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array:22 [ "pii" => "S0301054609000172" "issn" => "03010546" "doi" => "10.1016/j.aller.2009.04.001" "estado" => "S300" "fechaPublicacion" => "2009-07-01" "aid" => "16" "copyright" => "SEICAP" "copyrightAnyo" => "2009" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Allergol Immunopathol (Madr). 2009;37:173-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2571 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 1985 "PDF" => 575 ] ] "itemSiguiente" => array:18 [ "pii" => "S0301054609000184" "issn" => "03010546" "doi" => "10.1016/j.aller.2009.03.001" "estado" => "S300" "fechaPublicacion" => "2009-07-01" "aid" => "17" "copyright" => "SEICAP" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2009;37:175-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2242 "formatos" => array:3 [ "EPUB" => 6 "HTML" => 1878 "PDF" => 358 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Exercise-induced bronchospasm in obese adolescents" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "175" "paginaFinal" => "179" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "W.A. Lopes, R.B. Radominski, N.A. Rosário Filho, N. Leite" "autores" => array:4 [ 0 => array:2 [ "nombre" => "W.A." "apellidos" => "Lopes" ] 1 => array:2 [ "nombre" => "R.B." "apellidos" => "Radominski" ] 2 => array:2 [ "nombre" => "N.A." "apellidos" => "Rosário Filho" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Leite" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054609000184?idApp=UINPBA00004N" "url" => "/03010546/0000003700000004/v1_201304101017/S0301054609000184/v1_201304101017/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Exercise-induced bronchospasm or dyspnoea in obese children?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "173" "paginaFinal" => "174" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Peroni, G. Paiola, L. Tenero, G. de Luca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Peroni" "email" => array:1 [ 0 => "peroni.diego@tiscalinet.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Paiola" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Tenero" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "de Luca" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Paediatric Department, University of Verona, Verona, Italy" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">Exercise-induced bronchospasm (EIB) is usually defined as one of the more common causes of exercise-induced dyspnoea (EID), causing difficult breathing during physical activity by obstruction of the airways, which is a hallmark of asthma.<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> However, 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.<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1,2</span></a> In clinical practice, most of the diagnoses of asthma induced by physical activity are based on the evaluation of symptoms reported by children or parents. This is often proved to be misleading because a link between the symptoms reported and the results of tests during physical activity, such as standardised exercise test, has not been demonstrated.<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1–3</span></a></p><p class="elsevierStylePara elsevierViewall">Overweight and obesity may contribute to dyspnoea during the physical activity and moreover, in recent years, several studies have investigated the correlation between obesity and chronic respiratory diseases such as asthma and EIB.<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> Castro-Rodriguez et al. have identified five possible biological mechanisms which can explain the relationship between asthma and obesity: mechanical effects of obesity on respiratory function, altered immune response and inflammatory activation of specific gene regions, hormonal influences related to gender, and influence of diet and physical activity.<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.<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. Overweight patients have a decreased tidal air volume and functional residual capacity, with consequently more difficulties to stand physical activity. The risk of asthma developing in overweight children is higher in females than in males, and higher in those girls who have an early menarche.<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a> Indeed, obese asthmatic patients require a greater number of medications for asthma; emergency visits; hospital admissions; and accesses to emergency care, more than asthmatic children who are not overweight.<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a></p><p class="elsevierStylePara elsevierViewall">In the present issue of Allergologia et Immunopathologia, Lopes et al.<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. Eighty adolescents of both genders, aged 10–16 years old, were divided into four groups: asthmatic obese, asthmatic non-obese, obese non-asthmatic, and healthy individuals, analysing how obesity can influence EIB. Every patient performed an exercise test and changes in the pulmonary function (FEV<span class="elsevierStyleInf">1</span>) have been evaluated. The study showed that obese asthmatic children have no greater risk frequency of EIB than non-obese asthmatic children (50% vs. 38%, respectively). However, maximum percent fall in FEV<span class="elsevierStyleInf">1</span> and area above the curve, calculated to evaluate EIB severity and recovery, were significantly greater in the asthmatic obese group compared to the asthmatic non-obese group. The authors concluded that although obesity does not increase the prevalence of EIB, being overweight can indeed contribute to increase EIB severity and to delay recovery among asthmatics.