Overweight and exercise-induced bronchoconstriction : is there a link?

Tämän tutkimuksen tarkoitus oli arvioida painoindeksin yhteyttä fyysiseen suorituskykyyn, rasitusastmareaktioon ja rasituksen laukaisemiin hengitystieoireisiin (yskään, vinkunaan ja hengenahdistukseen) kouluikäisillä lapsilla. 1120 ulkojuoksukokeen tulokset käytiin retrospektiivisesti läpi. Nämä ulkojuoksukokeet oli suoritettu Iho- ja allergiasairaalassa osana kouluikäisten lasten tavanomaisia astmaselvittelyjä. Keuhkojen toimintaa arvioitiin spirometrialla. Astmalle diagnostisen rasituksen laukaiseman keuhkoputkien supistumisen eli rasitusastmareaktion rajana pidettiin vähintään 15 prosentin laskua uloshengityksen sekuntikapasiteetissa rasituksen jälkeen. Fyysinen suorituskyky arvioitiin laskemalla todellisesta juoksuajasta ja -matkasta 6 minuutissa juostu matka. Hengitystieoireet ja -löydökset kirjattiin kokeen aikana, ja lasten ikään ja sukupuoleen suhteutettu painoindeksi eli ISO-BMI laskettiin kansallisia kasvuviitearvoja käyttäen. Suurempi ISO-BMI ja ylipaino ennustivat heikompaa fyysistä suorituskykyä. Lisäksi suurempi ISO-BMI oli yhteydessä yskään ja hengenahdistukseen rasituskokeen aikana. Sen sijaan ISO-BMI ei liittynyt rasitusastmareaktioon eikä vinkunaan. Tämän tutkimuksen löydösten perusteella kouluikäisillä lapsilla ylipaino voi ennustaa heikompaa fyysistä suorituskykyä ja rasitusperäisten hengitystieoireiden ilmaantumista, mutta ei rasitusastmareaktiota. Mikäli asianmukaisia keuhkojen toimintatutkimuksia ei suoriteta, voidaan astmadiagnoosi asettaa väärin perustein. Tutkimus on toistaiseksi suurin kouluikäisten lasten ylipainon, rasitusastmareaktion ja fyysisen suorituskyvyn yhteyttä tarkasteleva tutkimus, mutta koska tutkimus oli luonteeltaan retrospektiivinen asiakirjatutkimus, tulokset tulisi jatkossa vahvistaa prospektiivisella seurantatutkimuksella

Overweight and exercise-induced bronchoconstriction - Is there a link?

Background The objective of this study was to evaluate the role of body mass index with regard to exercise performance, exercise-induced bronchoconstriction (EIB), and respiratory symptoms in 7- to 16-year-old children. Methods A total of 1120 outdoor running exercise challenge test results of 7- to 16-year-old children were retrospectively reviewed. Lung function was evaluated with spirometry, and exercise performance was assessed by calculating distance per 6 minutes from the running time and distance. Respiratory symptoms in the exercise challenge test were recorded, and body mass index modified for children (ISO-BMI) was calculated for each child from height, weight, age, and gender according to the national growth references. Results Greater ISO-BMI and overweight were associated with poorer exercise performance (P <.001). In addition, greater ISO-BMI was independently associated with cough (P = .002) and shortness of breath (P = .012) in the exercise challenge. However, there was no association between ISO-BMI and EIB or with wheeze during the exercise challenge. Conclusion Greater ISO-BMI may have a role in poorer exercise performance and appearance of respiratory symptoms during exercise, but not in EIB in 7- to 16-year-old children.Peer reviewe

Serum soluble T-H cell activity markers and high-sensitivity C-reactive protein in multiple-trigger wheezers

Peer reviewe

Vitamin D, high-sensitivity C-reactive protein, and airway hyperresponsiveness in infants with recurrent respiratory symptoms

