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Santos CMDA, Quirino PGC, Rizzo JÂ, Medeiros D, Ferreira JJDA, Costa MDC, Gaua N, Freya B, Martins MDO, Junior MACV. Respiratory muscles's thermographic analysis in asthmatic youth with and without bronchospasm induced by eucapnic voluntary hyperpnea. Clin Physiol Funct Imaging 2024; 44:324-331. [PMID: 38544320 DOI: 10.1111/cpf.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 06/06/2024]
Abstract
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.
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Affiliation(s)
- Camila M de A Santos
- Physical Education Department, Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraíba, Recife, Brazil
- Allergology and Clinical Immunology Department, Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
| | - Polyanna G C Quirino
- Physical Education Department, Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraíba, Recife, Brazil
- Allergology and Clinical Immunology Department, Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
| | - José Â Rizzo
- Allergology and Clinical Immunology Department, Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
- Medicine Department, Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Décio Medeiros
- Allergology and Clinical Immunology Department, Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
- Medicine Department, Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Manoel da C Costa
- Physical Education Department, Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraíba, Recife, Brazil
| | - Nádia Gaua
- Sport and Exercise Science Department, Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | - Bayne Freya
- Sport and Exercise Science Department, Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | - Marcelle de O Martins
- Physical Education Department, Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraíba, Recife, Brazil
| | - Marco A C V Junior
- Physical Education Department, Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraíba, Recife, Brazil
- Allergology and Clinical Immunology Department, Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil
- Department of Dentistry, Hebiatrics Postgraduation Program, Universidade de Pernambuco, Recife, Pernambuco, Brazil
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Jordan KA, Mackintosh KA, Davies GA, Griffiths CJ, Lewis PD, McNarry MA. Perceptions surrounding the possible interaction between physical activity, pollution and asthma in children and adolescents with and without asthma. BMC Public Health 2023; 23:2416. [PMID: 38053057 PMCID: PMC10696824 DOI: 10.1186/s12889-023-17174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
A cornerstone of asthma management is maintaining physical activity (PA), but this may lead to increased exposure to, and deeper inhalation of, pollutants. Furthermore, children and adolescents may be more susceptible to the deleterious impacts of such exposures. Despite the recent air quality campaigns and media coverage surrounding the dangers of air pollution to respiratory health, few target children and their understanding of such issues.Using semi structured interviews, understanding of PA, air pollution and their interaction was explored with 25 youth aged 7-17 years. Utilising NVIVO 12 software, an atheoretical, inductive thematic analysis was conducted to identify key themes which were subsequently presented as pen profiles with the number of common responses within a theme indicative of its strength.The majority (88%) of youth's indicated traffic-related air pollution and global manufacturing as key sources of air pollution. Whilst all youths were aware of outdoor pollution, only 52% were aware of indoor air pollutants, of which 62% had asthma. Despite some uncertainty, all youths described pollution in a negative fashion, with 52% linking air pollution to undesirable effects on health, specifically respiratory health. PA in a polluted area was thought to be more dangerous than beneficial by 44%, although 24% suggested the benefits of PA would outweigh any detriment from pollution.Youth are aware of, and potentially compensate for, the interaction between air pollution and PA. Strategies are needed to allow youth to make more informed decisions regarding how to promote PA whilst minimising exposure to air pollution.
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Affiliation(s)
- Kathryn A Jordan
- Department of Sport and Health Sciences, Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, Wales, UK
| | - Kelly A Mackintosh
- Department of Sport and Health Sciences, Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, Wales, UK
| | - Gwyneth A Davies
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
| | - Chris J Griffiths
- Barts Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Paul D Lewis
- School of Management, Swansea University and Vindico ICS, Swansea, UK
| | - Melitta A McNarry
- Department of Sport and Health Sciences, Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, Wales, UK.
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Magwenzi P, Rusakaniko S, Sibanda EN, Gumbo FZ. Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa. Respir Res 2022; 23:254. [PMID: 36123720 PMCID: PMC9487077 DOI: 10.1186/s12931-022-02170-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/09/2022] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of 'asthma' defined by symptoms is high compared to 'doctor diagnosed asthma'. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? METHODS The Arksey and O'Malley's framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The 'Preview, Question, Read, Summarise' system was used and a narrative report was used to summarise the findings. RESULTS A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. CONCLUSION This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis.
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Affiliation(s)
- P. Magwenzi
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
| | - S. Rusakaniko
- Family Medicine, Global and Public Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
| | - E. N. Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, 113, Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - F. Z. Gumbo
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
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Hengeveld VS, Keijzer PB, Diamant Z, Thio BJ. An Algorithm for Strategic Continuation or Restriction of Asthma Medication Prior to Exercise Challenge Testing in Childhood Exercise Induced Bronchoconstriction. Front Pediatr 2022; 10:800193. [PMID: 35273926 PMCID: PMC8902070 DOI: 10.3389/fped.2022.800193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Exercise induced bronchial (EIB) constriction is a common and highly specific feature of pediatric asthma and should be diagnosed with an exercise challenge test (ECT). The impact of EIB in asthmatic children's daily lives is immense, considering the effects on both physical and psychosocial development. Monitoring childhood asthma by ECT's can provide insight into daily life disease burden and the control of asthma. Current guidelines for bronchoprovocation tests restrict both the use of reliever and maintenance asthma medication before an exercise challenge to prevent false-negative testing, as both have significant acute bronchoprotective properties. However, restricting maintenance medication before an ECT may be less appropiate to evaluate EIB symptoms in daily life when a diagnosis of asthma is well established. Rigorous of maintenance medication before an ECT according to guidelines may lead to overestimation of the real, daily life asthma burden and lead to an inappropiate step-up in therapy. The protection against EIB offered by the combined acute and chronic bronchoprotective effects of maintenance medication can be properly assessed whilst maintaining them. This may aid in achieving the goal of unrestricted participation of children in daily play and sports activities with their peers without escalation of therapy. When considering a step down in medication, a strategic wash-out of maintenance medication before an ECT aids in providing objective support of potential discontinuation of maintenance medication.
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Affiliation(s)
- Vera S Hengeveld
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Pascal B Keijzer
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Zuzana Diamant
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium.,Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden.,Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czechia.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Boony J Thio
- Department of Paediatrics, Medisch Spectrum Twente, Enschede, Netherlands
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Hengeveld VS, van der Kamp MR, Thio BJ, Brannan JD. The Need for Testing-The Exercise Challenge Test to Disentangle Causes of Childhood Exertional Dyspnea. Front Pediatr 2021; 9:773794. [PMID: 35071131 PMCID: PMC8770982 DOI: 10.3389/fped.2021.773794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom. Common causes of exertional dyspnea are exercise induced bronchoconstriction (EIB), dysfunctional breathing, physical deconditioning and the sensation of dyspnea when reaching the physiological limit. These causes frequently coexist, trigger one another and have overlapping symptoms, which can impede diagnoses and treatment. In the majority of children with exertional dyspnea, EIB is not the cause of symptoms, and in asthmatic children it is often not the only cause. An exercise challenge test (ECT) is a highly specific tool to diagnose EIB and asthma in children. Sensitivity can be increased by simulating real-life environmental circumstances where symptoms occur, such as environmental factors and exercise modality. An ECT reflects daily life symptoms and impairment, and can in an enjoyable way disentangle common causes of exertional dyspnea.
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Affiliation(s)
- Vera S Hengeveld
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Mattiènne R van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Boony J Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - John D Brannan
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Schiwe D, Heinzmann-Filho JP, Schindel CS, Gheller MF, Campos NE, Santos G, Donadio MVF, Pitrez PM. Diagnostic performance of the physical activity-related question of the GINA questionnaire to detect exercise-induced bronchoconstriction in asthma. An Pediatr (Barc) 2020; 95:40-47. [PMID: 34225955 DOI: 10.1016/j.anpede.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/11/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents. MATERIAL AND METHODS We divided participants (aged 6-18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument. RESULTS We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV1z-score of -0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV1 after the EIB test. We found a higher frequency of EIB in participants with FEV1 z-score values of less than -1.0 compared to those with a z-score of -1.0 or greater (P = .05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (P = .41), with sensitivity of 42.1% and specificity of 57.1%. CONCLUSIONS The item concerning physical activity in the GINA questionnaire has insufficient diagnostic power to detect EIB in children and adolescents with asthma.
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Affiliation(s)
- Daniele Schiwe
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - João Paulo Heinzmann-Filho
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia Silva Schindel
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Mailise Fátima Gheller
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Natália Evangelista Campos
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Giovana Santos
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paulo Márcio Pitrez
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
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Motomura C, Matsuzaki H, Odajima H, Oki T, Yasunari Y, Kawano T, Iwata M, Okabe K, Wakatsuki M, Murakami Y, Taba N, Honjo S, Ohga S. Effect of age on exercise-induced bronchoconstriction in children and adolescents with asthma. J Asthma 2020; 59:297-305. [PMID: 33207980 DOI: 10.1080/02770903.2020.1853767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The relationship between exercise-induced bronchoconstriction (EIB) and exertional dyspnea in children and adolescents is yet to be fully established. This study examined whether indicators of fractional exhaled nitric oxide (FeNO), forced expiratory volume in 1 s (FEV1) percent predicted at baseline, and dyspnea are useful for predicting children and adolescents with EIB. METHODS We enrolled 184 children and adolescents diagnosed with asthma (mean age 11.2 years); participants were divided into two groups according to age (12 years) and were subjected to a 6-min exercise challenge test. Lung function tests and modified Borg scale scores were used to examine perceptions of dyspnea at 0, 5 and 15 min after exercise. RESULTS Among children, the maximum percentage drop in FEV1 after exercise correlated significantly with FeNO (adjusted β = 2.3, P < 0.001) and with the perception of dyspnea at 5 min after exercise (adjusted β = 1.9, P < 0.001). Among adolescents, the maximum percentage drop in FEV1 correlated with FeNO (adjusted β = 2.7, P = 0.007) and with lung function (FEV1, percent predicted; adjusted β = -0.28, P = 0.006). Children with EIB had significantly stronger dyspnea after exercise than did children without EIB. Adolescents even without EIB may experience more exertional dyspnea than children without EIB. CONCLUSIONS Overall, our findings indicated that EIB was associated with FeNO and exertional dyspnea in asthmatic children. By contrast, EIB was associated with FEV1 percent predicted at baseline and FeNO but not with exertional dyspnea in asthmatic adolescents.
