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Exercise induced breathing problems in adolescents
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
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 [en]
Exercise, dyspnoea, bronchoconstriction, laryngeal obstruction, adolescents, HRQoL, physical activity
National Category
Physiotherapy Respiratory Medicine and Allergy Pediatrics
Research subject
Lung Medicine
Identifiers
URN: urn:nbn:se:uu:diva-264370ISBN: 978-91-554-9379-0 (print)OAI: oai:DiVA.org:uu-264370DiVA: diva2:861316
Public defence
2015-12-04, Gunnesalen, Psykiatrins hus, Akademiska sjukhuset, 751 85, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-11-11 Created: 2015-10-10 Last updated: 2015-11-13
List of papers
1. Exercise-induced dyspnea is a problem among the general adolescent population
Open this publication in new window or tab >>Exercise-induced dyspnea is a problem among the general adolescent population
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2014 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 108, no 6, 852-858 p.Article in journal (Refereed) Published
Abstract [en]

Rationale: Respiratory symptoms during exercise are common and might limit adolescents' ability to take part in physical activity. Objective: To estimate the prevalence, determinants and consequences of exercise-induced dyspnea (EID) on daily life in a general population of 12-13 year old adolescents. Methods: A letter was sent to the parents of all 12-13 year old adolescents in the city of Uppsala (n = 3838). Parents were asked to complete a questionnaire together with their child on EID, asthma and allergy, consequences for daily life (wheeze, day time- and nocturnal dyspnea) and physical activity. The response rate was 60% (n = 2309). Results: Fourteen percent (n = 330) reported EID, i.e. had experienced an attack of shortness of breath that occurred after strenuous activity within the last 12 months. Female gender, ever-asthma and rhinitis were independently associated with an increased risk of EID. Ever-asthma was reported by 14.6% (n = 338), and 5.4% (n = 128) had both EID and ever-asthma. Sixty-one percent (n = 202) of the participants with EID did not have a diagnosis of asthma. In addition to rhinitis, participants with EID reported current wheeze and day-time as well as nocturnal dyspnea more often. than the group without EID. No difference was found in the level of physical activity between participants with and without EID. Conclusion: Adolescents with undiagnosed exercise-induced dyspnea have respiratory symptoms and are affected in daily life but have the same level of physical activity as adolescents without exercise-induced respiratory symptoms. 

Keyword
Exercise-induced dyspnea, Asthma, Exercise, Adolescents, Questionnaire
National Category
Respiratory Medicine and Allergy Physiotherapy
Identifiers
urn:nbn:se:uu:diva-229524 (URN)10.1016/j.rmed.2014.03.010 (DOI)000338409500004 ()
Available from: 2014-08-12 Created: 2014-08-11 Last updated: 2017-12-05Bibliographically approved
2. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
Open this publication in new window or tab >>Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population
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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.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-241953 (URN)10.1136/thoraxjnl-2014-205738 (DOI)000346338300012 ()
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
3. Exercise test using dry air in random adolescents: temporal profile and predictors of bronchoconstriction
Open this publication in new window or tab >>Exercise test using dry air in random adolescents: temporal profile and predictors of bronchoconstriction
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2016 (English)In: Respirology (Carlton South. Print), ISSN 1323-7799, E-ISSN 1440-1843, Vol. 21, no 2, 289-296 p.Article in journal (Refereed) Published
Abstract [en]

Background and objective

Guidelines recommend exercise tests using dry air to diagnose exercise-induced bronchoconstriction (EIB). Lung function changes subsequent to these tests have not been investigated in a general adolescent population, and it remains unknown whether signs of airway inflammation, measured using exhaled nitric oxide (FeNO), can predict a positive response. The aim of this study was to investigate the temporal aspect of decline in forced expiratory volume in 1 s (FEV1) after an exercise test using dry air, and to investigate predictors of EIB.

Methods

From a cross-sectional study on adolescents aged 13–15 years (n = 3838), a random subsample of 146 adolescents (99 with and 47 without self-reported exercise-induced dyspnoea) underwent standardized treadmill exercise tests for EIB while breathing dry air.

Results

Of the adolescents, 34% had a positive EIB test (decline of ≥10% in FEV1 from baseline) within 30 min. Of the subjects with EIB, 53% showed the greatest decline in FEV1 at 5 to 10 min (mean decline 18.5%), and the remaining 47% of the subjects showed the greatest decline at 15 to 30 min (mean decline 18.9%) after exercise. Increased FeNO (>20 ppb), female gender and self-reported exercise-induced dyspnoea were independently associated with a positive EIB test.

Conclusion

When assessing general adolescents for EIB with exercise test using dry air, there is a temporal variation in the greatest FEV1 decline after exercise. Therefore, lung function should be measured for at least 30 min after the exercise. Increased FeNO, female gender and self-reported exercise-induced dyspnoea can be predictors of a positive EIB test.

Keyword
adolescents, dry air, exercise induced bronchoconstriction test, exhaled nitric oxide, general population
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-264375 (URN)10.1111/resp.12682 (DOI)000373127300011 ()26588807 (Scopus ID)
Funder
Swedish Heart Lung Foundation
Available from: 2015-10-10 Created: 2015-10-10 Last updated: 2017-12-01
4. The relationship between exercise induced bronchial obstruction and health related quality of life in female and male adolescents from a general population
Open this publication in new window or tab >>The relationship between exercise induced bronchial obstruction and health related quality of life in female and male adolescents from a general population
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2016 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 16, 63Article in journal (Other academic) Published
Abstract [en]

Background: Previous studies have observed that exercise-induced bronchoconstriction (EIB) is more common and more strongly related to exercise related breathing problems in female adolescents than male adolescents. However, few studies have investigated the association between EIB and health related quality of life (HRQoL) from a gender perspective. The aim of this study was to examine the association between EIB and HRQoL and physical activity level in female and male adolescents with and without EIB. Methods: From a population based study on exercise-induced breathing problems among adolescents (13-15 years, n = 3838) a cross sectional study with prospective data collection was carried out in a random subsample of 140 adolescents. The subjects in the sample were tested for EIB with a standardised exercise test, of which 49 adolescents were tested positive. HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQL) and the adolescents' physical activity levels were measured objectively with accelerometer. Results: The female subjects with EIB reported a lower HRQoL, both in total score (p = 0.03) and physical functioning score (p = 0.009) and had a lower baseline FEV1 compared to females without EIB (88 vs. 94 % predicted, p = 0.001). No differences were found in HRQoL or baseline lung function between males with or without EIB. There were no differences in minutes of moderate to vigorous physical activity per day between females or males with and without EIB. Conclusion: In a general population, the female adolescents with EIB had lower HRQoL and poorer baseline lung function compared to counterparts without EIB. These differences were not observed in males. EIB does not appear to affect the level of daily physical activity neither in females nor males.

Keyword
Adolescents; Exercise-induced bronchoconstriction; Health-related quality of life; Physical activity
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-264376 (URN)10.1186/s12890-016-0226-0 (DOI)000375099200002 ()27117559 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2015-10-10 Created: 2015-10-10 Last updated: 2017-12-01Bibliographically approved

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