exercise-induced asthma

運動誘発性喘息

WordNet

1. do physical exercise; "She works out in the gym every day" (同)work_out
2. give a workout to; "Some parents exercise their infants"; "My personal trainer works me hard"; "work ones muscles"; "this puzzle will exercise your mind" (同)work, work_out
3. a task performed or problem solved in order to develop skill or understanding; "you must work the examples at the end of each chapter in the textbook" (同)example
4. the activity of exerting your muscles in various ways to keep fit; "the doctor recommended regular exercise"; "he did some exercising"; "the physical exertion required by his work kept him fit" (同)exercising, physical exercise, physical exertion, workout
5. systematic training by multiple repetitions; "practice makes perfect" (同)practice, drill, practice session, recitation
6. (usually plural) a ceremony that involves processions and speeches; "academic exercises"
7. reason or establish by induction
8. cause to arise; "induce a crisis" (同)bring_on
9. produce electric current by electrostatic or magnetic processes (同)induct
10. cause to do; cause to act in a specified manner; "The ads induced me to buy a VCR"; "My children finally got me to buy a computer"; "My wife made me buy a new sofa" (同)stimulate, cause, have, get, make
11. cause to occur rapidly; "the infection precipitated a high fever and allergic reactions" (同)stimulate, rush, hasten
12. respiratory disorder characterized by wheezing; usually of allergic origin (同)asthma attack, bronchial_asthma
13. brought about or caused; not spontaneous; "a case of steroid-induced weakness"

PrepTutorEJDIC

1. 〈U〉(身体の)『運動』;〈C〉体操 / 〈C〉(…の)『練習』,けいこ;練習問題《+『in』(『for』,『on』)+『名』》 / 〈U〉〈C〉《the~》(精神力・能力などを)『働かせること』,(権力などの)行使《+『of』+『名』》 / 《しばしば複数形で》(軍の)演習;《米》式,式典 / 〈C〉礼拝,勤行 / 〈手足など,体の器官〉‘を'『働かせる』,動かす,訓練する / 〈人〉‘に'(…の)『訓練をさらる』,(…で)〈人〉‘を'鍛練する《+『名』〈人〉+『in』+『名』(do『ing』)》 / 〈精神力・能力など〉‘を'『働かせる』,〈権力など〉‘を'行使する / 《文》《受動態で》(…について)〈人〉‘を'悩ます,心配させる《+『名』〈人〉+『about』(『over』)+『名』》 / 練習する;運動する
2. 〈人〉‘に'『勧めて』(…)『させる』 / …‘を'『引き起こす』,もたらす(cause) / 〈電気〉‘を'誘導する / …‘を'帰納する
3. 喘息(ぜんそく)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/22 19:51:02」(JST)

wiki en

[Wiki en表示]

Exercise-induced asthma
Classification and external resources
Specialty	pulmonology
ICD-10	J45.990
ICD-9-CM	493.81
DiseasesDB	31728
MedlinePlus	000036
eMedicine	sports/155
MeSH	D001250

Exercise-induced asthma, or E.I.A., occurs when the airways narrow as a result of exercise. The preferred term for this condition is exercise-induced bronchoconstriction (EIB); exercise does not cause asthma, but is frequently an asthma trigger.

Signs and symptoms

It might be expected that people with E.I.B. would present with shortness of breath, and/or an elevated respiratory rate and wheezing, consistent with an asthma attack. However, many will present with decreased stamina, or difficulty in recovering from exertion compared to team members, or paroxysmal coughing from an irritable airway. Similarly, examination may reveal wheezing and prolonged expiratory phase, or may be quite normal. Consequently, a potential for under-diagnosis exists. Measurement of airflow, such as peak expiratory flow rates, which can be done inexpensively on the track or sideline, may prove helpful.

Cause

While the potential triggering events for E.I.B. are well recognized, the underlying pathogenesis is poorly understood. It usually occurs after at least several minutes of vigorous, "aerobic" activity, which demands that normal nasal breathing be supplemented by mouth breathing. The resultant inhalation of air that has not been warmed and humidified by the nasal passages seems to generate increased blood flow to the linings of the bronchial tree, resulting in edema. Constriction of these small airways then follows, worsening the degree of obstruction to airflow. There is increasing evidence that the smooth muscle that lines the airways becomes progressively more sensitive to changes that occur as a result of injury to the airways from dehydration. The chemical mediators that provoke the muscle spasm appear to arise from mast cells.