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Affiliation(s)
- Chikako Motomura
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Takeshi Oki
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Yusuke Yasunari
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Kawano
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Mihoko Iwata
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koki Okabe
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Masatoshi Wakatsuki
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Yoko Murakami
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Naohiko Taba
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Schiwe D, Heinzmann-Filho JP, Schindel CS, Gheller MF, Campos NE, Santos G, Donadio MVF, Pitrez PM. [Diagnostic performance of the physical activity related question of the GINA questionnaire to detect exercise-induced bronchoconstriction in asthma]. An Pediatr (Barc) 2020. [PMID: 33172787 DOI: 10.1016/j.anpedi.2020.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the diagnostic performance of the item concerning physical activity of the Global Initiative for Asthma (GINA) asthma control questionnaire for detection of exercise-induced bronchoconstriction (EIB) in children and adolescents. MATERIAL AND METHODS We divided participants (aged 6 to 18 years) with a diagnosis of asthma into two groups according to the GINA severity classification: mild/moderate asthma (MMA) and severe therapy-resistant asthma (STRA). We collected anthropometric, clinical and functional data (spirometry) and performed an EIB test. We used item 4 of the GINA questionnaire regarding exercise-induced symptoms to assess the diagnostic power of this instrument. RESULTS We included 40 patients (17 with MMA and 23 with STRA) with a mean age of 11.3 years and a mean FEV1z-score of -0.33, of who 13 (32.5%) were classified as having uncontrolled asthma. Of the patients with uncontrolled asthma, 7 (53.8%) exhibited a decrease in the FEV1 after the EIB test. We found a higher frequency of EIB in participants with FEV1 z-score values of less than -1.0 compared to those with a z-score of -1.0 or greater (p = 0.05). There were no significant differences in the frequency of EIB based on disease severity and control. We also found no association of item 4 (GINA) with EIB. The area under the ROC curve demonstrated that the discriminative power of the GINA questionnaire for the detection of EIB is inadequate (p = 0.41), with sensitivity of 42.1% and specificity of 57.1%. CONCLUSIONS The physical activity related question of GINA has insufficient diagnostic power to detect EIB in children and adolescents with asthma.
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Affiliation(s)
- Daniele Schiwe
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil
| | - João Paulo Heinzmann-Filho
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil
| | - Cláudia Silva Schindel
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil
| | - Mailise Fátima Gheller
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil
| | - Natália Evangelista Campos
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil
| | - Giovana Santos
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brasil
| | - Márcio Vinícius Fagundes Donadio
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil.
| | - Paulo Márcio Pitrez
- Laboratorio de Actividad Física Pediátrica, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brasil; Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brasil
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Keijzer PB, van der Kamp MR, Thio BJ, de Jongh FH, Driessen JM. Assessing paediatric exercise-induced bronchoconstriction using electromyography. ERJ Open Res 2020; 6:00298-2019. [PMID: 32613016 PMCID: PMC7322899 DOI: 10.1183/23120541.00298-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/22/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Asthma is one of the most common chronic diseases in childhood, occurring in up to 10% of all children. Exercise-induced bronchoconstriction (EIB) is indicative of uncontrolled asthma and can be assessed using an exercise challenge test (ECT). However, this test requires children to undergo demanding repetitive forced breathing manoeuvres. We aimed to study the electrical activity of the diaphragm using surface electromyography (EMG) as an alternative measure to assess EIB. METHODS Forty-two children suspected of EIB performed an ECT wearing a portable EMG amplifier. EIB was defined as a fall in FEV 1 of more than 13%. Children performed spirometry before exercise, and at 1, 3 and 6 min after exercise until the nadir FEV1 was attained and after the use of a bronchodilator. EMG measurements were obtained between spirometry measurements. RESULTS Twenty out of 42 children were diagnosed with EIB. EMG peak amplitudes measured at the diaphragm increased significantly more in children with EIB; 4.85 μV (1.82-7.84), compared to children without EIB; 0.20 μV (-0.10-0.54), (p<0.001) at the lowest FEV 1 post-exercise. Furthermore, the increase in EMG peak amplitude could accurately distinguish between EIB and non-EIB using a cut-off of 1.15 μV (sensitivity 95%, specificity 91%). CONCLUSION EMG measurements of the diaphragm are strongly related to the FEV1 and can accurately identify EIB. EMG measurements are a less invasive, effort-independent measure to assess EIB and could be an alternative when spirometry is not feasible.
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Affiliation(s)
- Pascal B. Keijzer
- Medisch Spectrum Twente, Enschede, the Netherlands
- University of Twente, Enschede, the Netherlands
| | - Mattiènne R. van der Kamp
- Medisch Spectrum Twente, Enschede, the Netherlands
- Roessingh Research and Development, Enschede, the Netherlands
| | | | - Frans H.C. de Jongh
- Medisch Spectrum Twente, Enschede, the Netherlands
- University of Twente, Enschede, the Netherlands
| | - Jean M.M. Driessen
- OCON Sport, Hengelo, the Netherlands
- Tjongerschans Ziekenhuis, Heerenveen, the Netherlands
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10
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Lammers N, van Hoesel MHT, van der Kamp M, Brusse-Keizer M, van der Palen J, Visser R, Driessen JMM, Thio BJ. The Visual Analog Scale detects exercise-induced bronchoconstriction in children with asthma. J Asthma 2019; 57:1347-1353. [PMID: 31482747 DOI: 10.1080/02770903.2019.1652640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Exercise-induced bronchoconstriction (EIB) is a specific morbidity of childhood asthma and an important sign of uncontrolled asthma. The occurrence of EIB is insufficiently identified by the Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT). This study aimed to (1) evaluate the Visual Analog Scale (VAS) for dyspnea as a tool to detect EIB in asthmatic children and (2) assess the value of combining (C-)ACT outcomes with VAS scores. Methods: We measured EIB in 75 asthmatic children (mean age 10.8 years) with a standardized exercise challenge test (ECT) performed in cold and dry air. Children and parents reported VAS dyspnea scores before and after the ECT. Asthma control was assessed by the (C-)ACT. Results: Changes in VAS scores (ΔVAS) of children and parents correlated moderately with fall in forced expiratory volume in 1 second (FEV1), respectively rs=0.57 (p < .001) and rs=0.58 (p < .001). At a ΔVAS cutoff value of ≥3 in children, sensitivity and specificity for EIB were 80% and 79% (AUC 0.82). Out of 38 children diagnosed with EIB, 37 had a (C-)ACT score of ≤19 and/or a ΔVAS of ≥3, corresponding with a sensitivity of 97% and a negative predictive value of 96%. Conclusion: This study shows that the VAS could be an effective additional tool for diagnosing EIB in children. A reported difference in VAS scores of ≥3 after a standardized ECT combined with low (C-)ACT scores was highly effective in detecting and excluding EIB.
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Affiliation(s)
- N Lammers
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M H T van Hoesel
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands.,Roessingh Research and Development, Enschede, the Netherlands
| | - M Brusse-Keizer
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, the Netherlands
| | - R Visser
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J M M Driessen
- OCON Sport, Ziekenhuisgroep Twente, Hengelo, the Netherlands.,Department of Sportsmedicine, Tjongerschans Hospital, Heerenveen, the Netherlands
| | - B J Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, the Netherlands
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11
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Barnes PJ, Szefler SJ, Reddel HK, Chipps BE. Symptoms and perception of airway obstruction in asthmatic patients: Clinical implications for use of reliever medications. J Allergy Clin Immunol 2019; 144:1180-1186. [PMID: 31330221 DOI: 10.1016/j.jaci.2019.06.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Asthma causes the unpleasant sensation of breathlessness (dyspnea) caused by airway obstruction. Patients with poor perception of airway obstruction are at risk of delay in seeking medical attention and undertreatment, which can lead to avoidable deaths. Conversely, those with heightened perception are at risk of overtreatment and iatrogenic adverse effects with reliever medications, anxiety, and unnecessary use of health care resources. OBJECTIVE We sought to review evidence about symptom misperception in asthmatic patients and how to identify and manage affected patients, particularly with regard to reliever medications. METHODS We conducted a systematic literature search for studies of perception of airway function in asthmatic patients. We searched the OVID (Medline and Medline [R] in process [PubMed]), Embase, and Adisearch/Odyssey databases, restricting our search to human studies published in English from 1990-2018, with no restrictions on age, sex, or racial origin. RESULTS We found that both underperception and overperception assessed during induced bronchoconstriction or bronchodilation or during changes in airway resistance were common across all age groups and that aging, disease severity, smoking, sex, ethnicity, psychologic factors, and medication are all associated with differences in perception. Importantly, airway inflammation was associated with impaired perception and a history of severe or near-fatal asthma. We also identified knowledge gaps, such as whether an individual patient's perception varies over time and the influence perception has on patients' use of reliever medication. CONCLUSION We found that abnormal perception of airway obstruction has important clinical implications for the management of patients with asthma.
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Affiliation(s)
- Peter J Barnes
- National Heart & Lung Institute, Imperial College, London, United Kingdom.
| | - Stanley J Szefler
- Paediatric Asthma Research Program and the Breathing Institute, Children's Hospital Colorado, and the Department of Pediatrics, University Colorado School of Medicine, Aurora, Colo
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
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12
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de Aguiar KB, Anzolin M, Zhang L. Global prevalence of exercise-induced bronchoconstriction in childhood: A meta-analysis. Pediatr Pulmonol 2018; 53:412-425. [PMID: 29364581 DOI: 10.1002/ppul.23951] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022]
Abstract
AIM This systematic review and meta-analysis aimed to estimate the global prevalence of exercise-induced bronchoconstriction (EIB) in children and adolescents. METHOD We searched PubMed, Google Scholar, and the Virtual Health Library-BIREME from inception to December 23, 2017. We selected observational studies that reported the prevalence of EIB (diagnosed by exercise challenge test) in children and adolescents aged 5-18 years. We conducted random-effects meta-analyses to estimate the pooled prevalence of EIB and 95% CI. RESULTS We included 66 studies (55 696 participants, 5670 cases of EIB) in the review, of which 33 in general population of children and adolescents, 10 in child and adolescent athletes and 23 in children and adolescents with asthma. The global mean prevalence of EIB in the general population of children and adolescents was 9% (IC95%: 8-10%), with a higher rate (12%) in Asia-Pacific and America. The mean prevalence of EIB was 15% (95% CI: 9-21%) in child and adolescent athletes, and 46% (95% CI: 39-53%) in children and adolescents with asthma. We estimated that, globally, around 16.5 million (95% CI: 15-18 million) children and adolescents up to 18 years of age may have EIB. CONCLUSION EIB in childhood should be considered as a global public health problem that needs more attention. The substantial heterogeneity between studies highlights the need for evidence-based guidelines for diagnosis of EIB in this age group.
