The effect of exercise on ventilatory function in the child with asthma

doi:10.1016/S0007-0971(62)80005-9

British Journal of Diseases of the Chest

Volume 56, Issue 2, April 1962, Pages 78-86

https://doi.org/10.1016/S0007-0971(62)80005-9 Get rights and content

Summary

1.
Physical exercise has two quite distinct effects on ventilatory function in the asthmatic child depending upon its duration.
2.
Exercise of short duration, 1–2 minutes, produces an increase in the forced expiratory volume within 1 minute of the end of exercise.
3.
Prolonged exercise, 8–12 minutes, produces a decrease in the forced expiratory volume which reaches a minimum value between 1 and 5 minutes after exercise and then rapidly increases towards the resting level.
4.
The level of exercise determines the degree to which these ventilatory effects are evoked.
5.
Both the increase and decrease can be minimised or abolished by preliminary broncho-dilatation with isoprenaline sulphate. This suggests that the phenomena are due to changes in the airways resistance caused by broncho-dilatation or broncho-constriction in bronchi which are already to some extent constricted.

References (5)

McKerrowC.B. et al.
A Spirometer for Measuring the Forced Expiratory Volume with a Simple Calibrating Device
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WrightB.M.
A New Nebuliser
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There are more references available in the full text version of this article.

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Already in the first century AD, Araeteus the Cappadocian described respiratory symptoms induced by physical exercise [12]. However, a scientific objective interest for EIB can be dated back only to 1960, when Jones and co-workers focused on the transient airway response occurring because of exercise [13]. The prevalence of EIB ranges from 5% to 20% in the general population [14].
Regular physical activity is strongly recommended to prevent chronic respiratory diseases, including asthma. On the other hand, vigorous physical training may trigger airway symptoms and bronchoconstriction. The transient airway narrowing occurring because of exercise is named exercise-induced bronchoconstriction (EIB). Despite management according to guidelines, a significant proportion of patients experiences uncontrolled EIB, which thus represents a relevant unmet medical need. In particular, although prevention and treatment of EIB are effectively based on the use of beta-2 bronchodilator drugs, high heterogeneity in individual responses has been reported. Furthermore, even though beta-2 adrenergic drugs remain the mainstay of EIB management, occurrence of tolerance and side effects, as well as doping concerns have been reported with their use. In regard to this, inhaled antimuscarinics could represent an alternative or additional effective and safe bronchodilator therapeutic option for achieving optimal EIB control and minimize adverse events.
The present systematic review aims to collect and provide the most updated and evidence-based literature findings on the efficacy and safety of short- and long-acting inhaled anti-muscarinic drugs for the preventive treatment of EIB in both children and adults.
Take-Home Message: Anti-muscarinic drugs are effective and safe in preventing EIB, despite response variability is reported. Further studies should focus on long-acting molecules, chronic administration and phenotype-driven effects.
Work Group Report: Perspectives in Diagnosis and Management of Exercise-Induced Bronchoconstriction in Athletes
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In the first century AD, Araeteus the Cappadocian made one of the first attempts at characterizing exercise-induced bronchoconstriction: “If from running, gymnastics, or any other work, breathing becomes difficult, it is called asthma.”1 An article in the British Journal of Diseases of the Chest in the 1960s defined the airway obstruction following free running exercise challenge in children as “exercise induced asthma.”2 The term exercise-induced bronchoconstriction (EIB) describes transient airway narrowing that occurs during or after vigorous exercise because of large volumes of unconditioned air entering the lower airways to meet increased ventilatory demands.3
Exercise-induced bronchoconstriction, otherwise known as exercise-induced bronchoconstriction with asthma or without asthma, is an acute airway narrowing that occurs as a result of exercise and can occur in patients with asthma. A panel of members from the American Academy of Allergy, Asthma & Immunology Sports, Exercise, & Fitness Committee reviewed the diagnosis and management of exercise-induced bronchoconstriction in athletes of all skill levels including recreational athletes, high school and college athletes, and professional athletes. A special emphasis was placed on the recommendations and regulations set forth by professional athletic organizations after a detailed review of their collective bargaining agreements, substance abuse policies, antidoping program manuals, and the World Anti-Doping Agency antidoping code. The recommendations in this review are based on currently available evidence in addition to providing guidance for athletes of all skill levels as well as their treating physicians to better understand which pharmaceutical and nonpharmaceutical management options are appropriate as well as which medications are permitted or prohibited, and the proper documentation required to remain compliant.
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For the first 40 years of the 20th century treatment for asthma occurred in response to an asthma attack. The treatments were given by injection or orally and included the adrenergic agonists adrenalin/epinephrine and ephedrine and a phosphodiesterase inhibitor theophylline. Epinephrine became available as an aerosol in 1930. After 1945, isoprenaline, a non-selective beta agonist, became available for oral use but it was most widely used by inhalation. Isoprenaline was short-acting with unwanted cardiac effects. More selective beta agonists, with a longer duration of action and fewer side-effects became available, including orciprenaline in 1967, salbutamol in 1969 and terbutaline in 1970. The inhaled steroid beclomethasone was available by 1972 and budesonide by 1982. Spirometry alone and in response to exercise was used to assess efficacy and duration of action of these drugs for the acute benefits of beta₂ agonists and the chronic benefits of corticosteroids. Early studies comparing oral and aerosol beta₂ agonists found equivalence in bronchodilator effect but the aerosol treatment was superior in preventing exercise-induced bronchoconstriction. Inhaled drugs are now widely used including the long-acting beta₂ agonists, salmeterol and formoterol, and the corticosteroids, fluticasone, ciclesonide, mometasone and triamcinolone, that act locally and have low systemic bio-availability. Repurposing drugs as inhaled therapies permitted direct delivery of low doses of drug to the site of action reducing the incidence of unwanted side-effects and permitting the prophylactic treatment of asthma.
Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes
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Exercise-induced bronchoconstriction (EIB) is the transient narrowing of the airways during and after exercise that occurs in response to increased ventilation in susceptible individuals.1
Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations
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The effect of exercise on ventilatory function in the child with asthma

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