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Exercise Limitation in Children and Adolescents with Mild-to-Moderate Asthma
Olga Lagiou1,2, Sotirios Fouzas1,2, Dimosthenis Lykouras3
1Pediatric Respiratory Unit, University of Patras Medical School, Patras, Greece.
Insights
Children with controlled asthma have reduced exercise capacity primarily due to physical deconditioning, not ventilatory issues or exercise-induced bronchoconstriction (EIB). This finding highlights the importance of fitness in managing asthma symptoms during physical activity.
Area of Science:
- Pediatric Pulmonology
- Exercise Physiology
- Asthma Research
Background:
- Children with uncontrolled asthma exhibit exercise intolerance linked to ventilatory limitations, exercise-induced bronchoconstriction (EIB), or deconditioning.
- The specific factors contributing to reduced exercise capacity in children with controlled mild-to-moderate asthma remain unclear.
Purpose of the Study:
- To investigate the underlying mechanisms responsible for diminished exercise capacity in pediatric patients with controlled mild-to-moderate asthma.
- To compare exercise capacity and related physiological parameters between asthmatic children and healthy controls.
Main Methods:
- A cross-sectional study involving 45 children/adolescents (8-18 years) with controlled asthma and 61 healthy controls.
- Participants underwent spirometry, cardiopulmonary exercise testing (CPET), and a physical activity questionnaire.
- Multivariable linear regression analyzed the impact of EIB, ventilatory limitation, and physical deconditioning on maximal oxygen uptake (O2peak).
Main Results:
- Children with asthma showed significantly higher rates of inactivity (62.2% vs. 29.5%) and reduced exercise capacity (53.3% vs. 16.4%) compared to controls.
- Physical deconditioning was more prevalent in asthmatic children (37.8% vs. 14.8%) and was the sole significant predictor of lower O2peak.
- Exercise-induced bronchoconstriction (EIB) was observed in 11.1% of asthmatic participants.
Conclusions:
- Children with controlled mild-to-moderate asthma demonstrate reduced exercise tolerance compared to healthy peers.
- Physical deconditioning is the primary driver of decreased exercise capacity in this population.
- Ventilatory limitation and EIB play a minor role in limiting exercise capacity in children with controlled asthma.
Background:
Children with uncontrolled asthma are less tolerant to exercise due to ventilatory limitation, exercise-induced bronchoconstriction (EIB), or physical deconditioning. The contribution of these factors in children with controlled mild-to-moderate asthma is unknown.
Objective:
To explore the underlying mechanisms of reduced exercise capacity in children with controlled mild-to-moderate asthma.
Methods:
This was a cross-sectional study of 45 children and adolescents (age 8-18 years) with controlled mild-to-moderate asthma (asthma control test score 21-25) and 61 age-matched healthy controls. All participants completed a physical activity questionnaire and performed spirometry and cardiopulmonary exercise testing (CPET; maximal incremental protocol). Spirometric indices and CPET parameters were compared between the two groups. The effect of EIB (FEV1 decrease >10% post CPET), ventilatory limitation and physical deconditioning on maximum oxygen uptake (O2peak), was assessed by multivariable linear regression.
Results:
62.2% of children with asthma and 29.5% of controls (P = 0.002) were categorized as inactive. Reduced exercise capacity (O2peak <80%) was noted in 53.3% of asthmatics and 16.4% of controls (P < 0.001). EIB was documented in 11.1% of participants with asthma. Physical deconditioning was noted in 37.8% of children with asthma and in 14.8% of controls (P = 0.013). Physical deconditioning emerged as the only significant determinant of O2peak, irrespective of asthma diagnosis, body mass index, ventilatory limitation and EIB.
Conclusion:
Children with controlled mild-to-moderate asthma are less tolerant to strenuous exercise than their healthy peers. The decreased exercise capacity in this population should mainly be attributed to physical deconditioning, while the contribution of ventilatory limitation and EIB is rather small.
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