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Affiliation(s)
- Karine B de Aguiar
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil
| | - Marina Anzolin
- Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil
| | - Linjie Zhang
- Postgraduate Program in Health Sciences and Postgraduate Program in Public Health, Faculty of Medicine, Federal University of Rio Grande, Rio Grande-RS, Brazil
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13
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Feitosa LADS, de Britto MCA, Aliverti A, Noronha JB, de Andrade AD. Accuracy of optoelectronic plethysmography in childhood exercise-induced asthma. J Asthma 2018; 56:61-68. [PMID: 29360392 DOI: 10.1080/02770903.2018.1424196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the variations of end-expiratory volume of chest wall (EEVcw) measured by optoelectronic plethysmography (OEP) as a diagnostic tool in exercise-induced asthma (EIA) among asthmatic preschool children. METHODS Forty children diagnosed with asthma were included in the study. Spirometry was used as a gold standard test for comparison with OEP. A 10% decline in forced expiratory volume in 1 second was considered positive for EIA. OEP was performed with 8 cameras at a frequency of 60 Hz and 89 markers were placed on the thoraco-abdominal surface of participants. Following bronchoprovocation testing on a treadmill, series of OEP and spirometry were conducted between 5 and 30 minutes after exercise. To obtain the ideal cut-off point, a receiver operating characteristic (ROC) curve was constructed for the largest EEVcw. The highest Youden index was used as criteria to obtain the cut-off point with the best sensitivity and specificity. RESULTS Of the 40 children studied, 16 had EIA. According to the ROC curve, the cut-off point of 0.185% for EEWcw provided mean sensitivity (95% confidence interval) of 93.75% (0.69-0.99), for a specificity of 83.33% (0.63-0.95), when using the largest increase in the period of 5-30 minutes post-exercise. The low area of the ROC was 0.93 (0.85-1.00) for p < 0.001. CONCLUSION OEP can be accurately used to replace spirometry in asthmatic children unable to adequately execute the required manoeuvres.
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Affiliation(s)
| | - Murilo Carlos Amorim de Britto
- b Department of Pediatric Pulmonology , Instituto de Medicina Integral Prof. Fernando Figueira , Pernambuco, Recife , Brazil
| | - Andrea Aliverti
- c Department of Bioengineering , Politecnico di Milano , Milano , Italy
| | - Jéssica Brito Noronha
- a Department of Physiotherapy , Universidade Federal de Pernambuco , Pernambuco, Recife , Brazil
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14
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Choi YJ, Suh DI, Sohn MH, Koh YY. Dyspnea Perception During Induced Bronchoconstriction Is Complicated by the Inhaled Methacholine in Children With Clinical Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:131-136. [PMID: 29411553 PMCID: PMC5809761 DOI: 10.4168/aair.2018.10.2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 11/23/2022]
Abstract
Purpose Dyspnea is not widely utilized as an indicator of asthma provocation despite its universal presentation. We hypothesized that dyspnea severity was proportionate with the lung function decline, methacholine dose-step, and the degree of bronchial hyperresponsiveness (BHR). Methods We retrospectively analyzed 73 children's bronchial provocation test data with an assessment of dyspnea at every dose-step. Dyspnea severity was scored using a modified Borg (mBorg) scale. A linear mixed effect analysis was performed to evaluate the relationship between the mBorg scale, the percentage fall in the forced expiratory volume in 1 second (FEV1) (ΔFEV1%), the methacholine dose-step, and the degree of BHR (BHR grade). Results Subjects were divided into 5 BHR groups based on their last methacholine dose-steps. The mBorg scores did not differ significantly among BHR groups (P=0.596, Kruskal-Wallis test). The linear mixed effect analysis showed that ΔFEV1% was affected by the methacholine dose-step (P<0.001) and BHR grade (P<0.001). The mBorg score was affected by the dose-step (P<0.001) and BHR grade (P=0.019). We developed a model to predict the mBorg score and found that it was affected by the methacholine dose-step and ΔFEV1%, elevating it by a score of 0.039 (χ2 [1]=21.06, P<0.001) and 0.327 (χ2 [1]=47.45, P<0.001), respectively. A significant interaction was observed between the methacholine dose-step and ΔFEV1% (χ2 [1]=16.20, P<0.001). Conclusions In asthmatic children, inhaled methacholine, as well as the degree of BHR and lung function decline, may affect dyspnea perception during the bronchial provocation test. If we wish to draw meaningful information from dyspnea perception, we have to consider various complicating factors underlying it.
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Affiliation(s)
- Yun Jung Choi
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Department of Pediatrics, Severance Children's Hospital, Seoul, Korea
| | - Young Yull Koh
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
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15
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Schoos AMM, Christiansen CF, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. FeNO and Exercise Testing in Children at Risk of Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:855-862.e2. [PMID: 29133224 DOI: 10.1016/j.jaip.2017.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/05/2017] [Accepted: 10/13/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise testing is the gold standard for diagnosing exercise-induced bronchoconstriction in children, but requires considerable cooperation and medical resources. Therefore, fraction of exhaled nitric oxide (FeNO) has been proposed as a tool to predict the need for exercise testing. OBJECTIVE The objective of this study was to investigate the relationship between FeNO, exercise test results, and a history of respiratory symptoms during exercise in children at risk of asthma. METHODS FeNO measurement, exercise testing, and interview about respiratory symptoms during exercise were completed in 224 seven-year-old children from the at-risk Copenhagen Prospective Studies on Asthma in Childhood2000 birth cohort. The associations between FeNO, exercise test results, and reported respiratory symptoms during exercise were analyzed adjusting for gender, respiratory infections, and inhaled corticosteroid treatment. The associations were also analyzed stratified by asthma and atopic status. RESULTS Of the 224 children, 28 (13%) had an established asthma diagnosis and 58 (26%) had a positive exercise test (≥15% drop in forced expiratory volume in 1 second [FEV1] from baseline). FeNO and bronchial obstruction after exercise were linearly associated with a doubling of FeNO corresponding to a 2.4% drop in FEV1 (95% confidence interval, 0.8-4.1; P < .01). However, a receiver operating characteristic curve analysis showed that the best cutoff of FeNO for predicting exercise test outcome among children who reported respiratory symptoms during exercise was 17 ppb, which only had 74% negative predictive value. There was no association between FeNO and reported respiratory symptoms during exercise (odds ratio = 1.3 [0.8-1.9]; P = .29) or reported symptoms during exercise and exercise test results (odds ratio = 1.0 [1.0-1.1]; P = .12). CONCLUSIONS A history of respiratory symptoms during exercise was not associated with either elevated FeNO or a positive exercise test in children at risk of asthma. FeNO and exercise test results were linearly associated traits, but FeNO could not reliably be used dichotomized to predict the need of exercise testing.
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Affiliation(s)
- Ann-Marie Malby Schoos
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Figgé Christiansen
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Bo Lund Chawes
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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16
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Winn CON, Mackintosh KA, Eddolls WTB, Stratton G, Wilson AM, Rance JY, Doull IJM, McNarry MA, Davies GA. Perceptions of asthma and exercise in adolescents with and without asthma. J Asthma 2017; 55:868-876. [DOI: 10.1080/02770903.2017.1369992] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- C. O. N. Winn
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - K. A. Mackintosh
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - W. T. B. Eddolls
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - G. Stratton
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - A. M. Wilson
- Norwich Medical School, University of East Anglia, Norwich, England, UK
| | - J. Y. Rance
- College of Human and Health Sciences, Swansea University, Swansea, Wales, UK
| | - I. J. M. Doull
- Department of Paediatric Respiratory Medicine and Paediatric Cystic Fibrosis Centre, Children's Hospital for Wales, Cardiff, Wales, UK
| | - M. A. McNarry
- Applied Sports Technology Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, Wales, UK
| | - G. A. Davies
- Swansea University Medical School, Swansea University, Swansea, Wales, UK
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17
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Inci D, Guggenheim R, Altintas DU, Wildhaber JH, Moeller A. Reported Exercise-Related Respiratory Symptoms and Exercise-Induced Bronchoconstriction in Asthmatic Children. J Clin Med Res 2017; 9:410-415. [PMID: 28392861 PMCID: PMC5380174 DOI: 10.14740/jocmr2935w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
Background Unlimited physical activity is one of the key issues of asthma control and management. We investigated how reliable reported exercise-related respiratory symptoms (ERRS) are in predicting exercise-induced bronchoconstriction (EIB) in asthmatic children. Methods In this prospective study, 179 asthmatic children aged 7 - 15 years were asked for specific questions on respiratory symptoms related to exercise and allocated into two groups according to whether they complained about symptoms. Group I (n = 134) consisted of children answering “yes” to one or more of the questions and group II (n = 45) consisted of children answering “no” to all of the questions. Results Sixty-four of 179 children showed a positive exercise challenge test (ECT). There was no difference in the frequency of a positive test between children in group I (n = 48) and group II (n = 12) (P = 0.47). The sensitivity of a positive report for ERRS to predict a positive ECT was only 37%, with a specificity of 0.72. Conclusion According to current guidelines, the report or lack of ERRS has direct consequences on treatment decisions. However, the history of ERRS did not predict EIB and one-third of asthmatic children without complaints of ERRS developed EIB during the ECT. This raises the question of the need for objective measures of bronchial hyperresponsiveness (BHR) in pediatric asthma management.