Diagnosis

Exercise-induced bronchoconstriction can be difficult to diagnose clinically given the lack of specific symptoms and frequent misinterpretation as manifestations of vigorous exercise. There are many mimics that present with similar symptoms, such as vocal cord dysfunction, cardiac arrhythmias, cardiomyopathies, and gastroesophageal reflux disease. It is also important to distinguish those who have asthma with exercise worsening, and who consequently will have abnormal testing at rest, from true exercise-induced bronchoconstriction, where there will be normal baseline results. Because of the wide differential diagnosis of exertional respiratory complaints, the diagnosis of exercise-induced bronchoconstriction based on history and self-reported symptoms alone has been shown to be inaccurate and will result in an incorrect diagnosis more than 50% of the time.

Objective testing

Objective testing should begin with spirometry at rest. In true exercise-induced bronchoconstriction, the results should be within normal limits. Should resting values be abnormal, then asthma, or some other chronic lung condition, is present. There is, of course, no reason why asthma and exercise-induced bronchoconstriction should not co-exist but the distinction is important because without successful treatment of underlying asthma, treatment of an exercise component will likely be unsuccessful. If baseline testing is normal, some form of exercise or pharmacologic stress will be required, either on the sideline or practice venue, or in the laboratory.

Exercise testing

Treadmill or ergometer-based testing in lung function laboratories are effective methods for diagnosing exercise-induced bronchoconstriction, but may result in false negatives if the exercise stimulus is not intense enough.

Field-exercise challenge

Field-exercise challenge tests that involve the athlete performing the sport in which they are normally involved and assessing FEV₁ after exercise are helpful if abnormal but have been shown to be less sensitive than eucapnic voluntary hyperventilation.

Eucapnic voluntary hyperventilation challenge

The International Olympic Committee recommends the eucapnic voluntary hyperventilation (EVH) challenge as the test to document exercise-induced asthma in Olympic athletes. In the EVH challenge, the patient voluntarily, without exercising, rapidly breathes dry air enriched with 5% CO₂ for six minutes. The presence of the enriched CO₂ compensates for the CO₂ losses in the expired air, not matched by metabolic production, that occurs during hyperventilation, and so maintains CO₂ levels at normal.

Pharmacological challenge tests

Pharmacological challenge tests, such as the methacholine challenge test, have a lower sensitivity for detection of exercise-induced bronchoconstriction in athletes and are also not a recommended first-line approach in the evaluation of exercise-induced asthma.

Mannitol inhalation has been recently approved for use in the United States.

It should be noted, however, that a relatively recent review of the literature has concluded that there is currently insufficient available evidence to conclude that either mannitol inhalation or eucapnic voluntary hyperventilation are suitable alternatives to exercise challenge testing to detect exercise-induced bronchoconstriction and that additional research is required.

Treatment

Further information: Asthma#Treatment

Non-pharmacological treatment

The best treatment is avoidance of conditions predisposing to attacks, when possible. In athletes who wish to continue their sport or do so in adverse conditions, preventive measures include altered training techniques and medications.

Some take advantage of the refractory period by precipitating an attack by "warming up," and then timing competition such that it occurs during the refractory period. Step-wise training works in a similar fashion. Warm up occurs in stages of increasing intensity, using the refractory period generated by each stage to reach a full workload.

Pharmacological treatment

The treatment of EIB has been extensively studied in asthmatic subjects over the last 30 years, but not so in EIB. Thus, it is not known whether athletes with EIB or ‘sports asthma’ respond similarly to subjects with classical allergic or nonallergic asthma. However, there is no evidence supporting different treatment for EIB in asthmatic athletes and nonathletes.

The most common medication used is a beta agonist taken about 20 minutes before exercise. Some physicians prescribe inhaled anti-inflammatory mists such as corticosteroids or leukotriene antagonists, and mast cell stabilizers have also proven effective. A randomized crossover study compared oral montelukast with inhaled salmeterol, both given two hours before exercise. Both drugs had similar benefit but montelukast lasted 24 hours.

