Exercise-induced Bronchodilation in Asthma

doi:10.1378/chest.87.2.196

Chest

Volume 87, Issue 2, February 1985, Pages 196-201

https://doi.org/10.1378/chest.87.2.196 Get rights and content

Of 34 symptomatic adult asthmatic patients (23 men) aged 51 ± 13 years (mean ± 1 SD) with moderately severe airways obstruction who underwent maximal exercise testing at room temperature (22°C) and humidity (44 percent RH) using a bicycle ergometer, we identified seven male patients aged 56 ± 9 years in whom forced expired volume in one second (FEV₁) increased ≥20 percent over the baseline pre-exercise value (exercise-induced bronchodilation). At maximal exercise, these patients achieved an O₂ consumption of 1.4 ± 0.4 L/min and a minute ventilation of 56 ± 9 L/min. Baseline FEV₁ was 1.3 ± 0.5 L (SD) (43 ± 12 percent predicted) and increased to 2.1 ± 0 .5 L at five minutes after exercise and persisted at least 20 minutes. Exercise was repeated in all seven patients on a separate day one to six months later, and results were similar in six. In these seven patients, three minutes of voluntary isocapnic hyperventilation achieving a minute ventilation comparable to that during maximal exercise led to an increase in FEV₁ of 20 ± 18 percent (range 0 to 54 percent). The Δmax₅₀ was 22 ± 30 percent before, and 10 ± 21 percent after maximal exercise and 25 ± 37 percent before, and 11 ± 22 percent after isocapnic hyperventilation. Pre-treatment with acetylsalicylic acid (mean serum concentration 120 ± 64 μg/ml) in the six patients with reproducible bronchodilation completely blocked exercise bronchodilation in one patient and blunted it in four others. Findings suggest that a subset of adult patients with symptomatic asthma may develop bronchodilation after six to eight minutes of exercise, that exercise-induced bronchodilation may in part be reproduced with isocapnic hyperventilation, and that it may be blocked completely or partially by acetylsalicyclic acid, implying mediation by prostaglandins.

Section snippets

Materials and Methods

We studied in detail seven men, aged 56 ± 9 (mean ± l SD), who satisfied the criteria for asthma.⁷ These seven patients were chosen from a larger group of 34 consecutively studied symptomatic adult asthmatic patients (23 men) aged 51 ± 13 years) who had undergone lung function and exercise studies for evaluation of dyspnea or wheezing as part of a rehabilitation program. These seven patients were selected for further study because they demonstrated an improvement in forced expired volume in one

Results

Of the seven patients who underwent the repeated exercise protocol on a separate day one to six months after the initial study, six reproduced the significant improvement in FEV₁ (>20 percent) noted after the first exercise study (Fig 1). All six of these patients exhibited moderate or severe airflow obstruction at rest without diffusion impairment: FEV₁ 1.5 ± 0.3 L (mean ± l SD) (45 ± 11 percent predicted); FVC 2.9 ± 0.7 L (60 ± 11 percent predicted); TLC 7.7 ± 2.0 L (117 ± 17 percent

Discussion

Seven of 34 consecutively studied adult asthmatic patients with moderately severe airways obstruction developed substantial bronchodilation after six to eight minutes of exercise, and this phenomenon was reproducible in six of these seven patients who underwent exercise testing on two separate occasions. These observations are all the more interesting in view of previous reports which have emphasized exercise-induced bronchoconstriction in asthmatic patients after a similar duration of exercise1

ACKNOWLEDGMENT

Peter Gobel provided technical assistance.

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Cited by (29)