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Affiliation(s)
- Demet Inci
- Division of Respiratory Medicine, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Refoel Guggenheim
- Division of Respiratory Medicine, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Derya Ufuk Altintas
- Division of Paediatric Allergy and Immunology, Faculty of Medicine, University of Cukurova, 01330 Balcali, Saricam/Adana, Turkey
| | - Johannes H Wildhaber
- Department of Paediatrics, Cantonal Hospital Fribourg, HFR 1708 Freiburg, Switzerland
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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18
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Westergren T, Berntsen S, Lødrup Carlsen KC, Mowinckel P, Håland G, Fegran L, Carlsen KH. Perceived exercise limitation in asthma: The role of disease severity, overweight, and physical activity in children. Pediatr Allergy Immunol 2017; 28:86-92. [PMID: 27734537 DOI: 10.1111/pai.12670] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with asthma may be less physically active than their healthy peers. We aimed to investigate whether perceived exercise limitation (EL) was associated with lung function or bronchial hyper-responsiveness (BHR), socioeconomic factors, prenatal smoking, overweight, allergic disease, asthma severity, or physical activity (PA). METHODS The 302 children with asthma from the 10-year examination of the Environment and Childhood Asthma birth cohort study underwent a clinical examination including perceived EL (structured interview of child and parent(s)), measure of overweight (body mass index by sex and age passing through 25 kg/m2 or above at 18 years), exercise-induced bronchoconstriction (forced expiratory volume in one-second (FEV1 ) pre- and post-exercise), methacholine bronchial challenge (severe BHR; provocative dose causing ≥20% decrease in FEV1 ≤ 1 μmol), and asthma severity score (dose of controller medication and exacerbations last 12 months). Multivariate logistic regression analyses were conducted to assess associations with perceived EL. RESULTS In the final model explaining 30.1%, asthma severity score (OR: 1.49, (1.32, 1.67)) and overweight (OR: 2.35 (1.14, 4.82)) only were significantly associated with perceived EL. Excluding asthma severity and allergic disease, severe BHR (OR: 2.82 (1.38, 5.76)) or maximal reduction in FEV1 post-exercise (OR: 1.48 (1.10, 1.98)) and overweight (OR: 2.15 (1.13, 4.08) and 2.53 (1.27, 5.03)) explained 9.7% and 8.4% of perceived EL, respectively. CONCLUSIONS Perceived EL in children with asthma was independently associated with asthma severity and overweight, the latter doubling the probability of perceived EL irrespectively of asthma severity, allergy status, socioeconomic factors, prenatal smoking, or PA.
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Affiliation(s)
- Thomas Westergren
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Sveinung Berntsen
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Karin C Lødrup Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Petter Mowinckel
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Håland
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Liv Fegran
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Kai-Håkon Carlsen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Douros K, Boutopoulou B, Priftis KN. Blunted perception of dyspnea in asthmatic children: A potential misleading criterion. World J Clin Pediatr 2015; 4:38-40. [PMID: 26261764 PMCID: PMC4526836 DOI: 10.5409/wjcp.v4.i3.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/02/2015] [Accepted: 06/16/2015] [Indexed: 02/05/2023] Open
Abstract
Dyspnea (or breathlessness) is a symptom describing a perceived experience of breathing discomfort. Children’s awareness of dyspnea is variable and there is only a poor correlation between the objective respiratory distress measurements and the subjectively awareness of dyspnea. Those who do not perceive dyspnea may not be motivated to comply with their daily prophylactic treatment. Since dyspnea is the main symptom of asthma, and disease management is based largely on the description of symptoms between clinic visits, unreliable symptom report may mislead decision-making for long-term treatment of asthma. Thus, therapeutic decisions should not be taken solely on patients’ perception and description of dyspnea.
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20
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Visser R, Brusse-Keizer M, van der Palen J, Klok T, Thio BJ. The impact of discussing exercise test results of young asthmatic children on adherence to maintenance medication. J Asthma 2015; 52:743-8. [PMID: 25982906 DOI: 10.3109/02770903.2015.1008141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Parents' awareness of their child's asthma may improve by discussing an exercise challenge test (ECT) result with them. We investigated the influence of discussing an ECT result with parents on adherence to inhaled maintenance medication, parental illness perceptions and medication beliefs in young asthmatic children. METHODS A total of 79 children, 4-7 years old and enrolled in our standard comprehensive asthma care program, performed an ECT to assess exercise induced bronchoconstriction (EIB). The result of the ECT was immediately discussed with the parents. Median medication adherence level was measured with electronic medication loggers from six weeks before the ECT till six weeks afterwards. Parental beliefs about medicines and illness perceptions were measured with the Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perceptions Questionnaire (B-IPQ). RESULTS The median baseline adherence level was high (83%) and showed a small significant decline after the ECT. There was no significant difference in the decrease in median adherence level between the children with or without EIB. Most parents (82.1%) showed a positive necessity-concern ratio at baseline, as measured with the BMQ. There was no clinical relevant change in medication concerns and necessity scores or in illness perceptions. CONCLUSION Discussing ECT results with parents does not modify median adherence levels to inhaled maintenance medication nor medication beliefs of highly adherent young asthmatic children who are already enrolled in a comprehensive asthma care program.
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21
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Shefer G, Donchin M, Manor O, Levy-Hevroni R, Schechter A, Cohen R, Cohen HA, Kerem E, Engelhard D. Disparities in assessments of asthma control between children, parents, and physicians. Pediatr Pulmonol 2014; 49:943-51. [PMID: 24166798 DOI: 10.1002/ppul.22924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/15/2013] [Accepted: 09/16/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Assessment of asthma control in children by physicians, patients and their parents was compared, assuming parents may underestimate symptoms in asthmatic children and exploring whether physicians tend to agree with them. DESIGN Asthma control perception was assessed in 4- to 11-year-old asthmatic children and their parents, using C-ACT, during 2011-2012. Pediatric pulmonologists used GINA guidelines for their assessment; pediatricians, not having spirometry, used the information given in addition to physical examination. The C-ACT scores given by the children and their parents were further analyzed separately, and compared with their physicians' assessment. Statistical methods, which also measured possible influence of different variables, included kappa, Chi-square, linear-by-linear association, McNemar test and logistic regression. PATIENT SELECTION The study comprised 354 parents and children aged 4-11 years with moderate-severe asthma; 129 (36.4%) were treated by 23 pediatricians; 225 (63.6%) by 11 pediatric pulmonologists. RESULTS The C-ACT was generally found valid in assessing asthma control (P < 0.001; κ 0.529; CI 0.441, 0.617) and showed that in 229/354 (53%) of children the asthma was uncontrolled. Nevertheless, of the 229 children who indicated their asthma was uncontrolled, 124 (54.1%) of their parents (κ 0.245; CI 0.15, 0.34) and 96 (41.9%) of their physicians believed it to be controlled (κ 0.331; 0.24, 0.43). Comparing the physician-child discordance vis-à-vis the parents, the significant difference was when 96/229 children (41.9%) and 34/126 parents (27.0%) indicated the asthma was uncontrolled while the physician determined it controlled (OR 1.95; 1.19, 3.24). There were no significant differences between pediatric pulmonologists and pediatricians. CONCLUSIONS In addition to increasing awareness of parents to symptoms in their asthmatic children, physicians should question the child appropriately, as well as using the children's responses to C-ACT as an information source for properly assessing asthma control.
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Affiliation(s)
- Galit Shefer
- Braun School of Public Health and Community Medicine, Hebrew University-Haddassah, Jerusalem, Israel
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Linhares DVBR, da Fonseca JAL, Borrego LM, Matos A, Pereira AM, Sá-Sousa A, Gaspar A, Mendes C, Moreira C, Gomes E, Rebelo FF, Cidrais Rodrigues JC, Onofre JM, Azevedo LF, Alfaro M, Calix MJ, Amaral R, Rodrigues-Alves R, Correia de Sousa J, Morais-Almeida M. Validation of control of allergic rhinitis and asthma test for children (CARATKids)--a prospective multicenter study. Pediatr Allergy Immunol 2014; 25:173-9. [PMID: 24628568 DOI: 10.1111/pai.12218] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross-sectional validity, and longitudinal validity. METHODS A prospective observational study was conducted in 11 Portuguese centers. During two visits separated by 6 wk, CARATKids, visual analog scale scales and childhood asthma control test were completed, and participant's asthma and rhinitis were evaluated by his/her physician without knowing the questionnaires' results. Data-driven item reduction was conducted, and internal consistency, responsiveness analysis, and associations with external measures of disease status were assessed. RESULTS Of the 113 children included, 101 completed both visits. After item reduction, the final version of the questionnaire has 13 items, eight to be answered by the child and five by the caregiver. Its Cronbach's alpha was 0.80, the Guyatt's responsiveness index was -1.51, and a significant (p < 0.001) within-patient change of CARATKids score in clinical unstable patients was observed. Regarding cross-sectional validity, correlation coefficients of CARATKids with the external measures of control were between 0.45 and -0.69 and met the a priori predictions. In the longitudinal validity assessment, the correlation coefficients between the score changes of CARATKids and those of external measures of control ranged from 0.34 to 0.46. CONCLUSION CARATKids showed adequate psychometric properties and is ready to be used in clinical practice.