Three randomized double-blind cross-over trials have examined the effect of vitamin C on EIB. Pooling the results of the three vitamin C trials indicates an average 48% reduction in the FEV1 decline caused by exericise (Figure). The systematic review concluded that "given the safety and low cost of vitamin C, and the positive findings for vitamin C administration in the three EIB studies, it seems reasonable for physically active people to test vitamin C when they have respiratory symptoms such as cough associated with exercise." It should be acknowledged that the total number of subjects involved in all three trials was only 40.

Figure: This forest plot shows the effect of vitamin C (0.5–2 g/day) on post-exercise decline in FEV1 in three studies with asthmatic participants. Constructed from data in Fig. 4 of Hemilä (2013). The three horizontal lines indicate the three studies, and the diamond shape at the bottom indicates the pooled effect of vitamin C: decrease in the post-exercise decline in FEV1 by 48% (95%CI: 33 to 64%).

In May 2013, the American Thoracic Society issued the first treatment guidelines for EIB.

Prognosis

As evidenced by many professional athletes who have overcome EIB using some combination of accepted treatments, the prognosis is usually very good. Olympic swimmers Tom Dolan, Amy Van Dyken, and Nancy Hogshead, Olympic track star Jackie Joyner-Kersee, baseball Hall of Famer Catfish Hunter, and American football player Jerome Bettis are among the many who have done so. Tour de France winner Chris Froome admitted to suffer from the condition after being spotted using a nasal inhaler during race.

School children are also one of the major groups impacted by EIB as exercise programs and sports activities form a big part of most schools. Proactive schools usually set special EIB friendly guidelines for students with EIB so that they can be included in mainstream student exercise programs.

References

External links

• "Tips to Remember: Exercise-induced asthma". American Academy of Allergy, Asthma, and Immunology. Retrieved 2007-04-12. 
• "Exercise-Induced Asthma". National Jewish Medical and Research Center. July 2002. Retrieved 2010-04-11. 
• Reynolds, Gretchen (January 13, 2010). "Why Do So Many Winter Olympians Have Asthma?". The New York Times. Retrieved 2009-02-13. 
• What is Exercise-Induced Asthma?
• Fact sheet: Exercise-induced asthma

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 運動誘発性気管支収縮 exercise induced bronchoconstriction
• 2. 患者情報：運動誘発性喘息（詳細） exercise induced asthma beyond the basics
• 3. 小児および思春期における有酸素運動試験の概要 overview of aerobic exercise testing in children and adolescents
• 4. 喘息におけるβ刺激剤：急性期投与および予防的使用 beta agonists in asthma acute administration and prophylactic use
• 5. 気管支誘発試験 bronchoprovocation testing

English Journal

• Damage-associated molecular pattern and innate cytokine release in the airways of competitive swimmers.

• Seys SF1, Hox V, Van Gerven L, Dilissen E, Marijsse G, Peeters E, Dekimpe E, Kasran A, Aertgeerts S, Troosters T, Vanbelle V, Peers K, Ceuppens JL, Hellings PW, Dupont LJ, Bullens DM.
• Allergy.Allergy.2015 Feb;70(2):187-94. doi: 10.1111/all.12540.
• BACKGROUND: Daily intensive exercise by elite athletes can result in exercise-induced asthma especially in elite swimmers and this may be linked to epithelial damage.OBJECTIVE: To study airway epithelial damage and release of damage-associated molecular patterns (DAMPs) after intensive exercise in e
• PMID 25358760

• A systematic review of the literature on screening for exercise-induced asthma: considerations for school nurses.

• Worrell K1, Shaw MR2, Postma J3, Katz JR3.
• The Journal of school nursing : the official publication of the National Association of School Nurses.J Sch Nurs.2015 Feb;31(1):70-6. doi: 10.1177/1059840514523295. Epub 2014 Feb 12.
• Asthma is a major cause of illness, missed school days, and hospitalization in children. One type of asthma common in children is exercise-induced asthma (EIA). EIA causes airway narrowing with symptoms of cough and shortness of breath during exercise. The purpose of this article is to review the li
• PMID 24526571

• Do children with stable asthma benefit from addition of montelukast to inhaled corticosteroids: Randomized, placebo controlled trial.

