Exercise-induced asthma (EIA) and bronchospasm are triggered by exercise in patients with or without chronic asthma. EIA is diagnosed when exercise causes a 15% decrease in lung function and symptoms start after exercise and resolve within 60 minutes. It is common, affecting 10-20% of the general population and up to 90% of asthmatics. Treatment includes warm-up/cool-down periods, medication before exercise like bronchodilators, and ensuring proper asthma management.
Exercise testing is a non invasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercises
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Exercise testing is a non invasive procedure that provides diagnostic and prognostic information and evaluates an individual’s capacity for dynamic exercises
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
This is a journal article critique on a research which is entitled " INSPIRATORY MUSCLE TRAINING TO ENHANCE RECOVERY FROM MECHANICAL VENTILATION; A RANDOMIZED TRIAL"
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Asthma is a chronic inflammatory condition associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise).
Physiotherapy can provide relief from symptoms of uncontrolled asthma, including coughing, wheezing, tightness in the chest, shortness of breath and QOL.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
CHEST MOBILIZATION EXERCISES, COUNTER-ROTATION TECHNIQUE, BUTTERFLY TECHNIQUE, BREATH CONTROL DURING WALKING. These Mobilization Techniques are useful to improve Chest Wall Mobility and Expansion in Patients with Restricted Chest wall movements and also Postoperative patients
Inspiratory Muscle Training or Respiratory Muscle Training or Ventilatory Muscle Training. IMT is the physiotherapy technique, with the help of different breathing exercises.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Asthma is a chronic inflammatory condition associated with airway hyperresponsiveness (an exaggerated airway-narrowing response to specific triggers such as viruses, allergens and exercise).
Physiotherapy can provide relief from symptoms of uncontrolled asthma, including coughing, wheezing, tightness in the chest, shortness of breath and QOL.
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
physiotherapy management for chronic obstructive pulmonary disease Sunil kumar
role of physiotherapy in chronic obstructive pulmonary disease, principles of physical therapy management in copd, physiotherapy assessing and treatment for copd
Kombinationen mellem Buteyko åndedrætsmetoden og Frolovs åndedrætstræneren giver brugerne en stabil og god fremgang allerede efter få ugers brug. Frolovs åndedrætstræner egner sig til mennesker der skal ønsker et bedre helbred med øget opmærksomhed på åndedrættet.
Det er vigtigt at kombinere begge metoder for at få det bedst mulige resultat.
Frolovs åndedrætstræneren kan købes hos www.astmacare.dk hvor vi samtidig underviser i Buteyko åndedrætsmetoden, www.buteykoclinic.dk
1. Fawzia abo ali
Prof.of allergy &clinical immunology
Faculty of medicine
Ain shams university
2.
3. Exercise-induced
asthma & bronchospasm
• Definition: Airway obstruction, and hyper
responsiveness, triggered by exercise
- EIA: exercise induces symptoms of asthma in
patients who have asthma (90% of patients)
- EIB: exercise induces bronchospasm in patients
without chronic asthma, for example, an elite athlete.
4. physical activity is the second leading cause of airway
constriction after upper respiratory tract infections.
EIA: symptoms start after exercise, peak 8 to 15 minutes
after exercise and spontaneously resolve in 60 minutes.
EIA is diagnosed by a 15% decrease in FEV1.
EIA is most frequently seen in children and young adults
because of their high levels of physical activity.
5. Epidemiology
EIA affects:
90% of asthmatics
40-50% of patients with allergic rhinitis
3-13% of the general population
10-20% of athletes
6. Asthmogenic exercise:
The type of exercise performed directly affects
the intensity and duration of an EIA episode.
Asthmogenic sports are characterized by
sustained hyperpnea (deep, rapid breathing
during intense, prolonged aerobic activity)
- basketball
- cycling
- running
- hockey
7. Less asthmogenic sports:
sport that produces intermittent bursts of
hyperpnea, such as baseball, weight lifting
or tennis.
In addition, activities such as bike-riding
and swimming are less likely to induce EIA
than running.
Swimming appears to be the least
asthmogenic sport, which may in part be
related to the inhalation of humidified air.
8. The sequence of events in EIA is characteristic:
1. Airways dilate during exercise (FEV1 increases by
5% in normal people).
