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Exercise-induced bronchoconstriction in school-aged children who had chronic lung disease in infancy

Suchita Joshi¹, Thomas Powell, William J Watkins

¹Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom.

The Journal of Pediatrics

|November 1, 2012

Insights

Children with chronic lung disease (CLD) in infancy experience significant exercise-induced bronchoconstriction. This condition, characterized by airway narrowing after exercise, effectively responds to bronchodilator treatment with albuterol.

Area of Science:

Pediatric Pulmonology
Respiratory Medicine
Exercise Physiology

Background:

Infancy chronic lung disease (CLD) can impact long-term respiratory health in children.
Exercise-induced bronchoconstriction (EIB) is a common respiratory issue, particularly in individuals with pre-existing lung conditions.
Limited data exists on the prevalence and management of EIB in school-aged children with a history of CLD.

Purpose of the Study:

To assess exercise-induced bronchoconstriction (EIB) in children aged 8-12 with a history of chronic lung disease (CLD) from infancy.
To evaluate the effectiveness of albuterol bronchodilation in treating EIB in this cohort.
To compare EIB and its response to bronchodilation in children with CLD versus preterm and term controls.

Main Methods:

Ninety-two children (29 with CLD, 33 preterm, 30 term) underwent spirometry before and after exercise testing.
Cycle ergometry was used to induce potential bronchoconstriction.
Spirometry was repeated after bronchodilation with albuterol to assess reversibility.

Main Results:

Children with CLD reported higher rates of asthma and exercise-induced wheeze compared to controls.
Maximal exercise did not differ in ventilation or gas exchange across groups.
The CLD group exhibited the greatest post-exercise decrease in forced expiratory volume in 1 second (FEV1) (-11.0%) and the largest improvement after albuterol (16.0%), significantly more than control groups.

Conclusions:

School-aged children with a history of CLD in infancy demonstrate significant exercise-induced bronchoconstriction.
This exercise-induced bronchoconstriction is highly responsive to bronchodilator therapy.
Active assessment and treatment of reversible EIB are recommended for children with a history of CLD.

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Abstract

Objectives:

To assess for exercise-induced bronchoconstriction in 8- to 12-year-old children who had chronic lung disease (CLD) in infancy, and to evaluate the response of bronchoconstriction to bronchodilation with albuterol in comparison with preterm and term controls.

Study Design:

Ninety-two children, including 29 with CLD, 33 born preterm at ≤32 weeks' gestation, and 30 born at term, underwent lung spirometry before and after cycle ergometry testing and after postexercise bronchodilation with albuterol.

Results:

Doctor-diagnosed asthma and exercise-induced wheeze were reported more frequently in the CLD group than in the preterm and term groups, but only 10% were receiving a bronchodilator. There were no differences among the groups in peak minute ventilation, oxygen uptake, or carbon dioxide output at maximum exercise. After maximal exercise, predicted forced expiratory volume in 1 second (FEV1) decreased from a mean baseline value of 81.9% (95% CI, 76.6-87.0%) to 70.8% (95% CI, 65.5-76.1%) after exercise in the CLD group, from 92.0% (95% CI, 87.2-96.8%) to 84.3% (95% CI, 79.1-89.4%) in the preterm group, and from 97.5% (95% CI, 92.5-102.6%) to 90.3% (95% CI, 85.1-95.5%) in the term group. After albuterol administration, FEV1 increased to 86.8% (95% CI, 81.7-92.0%) in the CLD group, 92.1% (95% CI, 87.3-96.9%) in the preterm group, and 97.1% (95% CI, 92.0-102.3%) in the term group. The decrease in predicted FEV1 after exercise and increase in predicted FEV1 after bronchodilator use were greatest in the CLD group (-11.0% [95% CI, -18.4 to -3.6%] and 16.0% [95% CI, 8.6-23.4%], respectively; P < .005 for both), with differences of <8% in the 2 control groups.

Conclusion:

School-age children who had CLD in infancy had significant exercise-induced bronchoconstriction that responded significantly to bronchodilation. Reversible exercise-induced bronchoconstriction is common in children who experienced CLD in infancy and should be actively assessed for and treated.

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