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

The birth and development of clinical physiology in Finland

The specialty of clinical physiology was established in Finland about 20 years later than in Sweden. In the early 1960s, six physicians working mainly in preclinical departments of physiology were certified as specialists in clinical physiology. Many of the first specialists working in hospitals received specialist training in Sweden. The first hospital laboratories of clinical physiology were established in Tampere Central Hospital and Turku University Hospital in 1968. Thereafter, laboratories of clinical physiology were also established in Helsinki University Hospital and in Kuopio University Hospital and later also in most central hospitals. After clinical physiology laboratories were set up in hospitals and the number of specialists increased, the specialty gradually had more impact in clinical work. In the 1999 reform, nuclear medicine, which had previously been a subspecialty, was combined with clinical physiology. Arto Uusitalo was nominated the first professor of clinical physiology in Tampere University in 1984. The first professor in Helsinki University was Anssi Sovijarvi (1994), in Kuopio University Esko Lansimies (1998), and in Turku University Jaakko Hartiala (2003). Today, at four universities professors of clinical physiology and nuclear medicine lead research and medical education in this specialty. The hospital laboratories have modern equipment, which promotes multidisciplinary research with clinicians in fruitful collaboration. The Finnish Society of Clinical Physiology was founded in 1975. Today, it has about 160 members, about half of whom are specialists in the field. On its 40th anniversary, the Society decided to publish the history of clinical physiology in Finland.Peer reviewe

Patient Inspiratory Maneuver Performance; Peak Lungpower, Acceleration and Volume

Background: Use of drug delivery devices between nebulizers, dry powder inhalers (DPIs), or metered dose inhalers (MDIs), for treating patients with asthma and chronic obstructive pulmonary disease (COPD), is based on patients' capability of coordinating the inhalation maneuver and achieving sufficient airflow. There are limited data available with regard to how patients meet the requirements of successful inhalation performance, and how the concept of inspiratory lungpower could be applied. The aim of this work was to study the patient inspiratory airflow profile performance in large data sets. We analyzed how the Kamin-Haidl inhalation criteria were met by patients with DPIs such as Easyhaler for combination therapy (EH-combi), Easyhaler for monotherapy (EH-mono), Diskus, and Turbuhaler (TH), and applied peak lungpower instead of peak inspiratory flow rate as an indicator of patient performance. Materials and Methods: Data sets gathered in two previous studies for DPIs, that is, EH-combi, EH-mono, Diskus, and TH, were used to analyze how inspiratory lungpower representing inspiratory muscle power, flow acceleration, and volume after peak met the inhalation criteria. The measured patient airflow profiles through inhalers were assessed for patients with asthma or COPD. Results: Based on the Kamin-Haidl inhalation criteria, successful inhalation requirements were met with EH-combi in 96.1% and with EH-mono in 92.6% of patients. The success rates were 89.5% and 84.6% with Diskus and TH, respectively, (p <0.0001 between devices). In patients with asthma or COPD, the mean lungpower was 7.51 and 6.15 W for EH-combi, 8.79 and 6.88 W for EH-mono, 7.18 and 4.36 W for Diskus, and 9.65 and 6.86 W for TH, respectively, when patients followed the manufacturer's written instructions. Conclusions: Lungpower applied to the Kamin-Haidl inhalation criteria concept could be an applicable method for reviewing patient performance for different DPIs despite DPIs' characteristic differences in airflow resistance. In light of these results, DPIs provide a feasible treatment option for a large majority of respiratory patients.Peer reviewe

Näin tutkin, hoidan ja seuraan lasten astmaa

Teema : Astman tutkimukset ja hoidot• Alle 3-vuotiaan lapsen astma todetaan yleensä kliinisin perustein. Leikki-ikäisillä lapsilla käytetään ¬oskillometriaa ja kouluikäisillä spirometriaa keuhkojen toiminnan poikkeavuuden osoittamiseksi. • Toiminnalliset hengityshäiriöt ovat isommilla lapsilla erotusdiagnostinen haaste. • Inhaloitava kortisoni on hoidon perusta, ja suurimmalla osalla lapsista se riittää anti-inflammatoriseksi hoidoksi. • Oleellista on huolehtia lääkitykseen sitoutumisesta, oikeasta inhalaatiotekniikasta ja opastaa omahoitoon. • Lapsen astma on yleensä lievä ja ennuste hyvä.Peer reviewe

Observational study of inhaled corticosteroid treatment for improved expiratory variability index in steroid-naive asthmatic children

Non peer reviewe

Airway hyperresponsiveness in young children with respiratory symptoms A five-year follow-up

