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Editorial
Exercise-induced bronchospasm or dyspnoea in obese children?
D. Peroni
Corresponding author
peroni.diego@tiscalinet.it

Corresponding author.
, G. Paiola, L. Tenero, G. de Luca
Paediatric Department, University of Verona, Verona, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">Exercise-induced bronchospasm &#40;EIB&#41; is usually defined as one of the more common causes of exercise-induced dyspnoea &#40;EID&#41;&#44; causing difficult breathing during physical activity by obstruction of the airways&#44; which is a hallmark of asthma&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> However&#44; dyspnoea is a complex psycho-physiological symptom characterized by sensation of an increase in the perceived work of breathing which may manifest during physical activity and resulting from many different causes&#46;<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#44;2</span></a> In clinical practice&#44; most of the diagnoses of asthma induced by physical activity are based on the evaluation of symptoms reported by children or parents&#46; This is often proved to be misleading because a link between the symptoms reported and the results of tests during physical activity&#44; such as standardised exercise test&#44; has not been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p class="elsevierStylePara elsevierViewall">Overweight and obesity may contribute to dyspnoea during the physical activity and moreover&#44; in recent years&#44; several studies have investigated the correlation between obesity and chronic respiratory diseases such as asthma and EIB&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> Castro-Rodriguez et al&#46; have identified five possible biological mechanisms which can explain the relationship between asthma and obesity&#58; mechanical effects of obesity on respiratory function&#44; altered immune response and inflammatory activation of specific gene regions&#44; hormonal influences related to gender&#44; and influence of diet and physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a> The excessive accumulation of adipose tissue at the chest wall may alter the pulmonary respiratory mechanisms favouring an increase in the response of bronchial smooth muscle&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> Both asthma and obesity can cause excessive reduction of small airways diameter and increase gas trapping&#46; Overweight patients have a decreased tidal air volume and functional residual capacity&#44; with consequently more difficulties to stand physical activity&#46; The risk of asthma developing in overweight children is higher in females than in males&#44; and higher in those girls who have an early menarche&#46;<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a> Indeed&#44; obese asthmatic patients require a greater number of medications for asthma&#59; emergency visits&#59; hospital admissions&#59; and accesses to emergency care&#44; more than asthmatic children who are not overweight&#46;<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara elsevierViewall">In the present issue of Allergologia et Immunopathologia&#44; Lopes et al&#46;<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> report the results of a study assessing the frequency and severity of EIB in obese adolescents&#46; Eighty adolescents of both genders&#44; aged 10&#8211;16 years old&#44; were divided into four groups&#58; asthmatic obese&#44; asthmatic non-obese&#44; obese non-asthmatic&#44; and healthy individuals&#44; analysing how obesity can influence EIB&#46; Every patient performed an exercise test and changes in the pulmonary function &#40;FEV<span class="elsevierStyleInf">1</span>&#41; have been evaluated&#46; The study showed that obese asthmatic children have no greater risk frequency of EIB than non-obese asthmatic children &#40;50&#37; vs&#46; 38&#37;&#44; respectively&#41;&#46; However&#44; maximum percent fall in FEV<span class="elsevierStyleInf">1</span> and area above the curve&#44; calculated to evaluate EIB severity and recovery&#44; were significantly greater in the asthmatic obese group compared to the asthmatic non-obese group&#46; The authors concluded that although obesity does not increase the prevalence of EIB&#44; being overweight can indeed contribute to increase EIB severity and to delay recovery among asthmatics&#46;<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> All these evidences lead to consider that obese asthmatics can present difficulties in the recovery of normal pulmonary function with a consequent limitation of their participation in physical and sporting activities&#46;</p><p class="elsevierStylePara elsevierViewall">Therefore&#44; dyspnoea during exercise in obese patients should not always be considered a manifestation of EIB&#44; but should be placed in the differential diagnosis with other causes for EID&#44; which include normal physiologic exercise limitation&#44; vocal cord dysfunction&#44; exercise-induced laryngomalacia and hyperventilation syndrome&#46;<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1&#8211;3</span></a> Physical deconditioning&#44; common in sedentary&#44; obese children&#44; is one common cause of EID&#44; particularly in school-age children who do not have asthma&#44; although some of these children are mistakenly diagnosed as having asthma&#46;</p><p class="elsevierStylePara elsevierViewall">The person with excess weight is most prone to the development of EID for physical characteristics which alter the lung mechanism and bronchial responsiveness&#46;</p><p class="elsevierStylePara elsevierViewall">Obesity also affects the perception of symptoms of asthma and asthma severity change through co-morbidities associated with asthma&#59; such as gastro-oesophageal reflux&#44; obstructive sleep apnoea and obesity hypoventilation syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a></p><p class="elsevierStylePara elsevierViewall">Epidemiological data from Glazebrook et al&#46; have shown that most of the children with severe asthma are obese and are much less active than children in the control group&#46;<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> Although obesity per se seems not to be a risk factor for bronchial obstruction&#44; obese patients have an increased risk for dyspnoea&#44; and often obese asthmatic children require a larger use of bronchodilators&#46;<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> Therefore&#44; obesity and asthma are often considered barriers to physical activity by children and their parents&#46; The cause of this reduction in physical activity may be related to organisational policies&#44; incorrect assessment of symptoms&#44; family beliefs and inappropriate behaviour&#46; Schools may be partly responsible since they often do not encourage children to participate in physical activity&#46; Teachers are not aware of the characteristics of asthma medications and what these children need before the physical effort in order to prevent the acute attacks&#46;<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a></p><p class="elsevierStylePara elsevierViewall">Furthermore&#44; the benefits which are available from the physical activity are not only physical&#46; It improves mental health by increasing self-esteem&#44; social skills and the value of physical assessment&#46;<a class="elsevierStyleCrossRef" href="#bib13"><span class="elsevierStyleSup">13</span></a> This could be particularly relevant for the overweight asthmatics who may be limited by both conditions in the management of physical activities&#46; It has been well demonstrated that excessive body weight is associated with additional loss of quality of life in children with asthma&#46;<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a></p><p class="elsevierStylePara elsevierViewall">On the contrary&#44; the weight loss associated with a reduced physical obstruction of the airways improves PEF in obese patients with asthma&#46; Moreover&#44; there has been an improvement in pulmonary mechanics and better control of bronchospasm&#46;<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a></p><p class="elsevierStylePara elsevierViewall">In conclusion&#44; physical activity should become an integral part of therapeutic and preventive strategies of asthma and obesity when expressed alone or simultaneously&#46; The real bronchospasm induced by the physical activity may be recognised by specific diagnostic tools and become a sign of poor therapeutic control&#44; not an occasion to diminish the exercise&#44; particularly in obese asthmatic children&#46;</p></span>"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos