Presentación en Hospital General de Catalunya, 2º PNEUMO UPDATE, 14 de Octubre 2016, Sant Cugat del Vallés , Barcelona

1. 1
Asma y Ejercicio
Josep
Morera
Barcelona.
Octubre
2016

2. 2
Asma y Ejercicio

3. 3
Asma y Ejercicio

4. 4
Asma y Ejercicio
1.-­‐
Definición/Concepto
2.-­‐
Prevalencia/Epidemiologia
3.-­‐
Fisiopatología/E@ología
4.-­‐
Tratamiento
5.-­‐
Diagnós@co
Diferencial
6.-­‐
Conclusiones

5. 5
Asma
y
Ejercicio

6. 6
Asma
y
Ejercicio

7. 7
Asma y Ejercicio
An
Official
American
Thoracic
Society
Clinical
PracCce
Guideline:
Exercise-­‐induced
BronchoconstricCon
Jonathan
P.
Parsons,
Teal
S.
Hallstrand,
John
G.
Mastronarde,
David
A.
Kaminsky,
Kenneth
W.
Rundell,
James
H.
Hull,
William
W.
Storms,
John
M.
Weiler,
Fern
M.
Cheek,
Kevin
C.
Wilson,
and
Sandra
D.
Anderson;
Volume
187,
Issue
9(May
1,
2013)

8. 8
Asma y Ejercicio
Volume
63,
Issue
8
August
2008
Pages
953–961
Exercise-­‐induced
hypersensiCvity
syndromes
in
recreaConal
and
compeCCve
athletes:
a
PRACTALL
consensus
report
(what
the
general
pracCConer
should
know
about
sports
and
allergy)
Schwartz
LB1,
Delgado
L,
Craig
T,
Bonini
S,
Carlsen
KH,
Casale
TB,
Del
Giacco
S,
Drobnic
F,
van
Wijk
RG,
Ferrer
M,
Haahtela
T,
Henderson
WR,
Israel
E,
Lötvall
J,
Moreira
A,
Papadopoulos
NG,
Randolph
CC,
Romano
A,
Weiler
JM.

9. 9
Asma y Ejercicio
Volume
63,
Issue
5
May
2008
Pages
492–505
Treatment
of
exercise-­‐induced
asthma,
respiratory
and
allergic
disorders
in
sports
and
the
relaConship
to
doping:
Part
II
of
the
report
from
the
Joint
Task
Force
of
European
Respiratory
Society
(ERS)
and
European
Academy
of
Allergy
and
Clinical
Immunology
(EAACI)
in
cooperaCon
with
GA(2)LEN.
Carlsen
KH1,
Anderson
SD,
Bjermer
L,
Bonini
S,
Brusasco
V,
Canonica
W,
Cummiskey
J,
Delgado
L,
Del
Giacco
SR,
Drobnic
F,
Haahtela
T,
Larsson
K,
Palange
P,
Popov
T,
van
Cauwenberge
P;
European
Respiratory
Society;
European
Academy
of
Allergy
and
Clinical
Immunology;
GA(2)LEN.

10. 10
Asma y Ejercicio
La
broncoconstricción/hiperreacCvidad
inducida
por
ejercicio
(EIB),se
refiere
a
un
“estrechamiento”de
las
vías
aéreas
como
resultado
del
ejercicio.
Los
asmáCcos
con
gran
frecuencia
sufren
EIB
El
asma
inducido
por
ejercicio
(EIA)
es
un
concepto
que
se
solapa
con
el
de
EIB
El
asma
bronquial
en
los
Atletas
de
Elite
es
una
situación
clínica
que
se
solapa
con
las
anteriores
El
EIB
ha
recibido
otros
nombres
como“THERMALLY
BRONCHOCONSTRICTION”
An
Official
American
Thoracic
Society
Clinical
Prac5ce
Guideline:
Exercise-­‐induced
Bronchoconstric5on

11. 11
Asma y Ejercicio
-­‐ Clínica
suges@va(Tos,
disnea,@rantez
torácica,sibilantes
postejercicio
-­‐ FEV1
pre-­‐post
ejercicio(FEV
≥
al
10%)
-­‐ Test
específicos
de
ejercicio
-­‐ Test
de
provocación
con
Metacolina
y/o
Manitol
-­‐ Otros:
PEAK
FLOW
(gráfica)
ÓXIDO
NÍTRICO
EXHALADO
(FENO)
Inhalación
hiperesmolar
de
aerosoles
4.5%
salinos
Hiperepnea
eucapníca
voluntaria
An
Official
American
Thoracic
Society
Clinical
Prac5ce
Guideline:
Exercise-­‐induced
Bronchoconstric5on

12. 12
Asma y Ejercicio
An
Official
American
Thoracic
Society
Clinical
Prac5ce
Guideline:
Exercise-­‐induced
Bronchoconstric5on

13. 13
Asma y Ejercicio

14. 14
Asma y Ejercicio
-­‐
Muy
frecuente
-­‐
Variable
según
países
y
áreas
-­‐
Entre
20-­‐50%
de
asmá@cos
@enen
asma
inducido
al
esfuerzo
-­‐
Entre
los
depor@stas
de
Elite
varia
entre
un
15-­‐75%

15. 15
Asma y Ejercicio
Exercise-­‐induced
wheeze,
urgent
medical
visits,
and
neighborhood
asthma
prevalence.
Map of New York City depicting study subjects’ places of residence overlaying neighborhood asthma prevalence.
Timothy R. Mainardi et al. Pediatrics 2013;131:e127-e135

16. 16
Asma y Ejercicio
Percentage
of
athletes
no@fying
(Sydney)
or
approved
(Salt
Lake
City,
Athens,
Torino)
for
b2-­‐agonist
use
and
the
percentage
of
individual
medals
won
by
these
athletes
at
the
2000
to
2006
Olympic
Games.
FITCH
ET
AL
260.e7
VOLUME
122,NUMBER
2

17. 17
Asma y
Ejercicio
K.H.
Carlsen
et
al.

18. 18
Asma y Ejercicio
-­‐ Enfriamiento
de
la
mucosa
-­‐ Calentamiento
de
la
mucosa
-­‐ Aumento
de
la
circulación
bronquial
submucosa
-­‐ Atopia/Alergia
-­‐ Mayor
exposición
a
polen
y
a
otros
alérgenos
-­‐ Exposición
a
Cloro
-­‐ Exposición
a
Ozono/otras
poluciones
ambientales
-­‐
Exposición
a
PM10
por
fuel
en
hielo
ar@ficial
-­‐ Inflamación
eosinovlica/neutrovlica
-­‐ Remodelamiento
-­‐ Otros

19. 19
Asma y Ejercicio
N
Engl
J
Med
1977;
297:743-­‐747October
6,
1977
N
Engl
J
Med
1987;
317:502-­‐504,

20. 20
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Inhala@on
Toxicology,
15:237–250,
2003

21. 21
Asma y Ejercicio
Bronchoscopy
and
bronchoalveolar
lavage
findings
in
cross-­‐country
skiers
with
and
without
ski
asthma”.Sue-­‐Chu
M1,
Larsson
L,
Moen
T,
Rennard
SI,
Bjermer
L.
Eur
Respir
J.
1999
Mar;13(3):626-­‐32.

22. 22
Asma y Ejercicio

23. 23
Asma y Ejercicio
AM
J
RESPIR
CRIT
CARE
MED
2000;161:1047–1050.

24. 24
Asma y Ejercicio
Exhaled
breath
condensate
cysteinyl
leukotrienes
are
increased
in
children
with
exercise-­‐induced
bronchoconstricCon.
Carraro
S1,
Corradi
M,
Zanconato
S,
Alinovi
R,
Pasquale
MF,
Zacchello
F,
Baraldi
E.
2005
Apr;115(4):764-­‐70.

25. 25
Asma y Ejercicio
J
Allergy
Clin
Immunol.
2005
Sep;
116(3):
586–593.
Airway
immunopathology
of
asthma
with
exercise-­‐
induced
bronchoconstricCon.
Hallstrand
TS1,
Moody
MW,
Aitken
ML,
Henderson
WR
Jr.

26. 26
Asma y Ejercicio
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
VOL
161
2000

27. 27
Asma y Ejercicio

28. 28
Asma y Ejercicio
MEDICINE
SCIENCE
IN
SPORTS
EXERCISE®
2003

29. 29
Asma y Ejercicio
Role
of
MUC5AC
in
the
pathogenesis
of
exercise-­‐induced
bronchoconstricCon.
Hallstrand,
Debley,
Farin,
Henderson.
CONCLUSIONS:
These
data
indicate
that
(1)
the
predominant
gel-­‐forming
mucin
expressed
in
induced
sputum
of
paCents
with
asthma
with
EIB
is
MUC5AC;
(2)
an
increase
in
MUC5AC
gene
expression
and
release
of
MUC5AC
protein
occurs
acer
exercise
challenge;
and
(3)
MUC5AC
release
may
occur
through
the
cysLT-­‐
associated
acCvaCon
of
sensory
airway
nerves
J
Allergy
Clin
Immunol.
2007
May;119(5):1092-­‐8

30. 30
Asma y Ejercicio
The
PotenCal
Role
of
8-­‐Oxoguanine
DNA
Glycosylase-­‐
Driven
DNA
Base
Excision
Repair
in
Exercise-­‐Induced
Asthma.
Belanger
KK1,
Ameredes
BT2,
Boldogh
I3,
Aguilera-­‐Aguirre
L4.
2016
Jul
25

31. 31
Asma y Ejercicio
The
PotenCal
Role
of
8-­‐Oxoguanine
DNA
Glycosylase-­‐
Driven
DNA
Base
Excision
Repair
in
Exercise-­‐Induced
Asthma.Belanger
KK1,
Ameredes
BT2,
Boldogh
I3,
Aguilera-­‐Aguirre
L4.
2016
Jul
25

32. 32
Asma y Ejercicio
Transglutaminase
2,
a
novel
regulator
of
eicosanoid
producCon
in
asthma
revealed
by
genome-­‐wide
expression
profiling
of
disCnct
asthma
phenotypes.Hallstrand
TS1,
Wurfel
MM,
Lai
Y,
Ni
Z,
Gelb
MH,
Altemeier
WA,
Beyer
RP,
Aitken
ML,
Henderson
WR.
Figure
1.
Comparison
of
lung
funcCon
and
gene
expression
between
asthmaCcs
with
EIB
and
an
asthmaCc
control
group
without
EIB.
(2010)
PLoS
ONE
5(1)

33. 33
Asma y Ejercicio

34. 34
Asma y Ejercicio
CombinaCon
of
budesonide/formoterol
on
demand
improves
asthma
control
by
reducing
exercise-­‐induced
bronchoconstricCon.Lazarinis
N1,
Jørgensen
L,
Ekström
T,
Bjermer
L,
Dahlén
B,
Pullerits
T,
Hedlin
G,
Carlsen
KH,
Larsson
K.
2014
Feb;69(2):130-­‐6.

35. 35
Asma y Ejercicio
Nedocromil
sodium
in
the
treatment
of
exercise-­‐induced
asthma:
a
meta-­‐analysis.
Spooner
C1,
Rowe
BH,
Saunders
LD.
Eur
Respir
J.
2000
Jul;16(1):30-­‐7

36. 36
Asma y Ejercicio
Dietary
salt,
airway
inflammaCon,
and
diffusion
capacity
in
exercise-­‐
induced
asthma.
Mickleborough
TD1,
Lindley
MR,
Ray
S.Med
Sci
Sports
Exerc.
2005
Jun;37(6):904-­‐14.

37. 37
Asma y Ejercicio
Treatment
of
exercise-­‐induced
asthma,
respiratory
and
allergic
disorders
in
sports
and
the
relaConship
to
doping:
Part
II
of
the
report
from
the
Joint
Task
Force
of
European
Respiratory
Society
(ERS)
and
European
Academy
of
Allergy
and
Clinical
Immunology
(EAACI)
in
cooperaCon
with
GA2LEN*
K.
H.
Carlsen1,
S.
D.
Anderson2,
L.
Bjermer3,
S.
Bonini4,
V.
Brusasco5,
W.
Canonica6,
J.
Cummiskey7,
L.
Delgado8,
S.
R.
Del
Giacco9,
F.
Drobnic10,
T.
Haahtela11,
K.
Larsson12,
P.
Palange13,
T.
Popov14,
P.
van
Cauwenberge15.
Allergy
2008:
63:
492–505

38. 38
Asma y Ejercicio
1.-­‐
Disfunción
de
cuerdas
vocales
2.-­‐
Anemia
3.-­‐
Miocardiopa{a
hipertrófica
4.-­‐
Obesidad/
no
fitness
5.-­‐
Disnea
Psicógena
6.-­‐
Uso
de
β-bloqueantes
7.-­‐
TEP
agudo/crónico
8.-­‐
Mal
de
montaña
9.-­‐
Edema
agudo
de
pulmón
10.-­‐
Otros
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%
ers with atopy, 12 were hyperrespo
Inflammatory Cell Counts
Assessable bronchial biopsy specim
subjects. Because of unavailability
counts were not performed in contr
ers. Data with cell counts are prese
1 and 2
Group analysis showed that skie
26-fold (p 0.001), and twofold (
phocyte, macrophage, and eosinoph
did controls. The skiers’ neutroph
greater than that of the asthmatic su
cyte count was not significantly diff
eosinophil, and mast cell counts
analysis by nonatopic status, the ne
not significantly different and the e
cantly lower than in asthmatic sub
was greater in skiers than in contr
cant differences in cell counts in no
perresponsive skiers. Both skier gr
age and lymphocyte counts than con
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.

39. 39
Asma y Ejercicio
Vocal
cord
dysfuncCon
in
paCents
with
exerConal
dyspnea.Morris
MJ1,
Deal
LE,
Bean
DR,
Grbach
VX,
Morgan
JA.
PATIENTS:Forty
military
paCents
with
complaints
of
exerConal
dyspnea
and
12
military
asymptomaCc
control
subjects.
CONCLUSIONS:Paradoxical
inspiratory
vocal
cord
closure
is
a
frequent
occurrence
in
paCents
with
symptoms
of
exerConal
dyspnea
and
should
be
strongly
considered
in
their
evaluaCon.
1999
Dec;116(6):1676-­‐82

40. 40
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011

41. 41
Asma y Ejercicio
Swimming-­‐induced
pulmonary
edema:
clinical
presentaCon
and
serial
lung
funcCon.
Adir
Y1,
Shupak
A,
Gil
A,
Peled
N,
Keynan
Y,
Domachevsky
L,
Weiler-­‐Ravell
D.
Chest.
2004
Aug;126(2):394-­‐9.

42. 42
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
2013
Jan
19;381(9862):242-­‐55.
Br
J
Sports
Med
2012;46(Suppl
I):i69–i77.

