PURPOSE: Exercise-induced bronchoconstriction (EIB) is common in “high ventilation” athletes, and the Eucapnic Voluntary Hyperpnea (EVH) airway provocation test is the standard EIB screen. Although the EVH test is widely used, the in-test performance in high ventilation athletes as well as the reproducibility of that performance has not been determined. Reproducibility of pre- and post-test spirometry and self-reported atopy/cough was also examined. METHODS: High ventilation athletes (competitive swimmers; n=11, 5 males) completed an atopy/cough questionnaire and EVH testing (operator controlled FiCO₂) on 2 consecutive days. RESULTS: Swimmers achieved 85%±9% and 87%±9% of target FEV1 volume on days 1 and 2, respectively, (P=0.45; ICC 0.57 [0.00-0.86]) resulting in a total ventilation of 687 vs 684 L [P=0.89, ICC 0.89 (0.65-0.97]) equating to 83%±8% and 84%±9% of predicted total volume (ICC 0.54 [0.00-0.85]) between days 1 and 2. FiCO₂ required to maintain eucapnic conditions was 2.5%. Pre-test FEV1 was less on day 2 (P=0.04; ICC >0.90). Day 1 to 2 post-test FEV1 was not different, and 4 swimmers were EIB positive (>10% fall in pre-post FEV1) on day 1 (3 on day 2). CONCLUSIONS: EVH in-test performance is reproducible however required less FiCO₂ than standard protocol and the swimmers under-ventilated by 125 and 139 L/min for days 1 and 2, respectively. How this affects EIB diagnosis remains to be determined; however, our results indicate a post-test FEV1 fall of ≥20% may be recommended as the most consistent diagnostic criterion.
Asthma, Exercise-Induced ; Athletes* ; Bronchoconstriction ; Cough ; Diagnosis ; Humans ; Respiratory Hypersensitivity ; Spirometry ; Swimming ; Ventilation*

Vocal cord dysfunction (VCD) is respiratory disorder characterized by paradoxical closure of the vocal cord during the respiratory cycle leading to obstructive airway symptoms. The clinical presentation of VCD is often dr amatic and its misdiagnosis as asthma of exercise-induced brochospasm(EIB) has led to inappropriate treatment including high dose corticosteroids, intubation, and tracheostomy. Many VCD patients are asympromatic at rest and require exercise challenge to elicit symptoms and vocal cord abnormalities. The "gold standard" for the diagnosis of VCD remains laryngoscopy of bronchoscopy with direct visualization of paradoxical adduction of the vocal cords. We report a case of exercise-induced Vocal cord masqueraded as exercise-induced asthma unresponsive to corticosteroids. And bronchodilator confirmed by typical bronchoscopic findings with paradoxial adduction of the vocal cords.
Adrenal Cortex Hormones ; Asthma* ; Asthma, Exercise-Induced ; Bronchoscopy ; Diagnosis ; Diagnostic Errors ; Humans ; Intubation ; Laryngoscopy ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

BACKGROUND: Exercise-induced bronchoconstriction (EIB), which describes acute airway narrowing that occurs as a result of exercise, is associated with eosinophilic airway inflammation, bronchial hyperresponsiveness. The forced expiratory volume in one second (FEV₁) is the most commonly used spirometric test in the diagnosis of EIB in exercise challenge in asthma. Other parameters such as forced expiratory flow at 50% of the vital capacity (FEF(50%)) and peak expiratory flow (PEF) are used less often in the diagnosis of EIB. OBJECTIVE: The purpose of this study is to evaluate the association of FEV₁ and FEF(50%), PEF parameters, blood eosinophil counts in EIB in children with mild asthma. METHODS: Sixty-seven children (male: 39, female: 28) with mild asthma were included in this study. Pulmonary functions were assessed before and at 1, 5, 10, 15, and 20 minutes after exercise. The values of spirometric FEV₁, FEF50(%), PEF, and blood eosinophil counts were evaluated in EIB in children with mild asthma. RESULTS: There was a positive correlation between FEV₁ with FEF(50%) and PEF values (p < 0.05; FEF(50%), r=0.68; PEF, r=0.65). Also, a positive correlation was found between blood eosinophil counts and the values of spirometric FEV₁, FEF(50%), and PEF (p < 0.05; FEV₁, r=0.54; FEF(50%), r=0.42; PEF, r=0.26). In addition to these correlations, in the exercise negative group for FEV₁, the FEF(50%) and PEF values decreased more than the cutoff values in 3, and 2 patients, respectively. CONCLUSION: According to the presented study, eosinophil may play a major role in the severity of EIB in mild asthma. FEF(50%) and PEF values can decrease in response to exercise without changes in FEV₁ in mild asthmatic patients.
Asthma ; Asthma, Exercise-Induced ; Bronchoconstriction ; Child ; Diagnosis ; Eosinophils ; Female ; Forced Expiratory Volume ; Humans ; Inflammation ; Respiratory Function Tests ; Spirometry ; Vital Capacity

