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 DENOMINATION
- Asthma for exercise,
- Broncoespasmo induced by exercise.
DEFINITION
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The asthma for exercise is a sensation of respiratory difficulty, with the presence of cough, sibilancias, and thoracic oppression after realizing a physical effort.
Normally the bronchial tree answers to the exercise with the increase of the radio of the interior of the bronchi (broncodilatación), but in the persons affected by the asthma by exercise the opposite takes place, they become closer and a broncoconstricción takes place.
CAUSES
The asthma induced by exercise (AIE) owes to the cooling and relative dryness of the airline (loss of H2O) for an increase of the ventilation during the exercise.
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The cooling and the dryness provoke changes in the osmolaridad of the mucous membrane, what it takes that, on the one hand, a mastocitos degranulación exists with mediators' liberation; and on the other hand, to which a stimulation happens vagal direct. The result is the broncoconstricción appearance.
- Cold of the inspired air,
- Low moisture of the inspired air,
- Loss of heat of the airline.
SYMPTOMS
The characteristics that define the AIE are the following ones:
- It can appear at any age, and it is so frequent in the adults as in the children. The configurations pícnicas (wide of corporal constitution) are more predisposed.
- It can turn out to be isolated or collaborate to any clinical form of bronchial asthma. In most of the asthmatic ones, the exercise provokes broncoconstricción.
- The severity of the AIE is not predictable from basal function. The patients with normal pulmonary function in rest can present important AIE.
- Phases typical of the AIE:
- (Asymptomatic) initial Broncodilatación. As in not asthmatic persons, in the patients with asthma the exercise produces an initial broncodilatación to itself, without symptoms.
- Clinical Broncospasmo. Spent 5-10 minutes since the effort was begun, when the cardiac frequency reaches approximately 160 beats per minute, the bronconstricción appears.
- Recovery phase. Between 30 and 60 minutes, after having begun the exercise, a return begins to the normality in the bronchial caliber and it eliminates the sensation disneica.
- Refractory period. In more than half of the cases of AIE, a period exists, from 2 until 4 hours of duration, during which the broncospasmo does not appear again, however much exercise keeps on being done. The refractory period owes to depleción of broncoconstricción mediators and/or to generation of prostaglandin broncodilatadoras (PGE2) during the exercise. The refractory period can be induced by means of warming up, and be used so that the asthmatic one does not diminish his sports yield.
- The AIE can get ready with the inhalation or capture previous to some medicines. The ß2-mimetic ones of short action are used for this end and it gives the cromoglicato, and the leucotrienos inhibiting ones.
DIAGNOSIS OF THE ASTHMA INDUCED BY EXERCISE
A history of cough, shortness of breath, sibilancias, thoracic oppression or problems of yield during the exercise AIE suggests.
The assertion diagnosis usually needs a test of exercise, which can be carried out:
- In laboratory conditions, by means of rolling tape or bicycle ergométrica and with cardiac and respiratory monitoring. The child must cover it of sufficiently intense form as to increase the basal cardiac frequency in 80 % as maximum, during 4 to 6 minutes.
- In career outdoors, trying to reproduce the situation that provokes the symptoms. There is evaluated the distance covered in 10-12 minutes and the excellent incidents along this test.
In any of two cases, they are realized espirometrías earlier and after the exercise at intervals of 5 minutes and during 20 to 30 minutes. A descent of 15 % in the VEMS is the criterion of diagnosis of asthma induced by exercise (AIE).
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