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Rapino D, Attanasi M, Consilvio NP, Scaparrotta A, Cingolani A, Cerasa M, Mohn A, Di Pillo S, Chiarelli F. Evaluation of association between airway hyperresponsiveness, asthma control test, and asthma therapy assessment questionnaire in asthmatic children. Multidiscip Respir Med 2013; 8:48. [PMID: 23879928 PMCID: PMC3733674 DOI: 10.1186/2049-6958-8-48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022] Open
Abstract
Background Achieving asthma control is a major challenge in children, otherwise symptoms perception remain poor especially at this age. The aim of this study is to evaluate the relationship between Asthma Control Test (ACTTM), Asthma Therapy Assessment Questionnaire (ATAQTM) and exercise-induced bronchospasm (EIB). Methods We studied 80 asthmatic children. Airways hyperresponsiveness (AHR) was assessed by exercise-induced bronchospasm (Balke Protocol). Asthma control was evaluated using two questionnaires in all subjects: ACT (composed by Childhood-ACT and ACT) and ATAQ. In addition the use of short acting beta 2 agonist agents (SABAs) was assessed for each patient. Non-parametric variables were compared by Chi Square Test. Binomial logistic regression was performed to estimate the two questionnaires Odds Ratio (OR) in finding AHR. Results We have found that ATAQ has a sensitivity and a specificity of 0.72 and 0.45 respectively; instead, ACT has a sensitivity and a specificity of 0.5 and 0.39 respectively in evaluating AHR. Patients with uncontrolled asthma according to ATAQ revealed a significant higher percentage of AHR compared with ACT (72% vs 50%, p < 0.01). Confirming this finding, patients declaring uncontrolled asthma to ATAQ have a significantly higher percentage (34%) of frequent SABAs use than the group with uncontrolled asthma to ACT (21%) (p <0.01). Binomial logistic regression shows how a test revealing uncontrolled asthma is associated with the increasing odds of having AHR according to ATAQ (OR = 3.8, p = 0.05), not to ACT (OR = 0.2, p = 0.1). Conclusions Our results show that ATAQ reflects AHR and asthma control better than ACT. Children with uncontrolled asthma according to ATAQ have higher odds of having AHR and use of rescue medications (SABAs) compared to patients declaring uncontrolled asthma according to ACT. However both questionnaires are not sufficient alone to fully evaluate asthma control in children and it is always necessary to perform functional tests and investigate patients lifestyle, drug use and other important data that a simple questionnaire is not able to point out
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Affiliation(s)
- Daniele Rapino
- Allergy and Respiratory Unit, Department of Pediatrics, G, D'Annunzio University of Chieti, Via Dei Vestini 5, Chieti 66013, Italy.
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Nuijsink M, Hop WCJ, Jongste JCD, Sterk PJ, Duiverman AEJ. Perception of bronchoconstriction: a complementary disease marker in children with asthma. J Asthma 2013; 50:560-4. [PMID: 23672570 DOI: 10.3109/02770903.2013.792347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Asthma guidelines use symptoms as the most important aspect of asthma control. Symptom perception varies widely between individuals. Over-perception as well as underperception of bronchoconstriction could have a negative effect on asthma management. We hypothesized that perception of bronchoconstriction in childhood asthma is not related to common measures of disease control. For that reason, we examined the clinical determinants of the perception of bronchoconstriction and the repeatability of perception measurements. PATIENTS AND METHODS In school-age children with moderately severe atopic asthma, we measured the perception of bronchoconstriction (decrease in forced expiratory volume in 1 second (FEV(1)) during methacholine bronchoprovocation challenges. The perception of bronchoconstriction was assessed as the slope of the relation between FEV(1) and Borg score, and as the Borg score at a 20% decrease in FEV(1) from baseline during the provocation test (PS(20)). Data from subjects who had a 20% or more decrease in FEV(1) (n = 112) were used for the analysis. Fifty-four children repeated the test after 3 months. Symptoms, use of rescue medication, and peak expiratory flows were scored in diaries during the 2 weeks before testing. RESULTS Symptom perception was significantly better in children without (PD(20) > 1570 μg, n = 28) than in children with airway hyperresponsiveness (PD(20) ≤ 1570 μg, n = 112), slope 0.22 versus 0.13 respectively (p < .001). Borg scores correlated with PD(20) (p = .01), baseline FEV(1) (only for slope, p = .04), and use of rescue beta agonist (p = .01), but not with other aspects of asthma control. Repeatability of Borg scores was good (slope: R = 0.59, PS(20): R = 0.52). CONCLUSION Poorer symptom perception in asthmatic children correlated with hyperresponsiveness, and was associated with lower baseline FEV(1) and less use of rescue bronchodilators. This suggests that the measurement of symptom perception should be taken into account in individual management plans for children with asthma.
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Affiliation(s)
- Marianne Nuijsink
- Department of Pediatrics Respiratory Medicine, Haga Hospital/Juliana Children's Hospital, The Hague, The Netherlands.
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van Leeuwen JC, Driessen JMM, Kersten ETG, Thio BJ. Assessment of exercise-induced bronchoconstriction in adolescents and young children. Immunol Allergy Clin North Am 2013; 33:381-94, viii-ix. [PMID: 23830131 DOI: 10.1016/j.iac.2013.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recent research shows important differences in exercise-induced bronchoconstriction (EIB) between children and adults, suggesting a different pathophysiology of EIB in children. Although exercise can trigger classic symptoms of asthma, in children symptoms can be subtle and nonspecific; parents, children, and clinicians often do not recognize EIB. With an age-adjusted protocol, an exercise challenge test can be performed in children as young as 3 years of age. However, an alternative challenge test is sometimes necessary to assess potential for EIB in children. This review summarizes age-related features of EIB and recommendations for assessing EIB in young children and adolescents.
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Affiliation(s)
- Janneke C van Leeuwen
- Department of Pediatrics, Medisch Spectrum Twente, VKC poli 17, Haaksbergerstraat 55, Enschede 7513 ER, The Netherlands.
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Dimitrakaki V, Porpodis K, Bebetsos E, Zarogoulidis P, Papaiwannou A, Tsiouda T, Tsioulis H, Zarogoulidis K. Attitudes of asthmatic and nonasthmatic children to physical exercise. Patient Prefer Adherence 2013; 7:81-8. [PMID: 23378744 PMCID: PMC3554104 DOI: 10.2147/ppa.s40577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to examine the physical activity of children with and without asthma in Greece, the factors affecting their intention to exercise, and the influence of gender. METHOD The study involved 50 children with asthma and 50 children without asthma, aged 9-14-years old. We used the leisure time exercise questionnaire to assess the frequency and intensity of exercise. The planned behavior scale examined seven factors affecting physical activity: attitude, intention, self-identity, attitude strength, social role model, information, and knowledge. RESULTS Asthmatic children did not differ significantly in mild, moderate, and overall level of physical activity from children without asthma but they participated less in intense and systematic exercise. The two asthmatic groups did not differ in any of the planned behavior factors. Significant differences between genders occurred with respect to self-identity and social role model. Boys appeared to exercise more regularly and intensely compared to girls. CONCLUSION Asthmatic children did not systematically participate in physical activity, preferring mostly mild and moderate intensity activities. Children with and without asthma had comparable positive attitudes and intentions toward exercise.
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Affiliation(s)
- Vithleem Dimitrakaki
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Konstantinos Porpodis
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Bebetsos
- Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Paul Zarogoulidis
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Correspondence: Paul Zarogoulidis G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Exohi 57010, Greece Tel +30 697 727 1974 Fax +30 231 099 2433 Email
| | - Antonis Papaiwannou
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Tsiouda
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Hlias Tsioulis
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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van Leeuwen JC, Driessen JMM, de Jongh FHC, Anderson SD, Thio BJ. Measuring breakthrough exercise-induced bronchoconstriction in young asthmatic children using a jumping castle. J Allergy Clin Immunol 2012. [PMID: 23199614 DOI: 10.1016/j.jaci.2012.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Elkins MR, Brannan JD. Warm-up exercise can reduce exercise-induced bronchoconstriction. Br J Sports Med 2012; 47:657-8. [PMID: 23038787 DOI: 10.1136/bjsports-2012-091725] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mark R Elkins
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. Breathlessness perception assessed by visual analogue scale and lung function in children with asthma: a real-life study. Pediatr Allergy Immunol 2012; 23:537-542. [PMID: 22625869 DOI: 10.1111/j.1399-3038.2012.01316.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In children with asthma, discrepancies between objective indicators of airway obstruction and symptom perception are often observed. Although visual analogue scale (VAS) has been proposed as a useful tool for assessing accurate symptom perception, previous studies conducted in children with asthma included only small cohorts. A study was therefore designed to investigate the usefulness of VAS in establishing a reliable relationship between breathlessness perception and lung function in a large cohort of children with clinical diagnosis of asthma. METHODS A total of 703 children [470 boys and 233 girls, median age 10.29 (8.33-12.58) yr] with asthma were included in this cross-sectional, real-life study. Perception of breathlessness was assessed by using VAS, and lung volumes and expiratory flows were measured by spirometry. RESULTS Most children had intermittent or mild persistent asthma (93.3%), and only 46 children had a significant bronchial obstruction defined by FEV(1) values <80% of predicted. Globally, VAS was significantly, even though weakly, related to lung function. Analyzing children with bronchial obstruction, a moderate relationship between both FEV(1) (r = 0.47) and FEF(25-75) (r = 0.42) and VAS was detected. A VAS value of 6 was found to be a reliable cutoff for discriminating children with bronchial obstruction (AUC 0.83 at ROC curve; OR 9.4). CONCLUSION The present study demonstrates that VAS might be considered a useful tool to assess symptom perception, mainly in children with airflow limitation.
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Affiliation(s)
- Maria A Tosca
- Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy
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Correia MADV, Rizzo JA, Sarinho SW, Sarinho ESC, Medeiros D, Assis F. Effect of exercise-induced bronchospasm and parental beliefs on physical activity of asthmatic adolescents from a tropical region. Ann Allergy Asthma Immunol 2012; 108:249-53. [DOI: 10.1016/j.anai.2012.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
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Chinellato I, Piazza M, Sandri M, Cardinale F, Peroni DG, Boner AL, Piacentini GL. Evaluation of association between exercise-induced bronchoconstriction and childhood asthma control test questionnaire scores in children. Pediatr Pulmonol 2012; 47:226-32. [PMID: 22058076 DOI: 10.1002/ppul.21542] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 07/17/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Asthma control represents a major challenge in the management of asthmatic children; however, correct perception of control is poor. The aim of the study was to evaluate the association between subjective answers given to the Childhood Asthma Control Test (C-ACT) and objective evaluation of exercise-induced bronchonstriction (EIB) by standardized treadmill exercise challenge. METHODS EIB was evaluated by standardized treadmill exercise challenge and related to C-ACT scores in 92 asthmatic children. RESULTS Of the 92 studied children only six children had a concordance between a positive challenge test (ΔFEV1 ≥ 13%) and a positive response to the exercise-related issue of the C-ACT questionnaire (C-ACT total score ≤ 19). There was no significant association between the degree of EIB and the scores relative to the single question on exercise-related problems while a significant association was found when considering the whole questionnaire with C-ACT total score > 19 (r = -0.40, P < 0.001). The two single questions showing a significant association were those focusing on nocturnal asthma. The areas under the ROC curve (AUC) for the sum of the scores of these questions in relationship to a positive response to the exercise test was 0.74. The AUC of the C-ACT total score was 0.76 and 0.55 for the specific question on EIB related problems. CONCLUSION The discrimination power of the C-ACT total score in relationship to EIB was moderately good, and C-ACT questionnaire was capable of correctly predicting the absence of EIB in children reporting a global score > 19. However, direct questions on EIB are associated with a high number of false positive and negative responses; better associations are found questioning on the presence on nocturnal symptoms.