Contribution of β-adrenergic receptors to exercise-induced bronchodilatation in healthy humans
2012, Respiratory Physiology and Neurobiology
Citation Excerpt :
In healthy subjects, exercise is usually associated with an increase in maximal expiratory flows or a decrease in airflow resistance, thus suggesting bronchodilatation (Agostoni et al., 2002; Gelb et al., 1985; Johnson et al., 1995, 1999; Pellegrino et al., 1999, 2010; Warren et al., 1984a).
Exercise in healthy subjects is usually associated with progressive bronchodilatation. Though the decrease in vagal tone is deemed to be the main underlying mechanism, activation of bronchial β₂-receptors may constitute an additional cause. To examine the contribution of β₂-adrenergic receptors to bronchodilatation during exercise in healthy humans, we studied 15 healthy male volunteers during maximum exercise test at control conditions and after a non-selective β-adrenergic blocker (carvedilol 12.5 mg twice a day until heart rate decreased at least by 10 beats/min) and inhaled β₂-agonist (albuterol 400 μg). Airway caliber was estimated from the partial flow at 40% of control forced vital capacity $({\dot{V}}_{part 40})$ and its changes during exercise from the slope of linear regression analysis of ${\dot{V}}_{part 40}$ values against the corresponding minute ventilation during maximal exercise until exhaustion. At control, ${\dot{V}}_{part 40}$ increased progressively and significantly with exercise. After albuterol, resting ${\dot{V}}_{part 40}$ was significantly larger than at control increased but did not further increase during exercise. After carvedilol, ${\dot{V}}_{part 40}$ was similar to control but its increase with exercise was significantly attenuated. These findings suggest that β₂-adrenergic system plays a major role in exercise-induced bronchodilation in healthy subjects.
Exercise induced bronchospasm in physically fit female students of Kerman University and their pulmonary function tests
2012, Journal of Bodywork and Movement Therapies
Citation Excerpt :
Airway caliber responses to physical activity in different sport conditions and different athletes varies considerably. Physical activity can induce bronchodilatation or bronchoconstriction (Crimi et al., 2002; Gotshall, 2006; Beck et al., 1994; Gelb et al., 1975; Rundell and Jenkinson, 2002). In some people and athletes, particularly in asthmatics and allergic individuals, following physical activity, bronchospasm and airway inflammation are common.
High prevalence of respiratory symptoms and bronchial hyper-responsiveness has been reported in professionals athletes, particularly in relation to climate and environment. However, the airway response to exercise in active population has been poorly investigated especially in women. The aim of this study was to examine pulmonary function test changes in physically fit female students of Kerman University.
Sixty physically fit female students (19 ± 1.12 years old) were randomly selected out of 500 students. Each subject underwent the physical fitness test (Couper test) of the maximal distance running in 12 min. The exercise induced bronchospasm (EIB) symptoms including coughing, wheezing, chest tightness, dyspnea, previously diagnosed asthma and allergy, the use of anti-asthmatics medication and the family history of asthma were recorded using a questionnaire. Pulmonary function tests including; forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), peak expiratory flow (PEF), and maximal expiratory flow at 50% of the FVC (MEF₅₀) were measured at rest (baseline), immediately, 5, and 15 min after an exercise test.
The result of this study showed that the prevalence of the symptoms of EIB was 40.0%. There was not any significant difference in baseline PFT values between symptomatic and asymptomatic subjects. However, All PFT values of symptomatic subjects were significantly lower than asymptomatic immediately after exercise (p < 0.05 to p < 0.01). In addition, PFT values were significantly reduced in all times intervals for the symptomatic subjects (p < 0.05 to p < 0.01).
The results showed a high prevalence of respiratory symptoms and EIB in healthy female students.
Pulmonary disorders in the training room
2005, Clinics in Sports Medicine
Bronchial hyperresponsiveness, airway inflammation, and airflow limitation in endurance athletes
2005, Chest
Citation Excerpt :
To our knowledge, our study is the first to investigate the relationship between BHR and objective VL in athletes. In asthmatic subjects, constant-load exercise by itself is thought to induce neither a modification35 nor a decrease14 in the bronchomotor tone, and EIB generally occurs after exercise. However, prolonged exercise duration (ie, ≥ 15 min) may induce bronchoconstriction and subsequent expiratory flow limitation.15,16,17
Whereas a high prevalence of bronchial abnormalities has been reported in endurance athletes, its underlying mechanisms and consequences during exercise are still unclear.
The purpose of this study was to assess the following: (1) bronchial responsiveness to methacholine and to exercise; (2) airway inflammation; and (3) airflow limitation during intense exercise in endurance athletes with respiratory symptoms.
Cross-sectional observational study.
Lung function and exercise laboratory at a university hospital.
Thirty-nine endurance athletes and 13 sedentary control subjects were explored for the following: (1) self-reported respiratory symptoms; (2) bronchial hyperresponsiveness (BHR) to methacholine and exercise; (3) airflow limitation during intense exercise; and (4) bronchial inflammation using induced sputum and nitric oxide (NO) exhalation.
Fifteen athletes (38%) showed BHR to methacholine and/or exercise in association with bronchial eosinophilia (mean [± SD] eosinophil count, 4.1 ± 8.5% vs 0.3 ± 0.9% vs 0%, respectively), higher NO concentrations (19 ± 10 vs 14 ± 4 vs 13 ± 4 parts per billion, respectively), a higher prevalence of atopy, and more exercise-induced symptoms compared with nonhyperresponsive athletes and control subjects (p < 0.05). Furthermore, airflow limitation during intense exercise was observed in eight athletes, among whom five had BHR. Athletes with airflow limitation reported more symptoms and had FEV₁, FEV₁/FVC ratio, and forced expiratory flow at midexpiratory phase values of 14%, 9%, and 29%, respectively, lower compared with those of nonlimited athletes (p < 0.05).
BHR in endurance athletes was associated with the criteria of eosinophilic airway inflammation and atopy, whereas airflow limitation during exercise was primarily a consequence of decreased resting spirometric values. Both BHR and bronchial obstruction at rest with subsequent expiratory flow limitation during exercise may promote respiratory symptoms during exercise in athletes.
Common medical problems in sports
1997, Clinics in Sports Medicine
It is difficult to attempt to include all of the possible health problems that befall athletes in a review article such as this. All of us at some time fit the definition of an “athlete.” We must thus consider the entire realm of health problems faced by all persons. This then becomes a description of internal medicine. Certainly, such a compendium of medical problems has been compiled in any of a number of internal medicine texts already published. But what are the medical problems commonly seen in athletes? To answer this question, the authors have combined their extensive experience in the realm of athletes from the weekend warrior to the elite professional. The authors have depended heavily on the athletic trainers and physical therapists with whom they work daily to compile a list of medical problems not covered in other articles in this review and that are dealt with while caring for athletes. The medical problems that we have selected occur often enough that a physician caring for athletes will see them during his or her career.
Patient familiarly is essential in proper medical care for the athlete. Medical problems may be suggested by an alteration in performance noted by the athlete, trainer, physical therapist, or coach. Training should result in an increase in performance over time. If this does not occur, there may be a medical reason for this lack of progress. “No pain, no gain” is not always true and may, in fact, be the single most prevalent attitude that keeps the offices of sports medicine specialists full.
Most athletes will initially try to work through the early signs and symptoms of medical problems. The weekend athlete does not usually know his or her body well enough to assess medical issues relating to a decrement in performance. The elite athlete often believes that he or she can “work through it.” A close working relationship with a health care professional to whom the athlete can turn to define contributing factors including medical problems is invaluable.
The refractory period after eucapnic voluntary hyperventilation challenge and its effect on challenge technique
1995, Chest
To evaluate whether there is a refractory period (RP) after hyperventilation challenge, we compared the bronchoconstrictive response to repetitive eucapnic voluntary hyperventilation challenge with dry, room temperature air (EVH). The serial challenges were identical with 11 known asthmatics hyperventilating for 6 min at a target minute ventilation of 30 times their FEV₁ measured before either challenge. There was a significant difference between the mean postchallenge fall in FEV₁ to the initial EVH challenge (27.4±9.8%) and the response to the second EVH challenge (16.1 ±5.9%) (p=0.0001), indicating refractoriness. We then evaluated whether 6 min of uninterrupted EVH challenge gives a similar bronchospastic response to that which results from an equivalent (by total minute ventilation) interrupted challenge of 2 min of EVH repeated three times. The mean postchallenge fall in FEV₁ in response to this interrupted challenge was 18.9±10.6%, which was significantly different from the 27.4% fall in response to 6 consecutive minutes of EVH (p=0.036). This study demonstrates that there is a refractory period after repeated EVH challenges and this refractoriness affects the response to interrupted, or dosed, EVH challenge.
(CHEST 1995; 108:419-24)