PURPOSE: To identify the causes and clinical characteristics, and the efficacy of various diagnostic approaches, we studied, prospectively, pediatric patients with chronic recurrent chest pain. METHODS: A prospective study of 122 patients with chronic recurrent chest pain from June 1998 to June 2003 was performed. The male and female ratio was 81:41, age 9.3+/-3.1 year. A single chart including pain description(histoy) and pain questionaire, with associated symptoms, was used for systematic history taking. The patients were devided in two groups, Group A, before June 2001(n=70), Group B, after June 2001(n=52). Chest X-ray and ECG were checked in all patients. Allergy tests and echocardiography, 24 hour ECG monitoring, exercise tests, pulmonary function tests, and gastrointestinal fiberendoscopy were performed selectively. RESULTS: Idiopathic origins were most common(32%). The remaining causes were psychogenic(23%) and exercise-induced asthma(20.5%), hyperventilation syndrome(9.1%), tachyarrhythmia(4.9%), cardiac (4.1%), pulmonary(3.3%), reflux esophagitis(2.5%), in order. The positive rate of allergy tests(24%) was higher than that of cardiac examinations(11-20%). Exercise-induced asthma was more common than psychogenic causes after June, 2001. Various abdominal symptoms accompanied idiopathic and psychogenic chest pains, and hyperventilation syndrome. Headaches were more commonly found in psychogenic pain, but chest tightness and dyspnea were common in hyperventilation syndrome. About half of exercise-induced asthma patients had symptoms of allergic rhinitis. CONCLUSION: In the majority(72%) of exercise-induced asthma, the chest pain was induced or aggravated by exercise, and relieved by rest. Causative antigens were detected in 69.2% of group B patients with exercise-induced asthma. Exercise-induced chest pain might be a first manifestation in allergy patients. So, we recommand allergy tests for patients with recurrent chest pains induced or aggravated by exercise. Hence, cardiac examinations such as echocardiography or 24 hour ECG monitoring could be performed selectively, case by case.
Asthma, Exercise-Induced ; Chest Pain* ; Child* ; Diagnosis* ; Dyspnea ; Echocardiography ; Electrocardiography ; Exercise Test ; Female ; Headache ; Humans ; Hypersensitivity ; Hyperventilation ; Male ; Prospective Studies ; Respiratory Function Tests ; Rhinitis ; Thorax*

PURPOSE: Obesity is one of the most frequent markers of health risk and the incidence of obesity has increased in Korea recently. Obesity leads to higher risks of hypertension, hyperlipidemia and insulin resistance. It also leads to risks of respiratory complications. This study was done to view the different effects of obesity on pulmonary functions according to body fat distribution before and after exercise. METHODS: 257 obese children enrolled in this study. All subjects were divided 2 groups, upper body obesity and lower body obesity group according to waist to hip ratio, trunk obesity and extremity obesity group according to centrality index. Pre-and post-exercise loading FEV1, FVC and PEFR were checked in all subjects and the changes of values in each groups were observed. RESULTS: 1) There were 68, 189, 136 and 121 children in upper body obesity group, lower body obesity group, trunk obesity group and extremity group respectively. 2) The % predicted value of FEV1, FVC and PEFR in upper body obesity group were lower than those in lower body obesity group before exercise loading. And the reduction of % predicted values of each parameters was more prominent in upper body obesity group than in lower body obesity group after exercise loading. 3) There was no difference of pulmonary function between trunk and extremity obesity group before exercise, but the reduction of % predicted values of each parameters was more prominent in trunk obesity group than in extremity obesity group after exercise loading. CONCLUSION: The exercise induced bronchospasm is more prominent in upper body and trunk obesity group than in lower body and extremity obesity group. Therefore the fat distribution of obese children must be considered in diagnosis and control of obesity.
Asthma, Exercise-Induced ; Body Fat Distribution ; Child ; Diagnosis ; Extremities ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Insulin Resistance ; Korea ; Obesity* ; Peak Expiratory Flow Rate ; Waist-Hip Ratio

BACKGROUND: Changes in airway mucosal osmolarity are an underlying mechanism of bronchoconstrictive responses to exercise and hypertonic saline (HS). The purpose of this study was to examine whether an osmotic challenge test using HS can predict exercise-induced bronchospasm (EIB) in asthma patients. METHODS: Thirty-six young male asthmatic patients underwent bronchial challenge tests based on 4.5% HS, exercise (> 24h later), and methacholine (MCh) at the Chonnam National University Hospital. The relationships between responses to HS and exercise, and between MCh and exercise were evaluated. RESULTS: The maximal fall in forced expiratory volume in one second following exercise was significantly higher in the HS-responders (n=19) than in the HS-nonresponders (n=17, 35.9+/-4.1% vs. 17.9+/-2.7%, p< 0.001), and there was a significant correlation between the severity of EIB and HS-airway hyperresponsiveness (AHR). When compared with the MCh-AHR test in terms of predicting EIB, the HS-AHR test showed higher specificity (71.4% vs. 42.9%), but a lower sensitivity (58.6% vs. 89.7%) and negative predictive value (29.4% vs. 50.0%). At the moderate AHR cutoff value, the MCh-AHR test had a specificity that was comparable with and predictive values that were higher than those of the HS-AHR test. CONCLUSIONS: The HS-AHR test was more specific than the MCh-AHR test, but was less sensitive and had a poorer negative predictive value, which in combination preclude the use of the HS-AHR test as a screening tool for EIB. The MCh-AHR test had a cutoff value for moderate AHR that may be more useful for predicting EIB in asthmatic patients.
Saline Solution, Hypertonic/*diagnostic use ; Predictive Value of Tests ; Methacholine Chloride/diagnostic use ; Male ; Humans ; Bronchoconstrictor Agents/diagnostic use ; Bronchial Provocation Tests/*methods ; Bronchial Hyperreactivity/*diagnosis ; Asthma, Exercise-Induced/*diagnosis ; Adult ; Adolescent

Anti-Asthmatic Agents ; therapeutic use ; Asthma, Exercise-Induced ; diagnosis ; epidemiology ; physiopathology ; therapy ; Child ; Constriction, Pathologic ; drug therapy ; etiology ; physiopathology ; Diagnosis, Differential ; Glucocorticoids ; therapeutic use ; Humans ; Risk Factors ; Treatment Outcome