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Affiliation(s)
- Iolanda Chinellato
- Department of Paediatrics, University of Verona, Policlinico GB Rossi, Piazzale L. Scuro 10, 37134 Verona, Italy
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Waibel V, Ulmer H, Horak E. Assessing asthma control: symptom scores, GINA levels of asthma control, lung function, and exhaled nitric oxide. Pediatr Pulmonol 2012; 47:113-8. [PMID: 22241569 DOI: 10.1002/ppul.21529] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 05/25/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND The childhood asthma control test (C-ACT) is a validated symptom score for assessing asthma control in children. We used a slightly modified version (C-ACT(M) ) of the German C-ACT and compared our results with the literature, correlated the children's part of C-ACT (C-ACT(children) ) with a visual analogue scale (VAS(children) ), explored the agreement between C-ACT(M) and GINA levels of asthma control, as well as the relationship between C-ACT(M) and lung function and exhaled nitric oxide (FeNO). METHODS We investigated 107 children with a diagnosis of asthma. The study protocol consisted of a clinical examination, assessment of asthma control according to GINA guidelines, administration of C-ACT(M) , VAS(children) , lung function, and FeNO. RESULTS Of our patients 66% had, according to GINA, partly controlled-/uncontrolled asthma, 18% were uncontrolled according to C-ACT(M) . Children with partly controlled-/uncontrolled asthma according to GINA had lower C-ACT(M) scores than did children with controlled asthma (16.1 ± 3.6 SD vs. 25.4 ± 1.8 SD; P < 0.000), and children with a C-ACT(M) score ≤ 19 had poorer lung function (mean FEV1% predicted 81.5 ± 13.5 SD vs. 94.2 ± 12.1 SD; P = 0.002). Spearman's rank correlation coefficients revealed significant correlations between all symptom scores. Multiple linear regression adjusted for age, gender, FEV1 and FeNO demonstrated a significant relationship between C-ACT(M) , VAS(children) , and FEV1 (P = 0.003, resp. <0.000), but no significant correlation between C-ACT(M) , VAS(children) , and FeNO. CONCLUSIONS The German version of C-ACT(M) is valid and useful for monitoring children with asthma along with tests aimed to follow up lung function and airway inflammation. Concordance between C-ACT(M) and GINA is moderate, because asthma control assessed by C-ACT(M) allows more symptoms and lung function is not included in the scoring.
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Affiliation(s)
- Vanessa Waibel
- University Hospital for Children and Adolescents, Innsbruck Medical University, Innsbruck, Austria.
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Value of the Likert dyspepsia scale in differentiation of functional and organic dyspepsia in children. J Pediatr Gastroenterol Nutr 2011; 52:392-8. [PMID: 21407108 DOI: 10.1097/mpg.0b013e3181fea0a9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM Dyspeptic symptoms may not allow clinicians to differentiate organic and functional gastrointestinal disorders. According to our dyspeptic patients' answers to dyspepsia questionnaire, we aimed to define the symptom scores directing organic dyspepsia (OD) before upper gastrointestinal endoscopy. PATIENTS AND METHODS One hundred sixty-one patients (ages 10-17 years, mean 13.5 ± 2.3 years, male/female: 2/3) with chronic upper gastrointestinal system symptoms lasting for at least 3 months were enrolled. Patients with predominated reflux symptoms were excluded by 24-hour pH monitoring. Before upper gastrointestinal endoscopy, severity and incidence of 8 gastrointestinal symptoms (epigastric pain, upper abdominal discomfort, retrosternal pyrosis, bitter or sour taste in mouth, halitosis, belching, nausea, and early satiety) were measured by 5-point Likert scale. Total score indicated severity score multiplied by incidence score. Antral biopsy samples were obtained. OD is defined as peptic ulcer, erosive esophagitis, erosive or nodular gastritis, and erosive duodenitis in endoscopy and/or moderate to severe antral gastritis in histology. Functional dyspepsia (FD) is defined as normal findings/mucosal hyperemia in endoscopy and/or mild antral gastritis in antral histology. We evaluated the relation among severity and incidence scores of each dyspeptic symptom in patients with OD or FD. Age, sex, body mass index, drug history, nutritional habits, the quality of life related to dyspepsia were also investigated in patients with OD and FD. RESULTS According to patients' histological and endoscopic findings, 100 (62%) patients were in the OD group and 61 (38%) patients were in the FD group. Of the dyspeptic complaints, the severity, incidence, and total scores of epigastric pain were significantly correlated with dyspepsia type (respectively, P = 0.042, P = 0.028, and P = 0.005). Of 93 patients who had an epigastric pain severity of 4 and 5 (namely, moderate to severe pain), 65 (70%) patients were in the OD group and 28 (30%) patients were in the FD group. Of 68 patients who had an epigastric pain severity of 0 to 3 (no epigastric pain or mild pain), 33 (48.5%) were in the OD group and 35 (51.5%) were in the FD group, and the difference was statistically significant (P = 0.042). After analyzing the total scores of 8 dyspeptic symptoms, one by one or in different combinations, we could not find a threshold (cutoff) score value that was able to indicate OD definitely. Age, sex, body mass index, and nutritional habits were not significantly different between patients with OD or FD. Nocturnal abdominal pain, pain before meals, and resolution of symptoms after meals or ingestion of antacid drugs were not significantly related to OD. Nocturnal abdominal pain was observed to be higher in the group with moderate to severe gastric inflammation. CONCLUSIONS In the present study, the severity, incidence, and total scores of epigastric pain were significantly related to OD; however, a cutoff value of dyspepsia symptom score for differentiation of OD and FD could not determined. In our study, Likert dyspepsia scale was not beneficial in differentiation of the OD/FD groups. We suggest that the Likert dyspepsia scale should be redesigned for children or the same scale should be applied in a larger cohort of dyspeptic children.
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Davis KJ, Disantostefano R, Peden DB. Is Johnny wheezing? Parent-child agreement in the Childhood Asthma in America survey. Pediatr Allergy Immunol 2011; 22:31-5. [PMID: 21261742 DOI: 10.1111/j.1399-3038.2010.01016.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We compared responses of children and parents to determine their level of agreement in a national, population-based survey regarding asthma-related health of US children. A telephone-based survey was conducted in 2004 among a national probability sample of children with current asthma in the United States. To compare responses between parent-child pairs, a subset of 284 children aged 10-15 were interviewed in addition to the parents. This survey collected data on asthma symptom prevalence, physical activity limitations and impact of exercise on asthma, and asthma management including medication use. Paired responses were compared using the kappa (κ) statistic. Overall, parents of 10-15-yr-olds underestimated the burden of asthma experienced by their children, especially the effects on physical activity. More than half (58%) of children replied that exercise was a trigger for their asthma compared to only 35% of parents (κ 0.23). Children were more likely than parents to mention activity limitations, specifically avoiding physical exertion (63% vs. 49%-κ 0.004). Prevalence of symptoms was also underreported by parents relative to children, particularly breathing problems (41% vs. 67%-κ 0.16) and cough (45% vs. 64%-κ 0.14). Maintenance therapy use in the past 4 weeks was reported by 35% of children, whereas 44% of parents believed their children had used maintenance therapy (κ 0.47). Relative to children's self-report, parents underestimated avoidance tactics used by their children with asthma, including exercise and physical activity self-limitation to prevent the onset or worsening of asthma symptoms. Parents also underreported asthma symptoms of their children aged 10-15 years old and were discordant with their children regarding medication use. Increasing regular communication about asthma between child, parent, and physician is warranted to improve asthma control and overall health.
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Affiliation(s)
- K J Davis
- Worldwide Epidemiology, GlaxoSmithKline Research and Development, Five Moore Drive, Research Triangle Park, NC 27709-3398, USA.
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Abstract
In clinical and research settings, it is increasingly acknowledged that adolescents may be better positioned than their caregivers to provide information in regard to their own health status, including information related to asthma. Very little is known, however, about the congruence between adolescent and caregiver responses to questions about asthma beyond reports of symptoms. We analyzed data for 215 urban, primarily African-American adolescent-caregiver pairs. Adolescents and caregiver reports concerning the adolescent's asthma-related medical history were moderately correlated and not found to differ at the aggregate level. Correlations between adolescent and caregiver reports of the adolescent's asthma symptoms and functional status were weak, although these differences deteriorated at the aggregate level. Adolescent-caregiver reports of symptoms and functioning were more likely to be in agreement if the adolescent was older, if school personnel were unaware of the child's asthma, and if the adolescent's asthma was classified as mild intermittent. For questions concerning the frequency of hospitalizations, emergency department visits, and physician visits, moderate correlations between adolescent and caregiver responses were noted, although with some differences at the aggregate level. Findings suggest that, when adolescents and their caregivers are asked about the adolescent's asthma in clinical and research settings, the extent to which the two perspectives are likely to agree depends on the type of information sought. Clinicians and researchers may obtain more accurate information if questions about symptoms and functional status are directed toward adolescents.