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: Presented at ATS Annual Meeting, Kansas City, May 1983.

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Chest

Exercise-induced Bronchodilation in Asthma

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGMENT

Lancet

J Allerg Clin Immunol

J Allerg Clin Immunol

Chest

Br J Dis Chest

Incidence of exercise-induced asthma in children

Pediatrics

The refractory period after exercise-induced asthma: its duration and relation to severity of exercise

Am Rev Respir Dis

Exercise-induced asthma: observations on the initiating stimulus

N Engl J Med

A comparison of histamine, methacholine and exercise airway reactivity in normal and asthmatic subjects

Am Rev Respir Dis

The place of physical exercise and bronchodilator drugs in the assessment of the asthmatic child

Arch Dis Child

American Thoracic Society Committee on Diagnostic Standards for Non-tuberculous Disease. Definitions and classifications of chronic bronchitis, asthma and pulmonary emphysema

Am Rev Respir Dis

Simplified diagnosis of small-airway obstruction

N Engl J Med

An automated system for assessing metabolic and respiratory function during exercise

J Appl Physiol

Site of airway obstruction in asthma as determined by measuring maximal expiratory flow by breathing air and a helium-oxygen mixture

J Clin Invest

Maximum expiratory flow rates in induced bronchoconstriction in man

J Clin Invest