Exercise-Induced Bronchoconstriction Diagnostics: Impact of a Repeated Exercise Challenge Test
Author(s)
Maj R. Angell,
Liv Berit Augestad,
Thorbjørn S. Haugen,
Anne Frostad,
Thor Arne Grønnerød,
Trine Stensrud*
Affiliation(s)
Department of Human Movement Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Clinic for Allergy and Airway Diseases, Oslo, Norway. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
Department of Human Movement Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Clinic for Allergy and Airway Diseases, Oslo, Norway. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
ABSTRACT
Exercise-Induced bronchoconstriction (EIB) is related to increased ventilation (VE) during exercise and describes the transient airway narrowing following exercise. A reliable diagnosis is essential for optimal treatment. The impact of a repeated exercise challenge test (ECT) in a clinical setting is not well established and conducting a repeated ECT with the possibility to adjust the exercise intensity on an individual basis may give more information. The aim of the study was to evaluate the test-retest reliability of an ECT for EIB and its association with exercise intensity. Methods: After examination by a pulmonologist, 20 referred subjects with symptoms strong indications of Exercise-Induced bronchoconstriction performed two consecutive exercise challenge tests on a treadmill. The exercise intensity of the repeated test was adjusted. Forced expiratory volume in 1 second (FEV1) was measured before and 1, 3, 6, 10, and 15 minutes after exercise. EIB was defined as a reduction of ≥ 10% in FEV1. Ventilation and heart rate were measured during exercise. Results: Five subjects tested positive in both tests, and ten subjects tested negative in both tests. Three subjects tested positive in the first test only, while two subjects tested positive in the second test only. The exercise intensity was not significantly different between the two tests for any of the subjects. Conclusion: There were 25% divergences in the diagnostic results of two consecutive exercise challenge tests. The difference in the test results was not explained by a difference in the exercise intensity.
KEYWORDS
Exercise-Induced Bronchoconstriction, Exercise Challenge Test, Forced Expiratory Volume in 1 Second, Exercise Intensity
Exercise-Induced Bronchoconstriction, Exercise Challenge Test, Forced Expiratory Volume in 1 Second, Exercise Intensity
Cite this paper
Angell, M. , Augestad, L. , Haugen, T. , Frostad, A. , Grønnerød, T. and Stensrud, T. (2014) Exercise-Induced Bronchoconstriction Diagnostics: Impact of a Repeated Exercise Challenge Test. Open Journal of Respiratory Diseases, 4, 55-63. doi: 10.4236/ojrd.2014.42009.
Angell, M. , Augestad, L. , Haugen, T. , Frostad, A. , Grønnerød, T. and Stensrud, T. (2014) Exercise-Induced Bronchoconstriction Diagnostics: Impact of a Repeated Exercise Challenge Test. Open Journal of Respiratory Diseases, 4, 55-63. doi: 10.4236/ojrd.2014.42009.
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http://dx.doi.org/10.1183/18106838.0701.034
[1] Nedocromil Sodium for Preventing Exercise-Induced Bronchoconstriction. Cochrane Database of Systematic Reviews [Database on the Internet] 2002. [2] Mast-Cell Stabilising Agents to Prevent Exercise-Induced Bronchoconstriction. Cochrane Database of Systematic Reviews [Database on the Internet] 2003. [3] Ernst, P., Ghezzo, H. and Becklake, M.R. (2002) Risk Factors for Bronchial Hyperresponsiveness in Late Childhood and Early Adolescence. European Respiratory Journal, 20, 635-639.
http://dx.doi.org/10.1183/09031936.02.00962002 [4] Rupp, N.T. (1996) Diagnosis and Management of Exercise-Induced Asthma. The Physical and Sports Medicine, 24, 77-87.
http://dx.doi.org/10.3810/psm.1996.01.1213 [5] Rundell, K.W., Im, J., Mayers, L.B., et al. (2001) Self-Reported Symptoms and Exercise Induced Asthma in the Elite Athlete. Medicine & Science in Sports & Exercise, 33, 208-213.
http://dx.doi.org/10.1097/00005768-200102000-00006 [6] Crapo, R.O., Casaburi, R., Coates, A.L., et al. (2000) Guidelines for Methacholine and Exercise Challenge Testing-1999. American Journal of Respiratory and Critical Care Medicine, 161, 309-329.
http://dx.doi.org/10.1164/ajrccm.161.1.ats11-99 [7] Sterk, P.J., Fabbri, L.M., Quanjer, P.H., et al. (1993) Airway Responsiveness. Standardized Challenge Testing with Pharmacological, Physical and Sensitizing Stimuli in Adults. European Respiratory Journal, 6, 53-83.
