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Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
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2015 (English)In: Thorax, ISSN 0040-6376, E-ISSN 1468-3296, Vol. 70, no 1, 57-63 p.Article in journal (Refereed) Published
Abstract [en]

Background Exercise-induced respiratory symptoms are common among adolescents. Exercise is a known stimulus for transient narrowing of the airways, such as exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO). Our aim was to investigate the prevalence of EIB and EILO in a general population of adolescents. Methods In this cross-sectional study, a questionnaire on exercise-induced dyspnoea was sent to all adolescents born in 1997 and 1998 in Uppsala, Sweden (n=3838). A random subsample of 146 adolescents (99 with self-reported exercise-induced dyspnoea and 47 without this condition) underwent standardised treadmill exercise tests for EIB and EILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease of >= 10% in FEV1 from baseline. EILO was investigated using continuous laryngoscopy during exercise. Results The estimated prevalence of EIB and EILO in the total population was 19.2% and 5.7%, respectively. No gender differences were found. In adolescents with exercise-induced dyspnoea, 39.8% had EIB, 6% had EILO and 4.8% had both conditions. In this group, significantly more boys than girls had neither EIB nor EILO (64.7% vs 38.8%; p=0.026). There were no significant differences in body mass index, lung function, diagnosed asthma or medication between the participants with exercise-induced dyspnoea who had or did not have a positive EIB or EILO test result. Conclusions Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents. EILO is equally common among girls and boys and can coexist with EIB.

Place, publisher, year, edition, pages
2015. Vol. 70, no 1, 57-63 p.
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-241953DOI: 10.1136/thoraxjnl-2014-205738ISI: 000346338300012OAI: oai:DiVA.org:uu-241953DiVA: diva2:782159
Note

Henrik Johansson and Katarina Norlander have shared first authorship on this paper.

Available from: 2015-01-20 Created: 2015-01-19 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Exercise induced breathing problems in adolescents
Open this publication in new window or tab >>Exercise induced breathing problems in adolescents
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Experiencing respiratory symptoms in conjunction with exercise is common in children and adolescents and can have a negative impact on daily life. The aim of the thesis was to estimate the prevalence of exercise-induced dyspnoea, exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (E-ILO) in a general adolescent population, and to explore factors associated with EIB.

Methods: All 12-13-year-old adolescents in the city of Uppsala (n=3,838) participated in a survey on exercise-induced dyspnoea. A subsample of adolescents who answered the survey, 103 randomly selected adolescents reporting exercise-induced dyspnoea and 47 random adolescents who did not report exercise-induced dyspnoea underwent standardised treadmill exercise tests for EIB and E-ILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease ≥10% in FEV1 from baseline. E-ILO was investigated using continuous laryngoscopy during exercise. Health related quality of life (HRQoL), and objectively measured daily physical activity were investigated in those with (n=49) and without (n=91) a positive EIB-test.

Results: The prevalence of exercise-induced dyspnoea was 14%, and the estimated prevalence of EIB and E-ILO in the total population was 19.2% and of 5.7%, respectively, with no gender differences. In adolescents with exercise-induced dyspnoea 40% had EIB, 6% had E-ILO, and 5% had both conditions.

An increased baseline level of fraction of nitric oxide in exhaled air (FeNO), female gender, and exercise-induced dyspnoea were associated with a positive EIB test. Female adolescents with EIB had lower HRQoL and lower baseline lung function compared to females without EIB. These differences were not observed in male adolescents. There was no difference in time spent in moderate- to vigorous daily physical activity between adolescents with and without EIB.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 61 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1149
Keyword
Exercise, dyspnoea, bronchoconstriction, laryngeal obstruction, adolescents, HRQoL, physical activity
National Category
Physiotherapy Respiratory Medicine and Allergy Pediatrics
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-264370 (URN)978-91-554-9379-0 (ISBN)
Public defence
2015-12-04, Gunnesalen, Psykiatrins hus, Akademiska sjukhuset, 751 85, Uppsala, 09:00 (Swedish)
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Supervisors
Available from: 2015-11-11 Created: 2015-10-10 Last updated: 2015-11-13
2. Exercise-induced laryngeal obstruction: Prevalence, laryngeal findings and evaluation of treatment
Open this publication in new window or tab >>Exercise-induced laryngeal obstruction: Prevalence, laryngeal findings and evaluation of treatment
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Exercise-induced laryngeal obstruction (EILO) is one of many different causes for adolescents to experience dyspnoea during exercise. Objective exercise-testing with continuous video laryngoscopy is crucial for a correct diagnosis since it is difficult to differentiate EILO from other exercise related conditions in the airways only on the symptomatology. The main symptom in EILO is inspiratory stridor arising from an obstruction at the laryngeal level during ongoing exercise which quickly resolves after the exercise has stopped. EILO is often misdiagnosed as exercise-induced bronchoconstriction (EIB), which is obstruction in the peripheral airways that typically arises after cessation of exercise.

From a previous survey investigating self-reported exercise-induced dyspnoea in all 12-13-year-old adolescents in Uppsala (n=3,838, response rate 60.2%) a subset of 150 randomly selected adolescents (103 with dyspnoea and 47 controls) performed standardized treadmill exercise-tests for EIB and EILO.

During the exercise-test for EIB the subjects breathed dry air according to the current recommended guidelines. EIB was defined as a decrease in FEV1 ≥10% from baseline. EILO was diagnosed during a continuous laryngoscopy exercise (CLE) test by use of the CLE-score method and was defined as an obstruction of grade 2 at either glottic or/and supraglottic laryngeal level. The estimated prevalence of EIB in the general population was 19.2% and the estimated prevalence of EILO was 5.7%. No gender differences were detected.

A diagnostic software program for EILO, EILOMEA, was compared with the CLE-score and the methods were found to be compatible. EILOMEA was used to map and compare laryngeal response patterns in adolescents with exercise-induced dyspnoea (EIB and/or EILO), in adolescents with dyspnoea but without a diagnosis of EIB or EILO, and in healthy controls, all of whom had performed the CLE-test. No differences were seen between the healthy controls and the adolescents with dyspnoea without a diagnosis. Only adolescents diagnosed with EILO showed a significant different laryngeal response pattern which strongly suggests that the diagnostic procedure is reliable.

In a follow-up study of patients referred for investigation of exercise-induced dyspnoea, we investigated the outcome of surgical vs. conservative treatment of EILO-positive subjects and subjects tested negative for the diagnosis, regarding the level of exercise-induced dyspnoea and physical activity. Surgically treated patients had less breathing problems and were more physically active than both conservatively treated patients and patients who were tested negative.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 61 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1300
Keyword
Exercise, laryngeal obstruction, bronchoconstriction, CLE-score, EILOMEA
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-315123 (URN)978-91-554-9819-1 (ISBN)
Public defence
2017-03-31, Skoogsalen, Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-03-08 Created: 2017-02-09 Last updated: 2017-03-13

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Johansson, HenrikNorlander, KatarinaBerglund, LarsJanson, ChristerMalinovschi, AndreiNordvall, LennartNordang, LeifEmtner, Margareta

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