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Long-term studies of the natural history of asthma in childhood. J Allergy Clin Immunol 2010; 126:187-97; quiz 198-9. [PMID: 20688204 DOI: 10.1016/j.jaci.2010.07.011] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 07/07/2010] [Accepted: 07/09/2010] [Indexed: 01/17/2023]
Abstract
Segmentation of children with asthma and other wheezy disorders remains the main research challenge today, as it was when described 2 centuries ago. Early childhood wheezy disorders follow different temporal trajectories, probably representing different underlying mechanisms (endophenotypes). Prospective identification of endophenotypes allowing accurate prediction of the clinical course is currently not possible. The variability of the clinical course remains an enigma and difficult to predict. Three of 4 school-aged children with asthma have outgrown disease by midadulthood. The risk of persistence increases with severity, sensitization, smoking, and female sex. Genetic risk variants might help disentangle the heterogeneity of asthma and other wheezy disorders. At early school age, children with asthma have reduced lung function. It is an important and unresolved question whether the airflow limitation associated with asthma already existed at birth or developed along with symptoms. Likewise, the association between the infant's bronchial responsiveness and development of asthma and other wheezy disorders is unclear. Neither primary prevention through manipulation of environmental factors nor secondary prevention through the use of inhaled corticosteroids can effectively halt the long-term disease progression in childhood. In conclusion, the natural history of asthma and the associated airway changes is still poorly understood, and we have not managed to translate findings from long-term studies into a deeper understanding of the underlying endophenotypes or improved disease management. We propose the need for a translational research approach based on long-term clinical studies of birth cohorts with comprehensive and objective assessments of intermediate phenotypes and environmental exposures combined with interdisciplinary basic research and a systems biology approach.
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Peterson JW, Sterling YM. Children's perceptions of asthma: African American children use metaphors to make sense of asthma. J Pediatr Health Care 2009; 23:93-100. [PMID: 19232925 DOI: 10.1016/j.pedhc.2007.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 10/04/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Children's views of their illness often are absent in decisions that affect their lives. This research, which is a component of a larger study, reports how African American children described their asthma. METHOD The study's design was descriptive and longitudinal, using an ethnographic approach. A subsample of 10 children diagnosed with asthma who resided in one of two study sites spontaneously described their asthma. The study was conducted in various settings where the researchers observed/participated in selected activities. Participants were interviewed several times, and field notes were recorded. RESULTS The qualitative findings are from participant observation and interviews of 10 children ages 9 to 12 years. Four of the most developed metaphors are reported here. Out of their experiences, children created their own metaphors for asthma that are concrete, familiar, and multi-vocal, allowing for embellishment. DISCUSSION Not all children use metaphors to explain or describe their asthma. Children who explain asthma in their own terms will feel valued and invested in their own health care as they find that their voices make a difference in decisions about their care.
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Affiliation(s)
- Jane W Peterson
- College of Nursing, Seatle University, Seattle, WA 98122-1090, USA.
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Tillie-Leblond I, Montani D, Crestani B, de Blic J, Humbert M, Tunon-de-Lara M, Magnan A, Roche N, Ostinelli J, Chanez P. Relation between inflammation and symptoms in asthma. Allergy 2009; 64:354-67. [PMID: 19210358 DOI: 10.1111/j.1398-9995.2009.01971.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggest that there is a relationship between the perception of symptoms and eosinophilic inflammation and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease-modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids.
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Affiliation(s)
- I Tillie-Leblond
- Respiratory Diseases Department, Hôpital Albert Calmette, Lille, France
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Weinberger M, Abu-Hasan M. Perceptions and pathophysiology of dyspnea and exercise intolerance. Pediatr Clin North Am 2009; 56:33-48, ix. [PMID: 19135580 DOI: 10.1016/j.pcl.2008.10.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dyspnea is a complex psychophysiologic sensation that requires intact afferent and efferent pathways for the full perception of the neuromechanical dissociation between the respiratory effort attempted and the work actually accomplished. The sensation is triggered or accentuated by a variety of receptors located in the chest wall, respiratory muscles, lung parenchyma, carotid body, and brain stem. The sensation of dyspnea is stronger in patients with higher scores for anxiety and has been reported in patients with anxiety disorders with no cardiopulmonary disease. These observations demonstrate the importance of cerebral cognition in this complex symptom. Ten cases are presented that illustrate different clinical manifestations of dyspnea.
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Affiliation(s)
- Miles Weinberger
- Pediatric Allergy and Pulmonary Division, Pediatrics Department, University of Iowa Children's Hospital, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
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Abstract
In asthma, symptoms are the main reason for recourse to healthcare and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. Uncontrolled asthmatics have an increased number of eosinophils in induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggests that there is a relationship between the perception of symptoms and eosinophilic inflammation, and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on retrospective evaluation of symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference maintenance therapy for persistent asthma and adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total dose of inhaled corticosteroids. A French expert group has undertaken a study of the association between inflammation and asthma symptoms by carrying out a critical review of the international literature.
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van Gent R, van Essen-Zandvliet EEM, Klijn P, Brackel HJL, Kimpen JLL, van Der Ent CK. Participation in daily life of children with asthma. J Asthma 2008; 45:807-13. [PMID: 18972300 DOI: 10.1080/02770900802311477] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Asthma can have a negative effect on psychological and social well-being in childhood. Sports participation, school attendance, and quality of life are important issues for children with asthma and their parents. However, a structural evaluation of these factors is not always incorporated in the routine medical approach of children with asthma. Moreover, goals in asthma treatment, such as minimal symptoms and normal activity levels, are achieved in a minority of children. This review describes determinants that are important for the well-being of children with asthma and their parents. Besides the control of symptoms, factors such as sports participation, socializing in peer groups, school attendance, and quality of life must be considered. These issues are relevant when evaluating the management of children and adolescents with asthma. A multidisciplinary evaluation by a pediatrician, school nurse, gym teacher, and psychologist might contribute to an important decrease in the impact of asthma on daily life.
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Affiliation(s)
- R van Gent
- Department of Paediatrics, Máxima Medical Centre, Veldhoven, The Netherlands.
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Pearlman DS, Rees W, Schaefer K, Huang H, Andrews WT. An evaluation of levalbuterol HFA in the prevention of exercise-induced bronchospasm. J Asthma 2007; 44:729-33. [PMID: 17994402 PMCID: PMC2409177 DOI: 10.1080/02770900701595667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Exercise-induced bronchospasm (EIB) affects up to 90% of all patients with asthma. Objective This study evaluated the ability of levalbuterol hydrofluoroalkane (HFA) 90 μg (two actuations of 45 μg) administered via metered dose inhaler (MDI) to protect against EIB in mild-to-moderate asthmatics. Methods This was a randomized, double-blind, placebo-controlled, two-way cross-over study. Patients with asthma (n = 15) were ≥18 years, had a ≥6-month history of EIB, ≥70% baseline predicted forced expiratory volume in 1 second (FEV1), and a 20% to 50% decrease in FEV1 after treadmill exercise challenge using single-blind placebo MDI. Levalbuterol or placebo was self-administered 30 minutes before exercise. Treatment sequences were separated by a 3-to 7-day washout period. Spirometry was performed predose, 20 minutes postdose/pre-exercise, and 5, 10, 15, 30, and 60 minutes post-exercise. The primary endpoint was the maximum percent decrease in FEV1 from baseline (postdose/pre-exercise). The percentage of protected (≤20% decrease in post-exercise FEV1) patients was also assessed. Results Levalbuterol had significantly smaller maximum percent post-exercise decrease in FEV1 compared with placebo (LS mean ± SE; −4.8% ± 2.8% versus −22.5% ± 2.8%, respectively). For levalbuterol, 14/15 (93.3%) patients had <20% decrease in post-exercise FEV1 compared with 8/15 (53.3%) for placebo (p = 0.0143). Treatment was well tolerated. Conclusion Levalbuterol HFA MDI (90 μg) administered 30 minutes before exercise was significantly more effective than placebo in protecting against EIB after a single exercise challenge and was well tolerated. Clinical Implications Levalbuterol HFA MDI when administered before exercise was effective in protecting adults with asthma from EIB.
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Affiliation(s)
- D S Pearlman
- Colorado Allergy and Asthma Centers, PC, Denver, Colorado 80230, USA.
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Vilozni D, Bentur L, Efrati O, Barak A, Szeinberg A, Shoseyov D, Yahav Y, Augarten A. Exercise challenge test in 3- to 6-year-old asthmatic children. Chest 2007; 132:497-503. [PMID: 17573494 DOI: 10.1378/chest.07-0052] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
RATIONALE The exercise challenge test (ECT) is a common tool to assess exercise-induced asthma (EIA) in school-aged children. EIA has not been explored in the early childhood setting. OBJECTIVE To assess the existence of EIA in children in this age group. MEASUREMENTS AND MAIN RESULTS A 6-min, controlled, free-run test was performed in 55 children (age range, 3 to 6 years old) who were classified into the following groups: 30 children in whom asthma had been previously diagnosed (group A); and 25 children with prolonged coughing (group B). Spirometry measurements were obtained before the run, and at 1, 2, 3, 5, 10, and 20 min after the run. A positive finding of EIA was defined as a 13% decrease from baseline FEV(1) or baseline forced expiratory volume in the first 0.5 s (FEV(0.5)). The actual duration of each run was age-related (mean [+/- SD] duration, 4.8 +/- 0.8 min). The nadir in indexes occurred after a mean time of 2.98 +/- 1.31 min. A positive EIA finding determined by FEV(1) was present in 15 children, and by FEV(0.5) in 34 children. Twenty-six children were from group A, but only 8 children were from group B. Wheezing and/or prolonged expiration were associated with a positive test result in 31 of 34 children. Coughing was frequent in children with both negative and positive ECT findings. CONCLUSION The present study documents for the first time the presence of EIA in response to a free-run test in early childhood. Our findings suggest that a free-run test for the presence of EIA is suitable, but that the running duration is limited by age. The duration of airflow limitation after exercise is significantly earlier and shorter in young children with asthma compared with older children. FEV(0.5) is a better index than the traditional FEV(1) for describing positive ECT results in young children. The association of wheezing and/or prolonged expiration may help in defining EIA in early childhood in the absence of a spirometer.
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Affiliation(s)
- Daphna Vilozni
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Ramat-Gan 52621, Israel.