43. 43
Asma y Ejercicio
chodilator test was negative in all control subjects (change in
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
use of inhaled 2-agonists. Coughing in episodes or in rela
to exercise was reported by 26 (65%) skiers. Of 15 (38%)
ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from
subjects. Because of unavailability of cryosections, neutro
counts were not performed in control subjects and in three
ers. Data with cell counts are presented in Table 2 and Fig
1 and 2
Group analysis showed that skiers had 43-fold (p 0.0
26-fold (p 0.001), and twofold (p 0.001) greater T-
phocyte, macrophage, and eosinophil counts, respectively,
did controls. The skiers’ neutrophil count was significa
greater than that of the asthmatic subjects, whereas the lym
cyte count was not significantly different, and the macroph
eosinophil, and mast cell counts were lower. On subg
analysis by nonatopic status, the neutrophil count in skiers
not significantly different and the eosinophil count was sig
cantly lower than in asthmatic subjects. The mast cell c
was greater in skiers than in controls. There were no sig
cant differences in cell counts in nonhyperresponsive and
perresponsive skiers. Both skier groups had greater macr
age and lymphocyte counts than controls (Figure 3A), whe
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
FEV1: 5.4 4.1% [mean SD]) and positive in all asthmatic
subjects (29.3 17.4%). Thirty (75%) skiers were hyperre-
sponsive to methacholine (median PD20 FEV1: 1,246 g [IQR:
to exercise was reported by 26 (65%) skiers. Of 15 (3
ers with atopy, 12 were hyperresponsive to methacho
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained
subjects. Because of unavailability of cryosections, n
counts were not performed in control subjects and in t
ers. Data with cell counts are presented in Table 2 an
1 and 2
Group analysis showed that skiers had 43-fold (p
26-fold (p 0.001), and twofold (p 0.001) greate
phocyte, macrophage, and eosinophil counts, respectiv
did controls. The skiers’ neutrophil count was sign
greater than that of the asthmatic subjects, whereas the
cyte count was not significantly different, and the mac
eosinophil, and mast cell counts were lower. On s
analysis by nonatopic status, the neutrophil count in s
not significantly different and the eosinophil count wa
cantly lower than in asthmatic subjects. The mast c
was greater in skiers than in controls. There were n
cant differences in cell counts in nonhyperresponsive
perresponsive skiers. Both skier groups had greater m
age and lymphocyte counts than controls (Figure 3A)
Figure 2. Density (cells/mm2
) of neutrophils in bronchial biopsy spec-
imens from skiers with and without BHR and from asthmatic subjects.
Horizontal bar median value.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk fa
occurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolu
Study design. – Retrospective case study and prospective frequency study.
Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review
between 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a
auscultation and radiologic features.
Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers withou
involved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exer
Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of lo
were observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in a
resolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal
* Auteur correspondant.
Adresse e-mail : guy.cochard@chu-brest.fr (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits re´serve´s.
doi:10.1016/j.annfar.2008.05.011
[Severe
forms
of
effort-­‐induced
asthma].
[ArCcle
in
French]Marotel
C1,
Natali
F,
Heyraud
JD,
Vaylet
F,
L'Her
P,
Bonnet
D,
Allard
P.Allerg
Immunol
(Paris).
1989
Feb;21(2):61-­‐4.
Abstract
Severe
reacCons
in
exercise-­‐induced
asthma
(EIA)
seem
to
be
underesCmated
in
the
published
literature.
We
report
two
cases
of
near-­‐miss
death
from
EIA
that
occurred
acer
a
short
run.
We
review
364
exercise
tests
that
were
performed
between
September
1987
and
October
1988
by
a
standardised
protocol
on
a
treadmill,
on
paCents
with
possible
EIA.
A
posiCve
test,
defined
by
a
fall
of
FEV1
of
at
least
20%
was
found
in
173
paCents.
From
21
paCents
with
a
fall
of
greater
than
50%,
4
presented
severe
signs
of:
Cyanosis.
Intense
dyspnea
with
impediment
of
speech.
General
malaise
with
hypertension.
These
4
paCents
were
not
greatly
different
from
paCents
of
the
50%
fall
group
when
compared
for
FEV1
before
the
test
and
for
heart-­‐rate
during
the
test.
They
differed
in
the
duraCon
of
the
asthma
atack,
which
was
more
protracted,
despite
the
use
of
beta-­‐2
agonists.
The
onset
of
severe
reacCons
is
2.3%
of
posiCve
tests
and
seems
to
be
unpredictable.

44. 44
Asma y Ejercicio

45. 45
Asma y Ejercicio
1.-­‐
Existen
ma@ces
entre
EIB
y
EIA
2.-­‐
Ambos,
EIB
y
EIA
son
muy
prevalentes
con
prevalencias
variables
3.-­‐
La
prevalencia
en
atletas
es
mas
alta
especialmente
en
esquí
de
fondo
y
natación
4.-­‐
Los
mecanismos
fisiopatológicos
son
varios
e
históricamente
ha
predominado
la
hipótesis
de
“enfriamiento”
de
la
mucosa
5.-­‐
El
tratamiento
fundamental
son
los
β-­‐adrenérgicos
SABA

46. 46