http://dx.doi.org/10.1183/09041950.053s1693 [8] Weiler, J.M., Bonini, S., Coifman, R., et al. (2007) American Academy of Allergy, Asthma & Immunology Work Group Report: Exercise-Induced Asthma. The Journal of Allergy and Clinical Immunology, 119, 1349-1358.
http://dx.doi.org/10.1016/j.jaci.2007.02.041 [9] Tanaka, H., Monahan, K.D. and Seals, D.R. (2001) Age-Predicted Maximal Heart Rate Revisited. Journal of the American College of Cardiology, 37, 153-156.
http://dx.doi.org/10.1016/S0735-1097(00)01054-8 [10] Trümper, C., Maueler, S., Vobejda, C., et al. (2009) Heart Rate-Based Protocols for Exercise Challenge Testing Do Not Ensure Sufficient Exercise Intensity for Inducing Exercise-Induced Bronchial Obstruction. British Journal of Sports Medicine, 43, 429-431.
http://dx.doi.org/10.1136/bjsm.2007.041715 [11] Carlsen, K.H., Engh, G. and Mork, M. (2000) Exercise-Induced Bronchoconstriction Depends on Exercise Load. Respiratory Medicine, 94, 750-755.
http://dx.doi.org/10.1053/rmed.2000.0809 [12] Anderson, S.D., Pearlman, D.S., Rundell, K.W., et al. (2010) Reproducibility of the Airway Response to an Exercise Protocol Standardized for Intensity, Duration, and Inspired Air Conditions, in Subjects with Symptoms Suggestive of Asthma. Respiratory Research, 11, 120-132.
http://dx.doi.org/10.1186/1465-9921-11-120 [13] Carlsen, K.H., Anderson, S.D., Bjermer, L., et al. (2008) Exercise-Induced Asthma, Respiratory and Allergic Disorders in Elite Athletes: Epidemiology, Mechanisms and Diagnosis: Part 1 of the Report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN. Allergy, 63, 387-403.
http://dx.doi.org/10.1111/j.1398-9995.2008.01662.x [14] Roca, J., Whipp, B.J., Agusti, A.G.N., et al. (1997) Clinical Exercise Testing with Reference to Lung Diseases: Indications, Standardization and Interpretation Strategies. European Respiratory Journal, 10, 2662-2689.
http://dx.doi.org/10.1183/09031936.97.10112662 [15] ATS, ERS (2005) ATS/ERS Recommandations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide. American Journal of Respiratory and Critical Care Medicine, 171, 912-930.
http://dx.doi.org/10.1164/rccm.200406-710ST [16] Cotes, J.E., Chinn, D.J., Quanjer, P.H., et al. (1993) Standardization of the Measurement of Transfer Factor (Diffusing Capacity). European Respiratory Journal, 6, 41-52.
http://dx.doi.org/10.1183/09041950.041s1693 [17] Dreborg, S. (2005) Evaluation of Allergen Exposure. The Journal of Allergy and Clinical Immunology, 116, 620-622.
http://dx.doi.org/10.1016/j.jaci.2005.06.027 [18] Miller, M.R., Hankinson, J., Brusasco, V., et al. (2005) Standardization of Spirometry. European Respiratory Journal, 26, 319-338.
http://dx.doi.org/10.1183/09031936.05.00034805 [19] Wanger, J., Clausen, J.L., Coates, A., et al. (2005) Standardization of the Measurement of Lung Volumes. European Respiratory Journal, 26, 511-522.
http://dx.doi.org/10.1183/09031936.05.00035005 [20] Quanjer, P.H., Tammeling, G.J., Cotes, J.E., et al. (1993) Lung Volumes and Forced Ventilatory Flows. European Respiratory Journal, 6, 5-40.
http://dx.doi.org/10.1183/09041950.005s1693 [21] Borg, G. (1998) Borg’s Perceived Exertion and Pain Scales. Human Kinetics, Champaign. [22] Hofstra, W.B., Sont, J.K., Sterk, P.J., et al. (1997) Sample Size Estimation in Studies Monitoring Exercise-Induced Bronchoconstriction in Asthmatic Children. Thorax, 52, 739-741.
http://dx.doi.org/10.1136/thx.52.8.739 [23] Rundell, K.W. and Sue-Chu, M. (2010) Field and Laboratory Exercise Challenges for Identifying Exercise-Induced Bronchoconstriction. Breathe, 7, 35-42.
http://dx.doi.org/10.1183/18106838.0701.034