Background: Vitamin D insufficiency might be associated with biased T-cell responses resulting in inflammatory conditions such as atopy and asthma. Little is known about the role of vitamin D in low-grade systemic inflammation and airway hyperresponsiveness (AHR) in young children. Objective: To evaluate whether vitamin D insufficiency and increased serum high-sensitivity C-reactive protein (hs-CRP) are linked to AHR in symptomatic infants. Methods: Seventy-nine infants with recurrent or persistent lower respiratory tract symptoms underwent comprehensive lung function testing and a bronchial methacholine challenge test. In addition, skin prick tests were performed and serum 25-hydroxyvitamin D (S-25-OHD), hs-CRP, total immunoglobulin E, and blood eosinophil levels were determined. Results: S-25-OHD was lowest in infants with blood eosinophilia and AHR (n = 10) compared with those with eosinophilia only (n = 6) or AHR only (n = 50) or those with neither (n = 13; P = .035). Moreover, vitamin D insufficiency (S-25-OHD <50 nmol/L) was most common in infants with blood eosinophilia and AHR (P = .041). Serum hs-CRP was lower in infants with recurrent physician-diagnosed wheezing (P = .048) and in those with blood eosinophilia (P = .015) than in infants without these characteristics and was not associated with S-25-OHD or AHR. S-25-OHD levels were significantly lower (median 54 nmol/L) during the autumn-winter season than in the spring-summer season (median 63 nmol/L; P = .026). Conclusion: Vitamin D insufficiency could underlie eosinophilia and AHR in infants with troublesome lung symptoms, whereas hs-CRPemediated low-grade systemic inflammation is rare in early childhood wheezing. (C) 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Peer reviewe

Small airway function in children with mild to moderate asthmatic symptoms

Background: Clinical significance of small airway obstruction in mild pediatric asthma is unclear. Objective: To evaluate small airway properties in children with mild to moderate asthmatic symptoms and the association of small airway function with asthma control and exercise-induced bronchoconstriction (EIB). Methods: Children (5-10 years old) with recurrent wheezing (n = 42) or persistent troublesome cough (n = 16) and healthy controls (n = 19) performed impulse oscillometry (IOS), spirometry, and a multiple-breath nitrogen washout (MBNW) test. Exhaled nitric oxide (NO) was measured at multiple flow rates to determine alveolar NO concentration (CAIN). Asthma control was evaluated with the Childhood Asthma Control Test (C-ACT), short-acting beta(2)-agonist (SABA) use within the past month, and asthma exacerbations within the past year. Results: IOS, spirometry, and exhaled NO indexes that are related to small airway function differed between children with recurrent wheezing and healthy controls, whereas only forced expiratory flow at 25% to 75% of the forced vital capacity was associated with persistent cough. The MBNW indexes showed no difference between the groups. Among symptomatic children, conducting airway ventilation inhomogeneity and CALV were associated with asthma exacerbations (P = .03 and P = .002, respectively), and lung clearance index and CALV were associated with EIB (P = .04 and P = .004, respectively). None of the proposed small airway indexes was associated with the C-ACT score or SABA use. Conclusion: Subtle changes were observed in the proposed small airway indexes of IOS, spirometry, and exhaled NO among children with mild to moderate recurrent wheezing. Small airway dysfunction, expressed as ventilation inhomogeneity indexes and CALV, was also associated with asthma exacerbations and EIB. (C) 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Peer reviewe

Expiratory variability index is associated with asthma risk, wheeze and lung function in infants with recurrent respiratory symptoms

Non peer reviewe

Nocturnal Heart Rate Variability Spectrum Characterization in Preschool Children with Asthmatic Symptoms

Asthma is a chronic lung disease that usually develops during chilhood. Despite that symptoms can almost be controlled with medication, early diagnosis is desirable in order to reduce permanent airway obstruction risk. It has been suggested that abnormal parasympathetic nervous system (PSNS) activity might be closely related with the pathogenesis of asthma, and that this PSNS activity could be reflected in cardiac vagal control. In this work, an index to measure the spectral regularity of the high frequency (HF) component of heart rate variability (HRV) spectrum, named peakness (P), is proposed. Three different implementations of P, based on electrocardiogram (ECG) recordings, impedance pneumography (IP) recordings and a combination of both, were employed in the characterization of a group of pre-school children classified attending to their risk of developing asthma. Peakier componentswere observed in the HF band of those children classified as high-risk (p < 0.005), who also presented reduced sympathvoagal balance. Results suggest that high-risk of developing asthma might be related with a lack of adaptability of PSNS

Heart Rate Variability Analysis in Risk of Asthma Stratification

Early diagnosis of asthma is crucial to avoid long-term effects such as permanent airway obstruction. Pathogenesis of asthma has been related with autonomic nervous system (ANS) dysfunction, concretely with abnormal parasympathetic activity. As heart rate variability (HRV) analysis does reflect ANS activity, it has been employed here in risk of asthma stratification