2. When the exercise is over, airway obstruction
begins and progresses until it reaches a peak in 5-10
minutes
3. Spontaneous resolution occurs in 30 minutes.
The tendency toward spontaneous remission is a
hallmark of EIA: one needs only to reverse the acute
event and the patient will then remain free of
symptoms.
9.
10. Pathogenesis
There are 2 theories for EIA pathogenesis:
thermal osmotic
Thermal hypothesis, there is no role for
biochemical mediators.
Osmotic theory has been gaining a wider
acceptance in recent years.
12. Several studies have noted an increase in the
concentration of cysteinyl leukotrienes (CysLTs) in the
airways of patients with EIB.
a recent study found that the fraction of exhaled nitric
oxide (FENO) is elevated in asthmatic patients with EIB,
Angiopoetin 2, a mediator that enhances microvascular
permeability, is increased in the airways in EIB
Mast cell infiltration of the airways has also been
implicated in EIB.
13. Duration of EIA Symptoms
• Symptoms begin during
or after exercise and
usually worsen 5-20
minutes after stopping
activity
• Some people experience
a “late-phase reaction” 4-
12 hours after exercising.
Symptoms usually less
severe.
14. Diagnosis
Exercise-induced asthma can be diagnosed by history
only and formal testing is usually required only in
competitive athletes.
Points in the patient history:
- Onset during or after exercise
- EIB not affect first 5 minutes of exercise
- Symptoms duration longer than 5 minutes
15.
16. Testing for EIA
- FRAST: free running asthma screening test
- Treadmill exercise test
- Cycling
FRAST
A simple screening test in children:
1. Establish a baseline PEF.
2. Have the child run continuously for 7 minutes (same
duration as treadmill exercise test), OR have the child run
until he/she has symptoms.
3. Check PEF, more than 15% decrease in PEF is
diagnostic of EIA.
18. Bronchial provocation tests used to diagnose asthma
in athletes
• Methacholine challenge
• Exercise challenge
• Mannitol inhalation
• Eucapnic voluntary hyperpnea
• Hypertonic saline challenge
19. Management
Non-pharmacological treatment:
- Ensure patient has taken asthma
medicine
• Warm-up and Cool down periods
• Hydrate before, during and after
exercise
• Check pollen and air quality
• Cold Weather
• - breath through the nose
20. Pharmacological treatment
Mnemonic for drugs used for treatment of EIB -
CLIMB:
Cromolyn
Leukotriene receptor antagonist (LTRA),
montelukast
Inhaled steroids (ICS)
Mast cell stabilizers other than cromolyn
Beta-2 agonists, albuterol
21.
22.
23. In conclusion
• EIA is common affecting10-20% of the general
population, and up to 90% of unselected asthmatics
• It is easily managed with warm-up and cool-
down, nasal breathing and pre-medication.
• Cough post exercise best predictor for positive
exercise challenge test
• 90% can be successfully treated with pre exercise
MDI
• Return to play usually safe
• Control of Exercise-induced asthma affords a healthy
lifestyle in which exercise is performed without
restrictions.
24. Resources
• American College of Allergy, Asthma, and Immunology
– http://www.acaai.org
• American College of Chest Physicians
– http://www.chestnet.org
• American Thoracic Society
– http://www.thoracic.org
• The Centers for Disease Control and Prevention
– http://www.cdc.gov/asthma
• National Asthma Education and Prevention Program
– http://www.nhlbi.nih.gov/about/naepp/
• Asthma and Allergy Foundation of America
– http://www.aafa.org
• American Lung Association
– http://www.lungusa.org
• American Academy of Allergy, Asthma, and Immunology
– http://www.aaaai.org
• Allergy and Asthma Network/Mothers of Asthmatics, Inc.
– http://www.aanma.org
Editor's Notes
Symptoms may begin during exercise and will usually worsen 5-20 minutes after your student stops the activity. Some individuals may experience a “late-phase reaction” 4-12 hours after exercising. These symptoms are usually less severe, but may last up to 24 hours. Students who are experiencing minor symptoms or are recovering from a recent asthma attack or episode/ illness may require exercise/activity modification. You may need to be creative to include these students, but participating at any level is better than being left out.