response to exercise. We studied 164 children with intermittent (n = 63), mild persistent (n = 30), moderate persistent (n = 40), and severe persistent asthma (n = 31). Subjects exercised for 6 min on a cycle ergometer at 80% of their maximum heart rate, and spirometry was performed before and 5, 10, and 20 min after exercise. There was good correlation between changes in FEV(1) and FEF(25-75%) after exercise (r = 0.60, P < 0.001 for intermittent asthma and r = 0.80, P < 0.001 for severe persistent asthma). The presence of a fall in both FEV(1) (>/=10%) and in FEF(25-75%) (>/=26%) when compared to a decrease in only one of these two indexes was significantly greater in children with more severe asthma (60.0% for intermittent asthma and 94.4% for severe persistent asthma, P = 0.022). FEF(25-75%) can decrease in response to exercise without changes in FEV(1), mainly in children with mild asthma. In the evaluation of the response to exercise in children with different asthma severities, more than one maximum expiratory flow-volume parameter should be used.
Assuntos
Asma Induzida por Exercício/diagnóstico , Espasmo Brônquico/diagnóstico , Espasmo Brônquico/fisiopatologia , Volume Expiratório Forçado/fisiologia , Análise de Variância , Antropometria , Estudos de Casos e Controles , Criança , Teste de Esforço , Feminino , Humanos , Modelos Lineares , Masculino , Probabilidade , Estudos Prospectivos , Troca Gasosa Pulmonar , Valores de Referência , Testes de Função Respiratória , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Exercise is one of the most common triggers of asthmatic symptoms. Many factors, including hyperventilation, determine the prevalence and severity of exercise-induced bronchospasm (EIB). However, the influence of time of day has not been adequately described. OBJECTIVE: We sought to compare morning and evening EIB and minute ventilation during exercise (VE). METHODS: Twenty-two patients with stable asthma and 12 control subjects underwent exercise challenge at 7 am and 6 pm. The time of the first challenge was randomly assigned; the second challenge was performed within 1 week of the first. The primary outcomes were EIB intensity (maximum fall in FEV(1)) and VE. RESULTS: The asthma group exhibited lower EIB values in the morning: 14.8% +/- 3.7% at 7 am vs 21.4% +/- 4.2% at 6 pm (P =.004)-ie, 0.37 +/- 0.09 L vs 0.53 +/- 0.10 L, respectively (P =.002). VE was higher at 7 am (55.4 +/- 4.7 L/min) than at 6 pm (52.4 +/- 4.3 L/min; P =.03). Baseline FEV(1) increased from 2.33 +/- 0.13 L (morning) to 2.49 +/- 0.15 L (evening; P =.04), and a significant correlation between baseline FEV(1) and EIB was found in the evening (r = +0.5; P =.049) but not in the morning. Post-exercise FEV(1) was similar at 7 am (1.96 +/- 0.13 L) and 6 pm (1.97 +/- 0.14 L). For the control group, no changes were detected in FEV(1) fall or VE. CONCLUSION: Baseline airway caliber contributes to the mechanisms of the morning-to-evening EIB enhancement.
Assuntos
Atividades Cotidianas , Asma Induzida por Exercício/fisiopatologia , Adulto , Espasmo Brônquico/fisiopatologia , Teste de Esforço , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Estudos Prospectivos , Ventilação Pulmonar , Fatores de TempoRESUMO
The prevalence of exercise-induced bronchospasm (EIB) in asthmatic individuals has been reported to vary from 40% to 90%. There are, however, few studies addressing the effects of asthma severity on airway responsiveness to exercise. The purpose of the present study was to investigate the effects of asthma severity on EIB in children. We studied 164 children classified as having intermittent (n = 63), mild persistent (n = 30), moderate persistent (n = 40), and severe persistent asthma (n = 31) according to the Global Initiative for Asthma classification. Subjects exercised for 6 min on a cycle ergometer at 80% of their maximum heart rate, and spirometry was performed before and 5, 10, and 20 min after exercise challenge. The prevalence of EIB in children with moderate or severe persistent asthma was significantly greater than in children with intermittent asthma (p < 0.001). EIB-positive children with intermittent asthma exhibited smaller changes in FEV1 than children in the other three groups (p < 0.001). There was no significant relationship between baseline FEV1 and the decline in FEV1 after exercise. We conclude that the prevalence of EIB is greater in children with more severe asthma, and that the intensity of response to exercise is not consistently related to the clinical severity of asthma.
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Asma/complicações , Asma/fisiopatologia , Espasmo Brônquico/etiologia , Exercício Físico , Adolescente , Ciclismo , Espasmo Brônquico/fisiopatologia , Criança , Volume Expiratório Forçado/fisiologia , Humanos , Índice de Gravidade de DoençaAssuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Ácaros/imunologia , Asma/etiologia , Espasmo Brônquico/etiologia , Poeira/efeitos adversos , Ácaros/classificação , Alérgenos/efeitos adversos , Asma/imunologia , Asma/fisiopatologia , Espasmo Brônquico/imunologia , Espasmo Brônquico/fisiopatologiaAssuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Poeira/efeitos adversos , Asma/etiologia , Espasmo Brônquico/etiologia , Ácaros/imunologia , Asma/fisiopatologia , Asma/imunologia , Espasmo Brônquico/fisiopatologia , Espasmo Brônquico/imunologia , Alérgenos/efeitos adversos , Ácaros/classificaçãoAssuntos
Humanos , Administração por Inalação , Corticosteroides/administração & dosagem , Asma/terapia , Beclometasona/análogos & derivados , Corticosteroides/efeitos adversos , Alérgenos/efeitos adversos , Asma/complicações , Beclometasona/análogos & derivados , Espasmo Brônquico/fisiopatologia , Nebulizadores e Vaporizadores , Receptores de GlucocorticoidesRESUMO
Se explora el mecanismo de la constricción bronquial al investigar la interacción entre la respuesta a un fármaco broncoconstrictor (histamina), el control vagal a los pulmones y el receptor beta-adrenérgico. Las experiencias se llevan a cabo en ratas (un animal poco sensible a la histamina) y en cobayos (muy sensible en cuanto a la respuesta broncoconstrictora). Se demuestra el control neural autónomo del calibre bronquial y el papel del receptor beta-adrenérgico, que aumenta la broncoconstricción en las ratas cuando es bloqueado por propranolol, no sucede así con los cobayos, lo que sugiere una mayor población de estos receptores celulares en las ratas