Asthma diagnosis and treatmentTreatment of airway inflammation improves exercise pulmonary gas exchange and performance in asthmatic subjects
Section snippets
Methods
See the Methods section in the Online Repository at www.jacionline.org for additional information.
Group characteristics
Descriptive characteristics and medications for the placebo and ICS groups are summarized in Table I. The 2 groups were similarly matched for all characteristics. Collectively, given the above average o2max and the airway responses to inhaled β-agonist, exercise, and methacholine, we have classified the current group of subjects as being habitually active subjects with mild-to-moderate asthma.
Pulmonary function: Effects of treatment and exercise
Results for resting and postexercise lung function before and after treatment are summarized in Table
Summary of findings
The principal finding of this study was that asthmatic subjects treated with ICSs had significant improvements in arterial blood oxygenation during exercise. This improvement was related to increased alveolar ventilation (ie, decreased Paco2) and improved pulmonary gas exchange efficiency during the exercise (ie, decreased AaDo2). Furthermore, all but one subject in the ICS group was able to exercise longer after treatment; exercise time was increased by approximately 6.0 minutes (74%) in these
Conclusion
The results from this study show that treatment of airway inflammation in habitually active subjects with mild-to-moderate asthma can improve arterial blood oxygenation and exercise performance during whole-body exercise. This improvement is due to increased alveolar ventilation (caused by an increased maximal flow-volume loop) and improved pulmonary gas exchange efficiency (ie, decreased AaDo2). Thus in asthmatic subjects with modest levels of airway inflammation and mildly to moderately
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2014, Middleton's Allergy: Principles and Practice: Eighth EditionEffect of adjunct fluticasone propionate on airway physiology during rest and exercise in COPD
2011, Respiratory MedicineCitation Excerpt :In the study of Worth et al.,11 differences in reduction of resting lung hyperinflation between the combination treatment and the LABA alone were not significant and the small improvements in dynamic inspiratory capacity recorded during exercise seem unlikely to account for all of the increased exercise tolerance. The question arises whether other physiological effects of ICS previously described in asthma (but not in COPD) during exercise, such as improved arterial oxygenation,15 contribute to improved exercise tolerance. The present study is the first to evaluate the effects of an ICS on airway physiology during rest and exercise in patients established on a maintenance long-acting bronchodilator regimen.
Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: A practice parameter
2010, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Some studies show the benefit of specific pharmacologic antagonists and mast cell–stabilizing agents on EIB, and other studies show increases in mediator concentrations in sputum and urine after exercise. Mast cells have long been thought to be an important source of mediators for EIB because drugs that prevent mast cell release of mediators or antagonize the effects of these mediators reduce the severity of EIB.79,80,107–118 Prostaglandin 2 (PGD2), is the major mast cell specific mediator in EIB.
Update in the understanding of respiratory limitations to exercise performance in fit, active adults
2008, ChestCitation Excerpt :A limited number of respiratory system limitations are amenable to treatment with concomitant improvements in performance. For example, consider the following: (1) airway function and gas-exchange abnormalities attending EIA can be markedly improved, along with exercise performance, following several weeks of treatment with relatively low doses of inhaled corticosteroids10,62; (2) feedback therapy has been successful in treating some cases of exercise-induced vocal cord abduction63; (3) selected use of vasodilator agents administered at high altitudes are able to reduce pulmonary vascular vasoconstriction, improve arterial oxygenation, and slightly improve exercise capacity in persons with hypoxia64,65; and (4) although there are many negative published findings concerning the effect of specific respiratory muscle training on exercise performance, some carefully controlled studies66 have suggested that this type of specific training will delay the onset of exercise-induced respiratory muscle fatigue and its cardiovascular sequelae, and will elicit small but significant increases in endurance performance. On the other hand, we caution that some of these therapeutic approaches are still highly experimental and have not yet been tested in large numbers of subjects.
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Supported by National Heart, Lung, and Blood Institute grants RO1-HL015469 and T32-HL07654; Veterans Affairs/Department of Defense; and the Department of Pediatrics, University of Wisconsin–Madison.
Disclosure of potential conflict of interest: H. C. Haverkamp, D. F. Pegelow, J. D. Miller, L. M. Romer, M. Santana, and M. W. Eldridge have received grant support from the National Heart, Lung, and Blood Institute; Veterans Affairs/Department of Defense; and the Department of Pediatrics, University of Wisconsin–Madison. J. A. Dempsey has declared that he has no conflict of interest.