Background: Recurrent wheezing in early life is transient in most children. The significance of airway hyper-responsiveness (AHR) in persistence of respiratory symptoms from infancy to early childhood is controversial. Objective: We evaluated whether AHR in wheezy infants predicts doctor-diagnosed asthma (DDA) or AHR at the age of 6 years. Methods: Sixty-one wheezy infants (age 6-24 months) were followed up to the median age of 6 years. Lung function and AHR with methacholine challenge test were assessed at infancy and 6 years. The exercise challenge test was performed at the age of 6 years. Atopy was assessed with skin prick tests. Results: At 6 years, 21 (34%) of the children had DDA. Children with DDA had higher logarithmic transformed dose-response slope (LOGDRS) to methacholine in infancy than children without DDA (0.047 vs 0.025; P = .033). Furthermore, AHR to methacholine in infancy and at 6 years were associated with each other (r = 0.324, P = .011). Children with exercise-induced bronchoconstriction (EIB) at 6 years were more reactive to methacholine in infancy than those without EIB (P = .019). Conclusion: Increased AHR in symptomatic infants was associated with increased AHR, DDA, and EIB at median the age of 6 years, suggesting early establishment of AHR. (C) 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.Peer reviewe

The continuous laryngoscopy exercise test in severe or in difficult-to-treat asthma in adults: a systematic review

Objective: A systematic review was performed to determine if the continuous laryngoscopy exercise test (CLE) has been used in the diagnostics of exercise dyspnea in adults with asthma, and whether inducible laryngeal obstruction (ILO) is found in those with asthma or with severe or difficult-to-treat asthma. Data Sources: We used Scopus and PubMed databases. The articles published up to 13 August 2019 were considered. Study Selections: We excluded manuscripts that did not contain information about adult patients with asthma. We included six studies from 59 search results in Scopus and none from the 17 search results in PubMed. Results: The articles included 455 study individuals. Of these, 229 (50.3%) had diagnosed asthma or were treated with asthma medication. Altogether 31/229 (13.5%) subjects with diagnosis of asthma or previous asthma treatment had exercise-induced laryngeal obstruction (EILO) as comorbidity. The CLE test was performed on 229 patients with asthma. The method was used only for differential diagnosis of exercise-induced dyspnea to confirm EILO. At least 10/455 (2.2%) out of the 455 subjects experienced adverse events. Conclusions: This systematic review revealed that only a small proportion of patients with asthma had undergone the CLE test to assess exercise-induced dyspnea. None of the selected manuscripts reported severity of asthma. Whether CLE provides a valuable diagnostic tool for patients with severe or difficult-to-treat asthma cannot be determined according to this review.Peer reviewe

Spirometrian suorittaminen ja tulkinta : uudet suomalaiset ja monikansalliset viitearvot käyttöön - Suomen Kliinisen Fysiologian yhdistyksen ja Suomen Keuhkolääkäriyhdistyksen suositus 2015

•Hil­jattain on jul­kaistu uu­det suoma­laiset ai­kuisten spi­ro­metrian vii­tearvot, joi­den mit­taukset kat­tavat myös vanhus­väestön 84 vuo­den ikään as­ti. •Uu­sien ar­vojen tulkin­nassa otetaan käyt­töön mi­tatun ar­von poik­keaman mää­rä viitear­vo­po­pu­laation ­kes­kiar­vosta z-yksik­köinä (sama kuin SD). Muu­toksen vaikeu­saste ar­vioidaan z-ar­von mu­kaan. •Nor­maalin va­riaation ala­raja on klii­ni­sissä tutki­muk­sissa kai­kille spi­ro­met­ria­muut­tu­jille sa­ma (z-ar­vona –1,65). Ter­veistä 95 % asettuu tä­män ra­jan ylä­puo­lelle. •Syn­ty­pe­rältään ulko­maa­laisten las­ten ja ai­kuisten tutki­muk­sissa suosi­tellaan käytet­tä­väksi uu­sia kansain­vä­lisiä GLI2012-vii­tear­voja. •Suo­ma­laisten las­ten tutki­muk­sissa suosi­tellaan käytet­tä­väksi edelleen van­hoja suoma­laisia viitear­voja, mut­ta nii­den klii­ni­sessä sovel­ta­mi­sessa suosi­tellaan nyt z-ar­vojen käyt­töä. •Ai­kuisten van­hat suoma­laiset vii­tearvot ei­vät ole perus­tuneet todel­lisiin mittaus­tu­loksiin yli 64-vuo­tiailla. Van­hojen ar­vojen käyt­tö on aiheut­tanut toden­nä­köi­sesti hengi­tys­tieobst­ruktion yli­diag­nos­tiikkaa vanhem­missa ikä­ryh­missä.Peer reviewe