• Stelmach I1, Ożarek-Hanc A2, Zaczeniuk M2, Stelmach W3, Smejda K2, Majak P2, Jerzynska J2, Anna J4.
• Pulmonary pharmacology & therapeutics.Pulm Pharmacol Ther.2015 Jan 29. pii: S1094-5539(15)00005-X. doi: 10.1016/j.pupt.2015.01.004. [Epub ahead of print]
• BACKGROUND: To determine the effects of montelukast added to maintenance inhaled steroids (ICS) therapy during the school year in children with stable asthma on the ICS use, frequency of exacerbations, lung function, asthma symptoms, fractional exhaled nitric oxide (FeNO) level and exercise-induced
• PMID 25640020

Japanese Journal

• 修飾因子 (特集 気管支喘息診療の進歩 2014)

• 堀口 高彦,志賀 守
• 日本呼吸器学会誌 = Annals of the Japanese Respiratory Society 3(2), 186-193, 2014-03-10
• NAID 40020029581

• 運動負荷テスト

• 小田嶋 博
• 日本小児アレルギー学会誌 28(3), 378-381, 2014
• 運動負荷テストはアレルギー疾患の診断においてしばしば行われる．その中でも最も多く，また，実施方法が確立されているのは，運動誘発喘息（EIA）に対する検査である．ここでは日常臨床で実際に行っている経験に基づいて，その方法について述べた．EIAは小児の日常生活のなかで頻度が高く，また実際の生活に結びつくことから，適切に評価し日常臨床に役立てていくことが望ましい．
• NAID 130004699433

• Low-Intensity Aerobic Exercise Mitigates Exercise-Induced Bronchoconstriction by Improving the Function of Adrenal Medullary Chromaffin Cells in Asthmatic Rats

• Qin Qingwu,Feng Juntao,Hu Chengping,Chen Xi,Qin Ling,Li Yuanyuan
• The Tohoku Journal of Experimental Medicine 234(2), 99-110, 2014
• … Exercise is one of the most common triggers of bronchoconstriction in patients with asthma. … The low levels of circulating epinephrine produced by the adrenal medullary chromaffin cells (AMCCs) are associated with exercise-induced bronchoconstriction (EIB) in asthmatics. … In the present study, we tested the hypothesis that low-intensity aerobic exercise may ameliorate EIB using a rat model of asthma. …
• NAID 130004687564

Related Links

• Exercise-induced asthma: MedlinePlus Medical Encyclopedia

Be Careful Where and When You Exercise Cold or dry air may trigger your asthma symptoms. If you do exercise in cold or dry air: Breathe through your nose. Wear a scarf or mask over your mouth. Do not exercise ...

• Asthma and Exercise | AAAAI

Asthma and Exercise: Tips to Remember Do you cough, wheeze and have a tight chest or shortness of breath when you exercise? If yes, you may have exercise-induced bronchoconstriction (EIB). This happens when the tubes ...

Related Pictures

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★リンクテーブル★

リンク元	「運動誘発性喘息」「EIA」「運動誘発喘息」
関連記事	「induce」「induced」「asthma」

「運動誘発性喘息」

　　[★]

英

exercise-induced asthma, exercise induced asthma, EIA

同

運動誘発喘息、運動誘発性気管支攣縮 運動誘発性気管支けいれん exercise-induced bronchospasm EIB、運動誘発性気管支収縮、運動誘発性気管支痙攣、運動誘発性気管支れん縮

関

気管支喘息、好中球遊走因子、物理アレルギー、気管支喘息

[show details]

運動誘発性喘息 : 約 13,300 件
運動誘発喘息 : 約 15,500 件

「EIA」

　　[★]

• 酵素免疫測定法, enzyme-linked immunoassay, enzyme immunoassay
• 運動誘発性喘息, exercise-induced asthma
• 環境影響評価, environmental impact assessment

「運動誘発喘息」

　　[★]

英

exercise-induced asthma

「induce」

　　[★]

• v.

• 誘発する、誘導する、誘起する、導入する、引き起こす

関

cause、challenge、derivation、elicit、elicitation、evocation、evoke、guidance、induction、inductive、introduce、introduction、precipitate、provocation、provoke、spark

　 　 　 　 　 　

「induced」

　　[★]

• v.

• (induceの過去分詞)誘導される、引き起こされる

hypercalcaemia induced pancreatitis 高カルシウム血症による膵炎

　

「asthma」

　　[★] 気管支喘息