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Liu AH, Zeiger R, Sorkness C, Mahr T, Ostrom N, Burgess S, Rosenzweig JC, Manjunath R. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol 2007; 119:817-25. [PMID: 17353040 DOI: 10.1016/j.jaci.2006.12.662] [Citation(s) in RCA: 667] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 11/20/2006] [Accepted: 12/13/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND For children younger than 12 years old with asthma, there are several quality-of-life instruments, clinical diaries, and questionnaires assessing symptoms; however, a validated tool for assessing asthma control is currently lacking. OBJECTIVE To develop and validate the Childhood Asthma Control Test (C-ACT), a self-administered tool for identifying children aged 4-11 years whose asthma is inadequately controlled. METHODS A 21-item questionnaire was administered to 343 patients with asthma and their caregivers, randomly assigning 75% (n = 257) for development and cross-sectional validation of the tool and 25% (n = 86) to a confirmatory sample. Stepwise logistic regression was used to reduce the 21 items to those best able to discriminate control as defined by the specialist's rating of asthma control. RESULTS Seven items were selected from regression analyses of the development sample to comprise the C-ACT. The scores of each item were summed for a total score (0-27), with lower scores indicating poorer control. Summed scores discriminated between groups of patients differing in the specialists' rating of asthma control (F = 36.89; P < .0001), the need for change in patients' therapy (F = 20.07; P < .0001), and % predicted FEV(1) (F = 2.66; P = .0494). A score of 19 indicated inadequately controlled asthma (specificity 74%, sensitivity 68%). These analyses were confirmed in the confirmatory sample. CONCLUSION The C-ACT is a validated tool to assess asthma control and identify children with inadequately controlled asthma. CLINICAL IMPLICATIONS The C-ACT can be valuable in clinical practice and research based on its validation, ease of use, input from the child and caregiver, and alignment with asthma guidelines.
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Affiliation(s)
- Andrew H Liu
- National Jewish Medical and Research Center and the University of Colorado School of Medicine, Denver, CO 80206, USA.
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Feldman JM, McQuaid EL, Klein RB, Kopel SJ, Nassau JH, Mitchell DK, Wamboldt MZ, Fritz GK. Symptom perception and functional morbidity across a 1-year follow-up in pediatric asthma. Pediatr Pulmonol 2007; 42:339-47. [PMID: 17358038 PMCID: PMC2966282 DOI: 10.1002/ppul.20584] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to examine the association between asthma symptom perception measured during a 5-6 week baseline and functional morbidity measured prospectively across a 1-year follow-up. Symptom perception was measured by comparing subjective ratings with peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV(1)). We hypothesized that accurate symptom perception (ASP) would be associated with less functional morbidity. Participants consisted of 198 children with asthma ages 7-17 recruited from three sites. The children used a programmable electronic spirometer in the home setting to guess their PEFR prior to exhalation. Each "subjective" guess was classified as being in an ASP, dangerous symptom perception (DSP; underestimation of symptoms), or symptom magnification (SM; overestimation) zone based upon the corresponding measurement of PEFR or FEV(1). An index of functional morbidity was collected by parent report at baseline and across 1-year follow-up. A greater proportion of ASP blows and a lower proportion of DSP blows based on PEFR predicted less functional morbidity reported at baseline, independent of asthma severity and race/ethnicity. A greater proportion of ASP blows (using PEFR and FEV(1)) and a lower proportion of SM blows (using FEV(1)) predicted less functional morbidity across 1-year follow-up. Symptom perception was not associated with emergency department visits for asthma at baseline or across follow-up. In comparison to PEFR, FEV(1) more frequently detected a decline in pulmonary function that children did not report. Symptom perception measured in naturalistic settings was associated with functional morbidity at baseline and prospectively across 1-year follow-up. Support was found for including multiple measures of pulmonary function in the assessment of asthma symptom perception.
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Affiliation(s)
- Jonathan M Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York 10461, USA.
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Lex C, Dymek S, Heying R, Kovacevic A, Kramm CM, Schuster A. Value of surrogate tests to predict exercise-induced bronchoconstriction in atopic childhood asthma. Pediatr Pulmonol 2007; 42:225-30. [PMID: 17245730 DOI: 10.1002/ppul.20556] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Exercise challenge tests are helpful in the diagnosis and management of childhood asthma, but methodology is complex and time-consuming. The aim of this study was to investigate whether exercise-induced bronchoconstriction (EIB) can be predicted by the results of different surrogate tests in a pediatric population. Eighty-five children (mean age: 11 years, range: 5-16 years) with atopic asthma were studied. Measurements of exhaled nitric oxide (eNO), spirometry and whole body plethysmography were performed followed by a standardized exercise testing. Questionnaires were completed asking for respiratory symptoms within 2 weeks preceding the study protocol. In 12/85 children (14%), forced expiratory volume in 1 sec (FEV1) was significantly reduced by > or = 15% after exercise testing. eNO was significantly elevated in this group of 12 patients as compared to patients without EIB (51.3 (31.1-67.3) parts per billion (ppb) versus 20.2 (10.9-42.3) ppb; P = 0.003). All children with normal eNO levels (< or = 25 ppb) had normal lung function results after exercise; hence the negative predictive value (NPV) of elevated eNO levels for prediction of EIB was 100%. However, the positive predictive value (PPV) was only 28%. The NPV and PPV for reported asthma symptoms within 2 weeks preceding the study were 96% and 26%, respectively. Considering recent symptom history in addition to elevated eNO improved the PPV to 40%, and resulted in the best combination of sensitivity and specificity. No baseline lung function parameter predicted whether a patient would develop EIB or not. In conclusion, eNO measurements, symptom questionnaires and most efficiently a combination of both surrogate tests can be used as time-saving methods to exclude EIB in atopic childhood asthma.
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Affiliation(s)
- Christiane Lex
- Department of Paediatric Cardiology and Pulmonology, Heinrich-Heine-University, Düsseldorf, Germany.
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Pianosi P, Smith CP, Almudevar A, McGrath PJ. Dalhousie dyspnea scales: Pictorial scales to measure dyspnea during induced bronchoconstriction. Pediatr Pulmonol 2006; 41:1182-7. [PMID: 17068820 DOI: 10.1002/ppul.20512] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to validate our Dalhousie Dyspnea Scales in children referred for histamine bronchoprovocation challenge. Seventy-four children rated their dyspnea after each FEV(1) measurement following inhalation of doubling histamine concentrations from 0.125 to 8.0 mg/ml by the standard tidal breathing method. Serial FEV(1) and dyspnea rating using the Dalhousie Dyspnea Scales were recorded and Kendall's tau was computed for dyspnea rating versus fall in FEV(1). Subjects were split into those with positive (DeltaFEV(1) >or= 20% with PC(20) <or= 8 mg/ml) or negative histamine challenge test. During histamine inhalation, dyspnea ratings on each of the subscales rose as FEV(1) fell across subjects, whether or not they were histamine-responsive (main effect), and then fell dramatically following relief of induced obstruction by bronchodilator.The Dalhousie Dyspnea Scales are useful and accurate tools to measure dyspnea due to bronchoconstriction in children.
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Affiliation(s)
- Paul Pianosi
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Mittal V, Khanna P, Panjabi C, Shah A. Subjective symptom perceptual accuracy in asthmatic children and their parents in India. Ann Allergy Asthma Immunol 2006; 97:484-9. [PMID: 17069103 DOI: 10.1016/s1081-1206(10)60939-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inaccurate symptom perception is a key factor in increased morbidity and mortality in asthmatic patients. Information is sparse on whether children and their parents can accurately perceive severity of symptoms. OBJECTIVE To determine symptom perceptual accuracy in children with asthma and either of their parents. METHODS Fifty-two asthmatic children and either of their parents recorded independently, for 2 weeks, subjective evaluation of the child's symptoms on a 100-mm visual analog scale (VAS). Peak expiratory flow (PEF) was used as an objective measurement. Both VAS and PEF data were graded into green, yellow, and red zones. The 2 sets of VAS zones (children and parents) were separately matched with PEF zones to determine perceptual accuracy. RESULTS Children and parents were accurate more than half of the time (60% and 62%, respectively), but accuracy decreased when the "child was unstable" (PEF <80% of personal best), with underestimation being significant (P < .001). Among the readings obtained, underestimation of severity of symptoms was significant in children with severe asthma (125 [45%] of 278 readings), those affected by environmental tobacco smoke (130 [24%] of 532), and those in the younger age group (127 [45%] of 280). Underestimation was significantly greater when PEF readings were in the yellow zone (P < .001). CONCLUSIONS Symptom perception by children was as reliable as that by their parents. However, parents and children tended to underestimate severity when the child was unstable. An early decline in PEF readings was missed by children and their parents, which could contribute to increased morbidity and mortality in this vulnerable age group.
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Affiliation(s)
- Vikas Mittal
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Abstract
Exercise activity is an important part of daily life for both healthy children and children with respiratory diseases. Overall fitness level and responses to exercise can be assessed through cardiopulmonary exercise tests (using a treadmill or a cycloergometer). In asthmatic children exercise tests are useful to diagnose exercise-induced bronchoconstriction, which may affect up to 80% of asthmatic subjects. In cystic fibrosis patient, as the disease progresses, lung function deteriorates and exercise tolerance likewise diminishes. This reduced tolerance may not be predicted on the base of a standard spirometry while an exercise test can offer useful information. Eventually, exercise testing is useful in children with bronchopulmonary dysplasia to determine any presence and extent of gas exchange and ventilation dysfunction during exercise. Exercise challenges are a valuable tool to assess exercise tolerance that may be not adequately reflected by resting lung function tests.
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Yoder KE, Shaffer ML, La Tournous SJ, Paul IM. Child assessment of dextromethorphan, diphenhydramine, and placebo for nocturnal cough due to upper respiratory infection. Clin Pediatr (Phila) 2006; 45:633-40. [PMID: 16928841 DOI: 10.1177/0009922806291014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to investigate the efficacy of dextromethorphan (DM), diphenhydramine (DPH), and placebo (PL) for symptoms attributed to upper respiratory infections as determined by children, and to evaluate the concordance of perception of nocturnal symptoms between children and parents. A total of 37 children age 6 to 18 years of age were randomized in a double-masked fashion to receive a single bedtime dose of DM, DPH, or PL. Children found no significant difference in the effect of DM, DPH, or PL for any study outcome, and responses by parents and children were significantly correlated.
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Affiliation(s)
- Katharine E Yoder
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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