<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.</p><p class="elsevierStylePara elsevierViewall">Therefore, dyspnoea during exercise in obese patients should not always be considered a manifestation of EIB, but should be placed in the differential diagnosis with other causes for EID, which include normal physiologic exercise limitation, vocal cord dysfunction, exercise-induced laryngomalacia and hyperventilation syndrome.<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1–3</span></a> Physical deconditioning, common in sedentary, obese children, is one common cause of EID, particularly in school-age children who do not have asthma, although some of these children are mistakenly diagnosed as having asthma.</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.</p><p class="elsevierStylePara elsevierViewall">Obesity also affects the perception of symptoms of asthma and asthma severity change through co-morbidities associated with asthma; such as gastro-oesophageal reflux, obstructive sleep apnoea and obesity hypoventilation syndrome.<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a></p><p class="elsevierStylePara elsevierViewall">Epidemiological data from Glazebrook et al. have shown that most of the children with severe asthma are obese and are much less active than children in the control group.<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, obese patients have an increased risk for dyspnoea, and often obese asthmatic children require a larger use of bronchodilators.<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> Therefore, obesity and asthma are often considered barriers to physical activity by children and their parents. The cause of this reduction in physical activity may be related to organisational policies, incorrect assessment of symptoms, family beliefs and inappropriate behaviour. Schools may be partly responsible since they often do not encourage children to participate in physical activity. 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.<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a></p><p class="elsevierStylePara elsevierViewall">Furthermore, the benefits which are available from the physical activity are not only physical. It improves mental health by increasing self-esteem, social skills and the value of physical assessment.<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. It has been well demonstrated that excessive body weight is associated with additional loss of quality of life in children with asthma.<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a></p><p class="elsevierStylePara elsevierViewall">On the contrary, the weight loss associated with a reduced physical obstruction of the airways improves PEF in obese patients with asthma. Moreover, there has been an improvement in pulmonary mechanics and better control of bronchospasm.<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a></p><p class="elsevierStylePara elsevierViewall">In conclusion, physical activity should become an integral part of therapeutic and preventive strategies of asthma and obesity when expressed alone or simultaneously. The real bronchospasm induced by the physical activity may be recognised by specific diagnostic tools and become a sign of poor therapeutic control, not an occasion to diminish the exercise, particularly in obese asthmatic children.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise-induced dyspnea in children and adolescents: if not asthma then what?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Abu-Hasan" 1 => "B. Tannous" 2 => "M. 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2021 December | 13 | 11 | 24 |
2021 November | 9 | 8 | 17 |
2021 October | 15 | 8 | 23 |
2021 September | 6 | 7 | 13 |
2021 August | 11 | 5 | 16 |
2021 July | 9 | 9 | 18 |
2021 June | 6 | 8 | 14 |
2021 May | 8 | 8 | 16 |
2021 April | 12 | 23 | 35 |
2021 March | 8 | 12 | 20 |
2021 February | 11 | 7 | 18 |
2021 January | 4 | 9 | 13 |
2020 September | 6 | 2 | 8 |
2019 August | 1 | 0 | 1 |
2018 February | 4 | 2 | 6 |
2018 January | 3 | 0 | 3 |
2017 December | 9 | 2 | 11 |
2017 November | 7 | 3 | 10 |
2017 October | 9 | 2 | 11 |
2017 September | 3 | 7 | 10 |
2017 August | 6 | 5 | 11 |
2017 July | 6 | 26 | 32 |
2017 June | 8 | 7 | 15 |
2017 May | 9 | 13 | 22 |
2017 April | 17 | 17 | 34 |
2017 March | 7 | 21 | 28 |
2017 February | 9 | 6 | 15 |
2017 January | 8 | 3 | 11 |
2016 December | 19 | 7 | 26 |
2016 November | 11 | 15 | 26 |
2016 October | 38 | 15 | 53 |
2016 September | 20 | 7 | 27 |
2016 August | 13 | 9 | 22 |
2016 July | 15 | 4 | 19 |
2016 June | 15 | 4 | 19 |
2016 May | 10 | 14 | 24 |
2016 April | 21 | 18 | 39 |
2016 March | 21 | 19 | 40 |
2016 February | 13 | 23 | 36 |
2016 January | 15 | 19 | 34 |
2015 December | 14 | 17 | 31 |
2015 November | 9 | 17 | 26 |
2015 October | 21 | 19 | 40 |
2015 September | 12 | 43 | 55 |
2015 August | 11 | 7 | 18 |
2015 July | 10 | 3 | 13 |
2015 June | 3 | 4 | 7 |
2015 May | 8 | 3 | 11 |
2015 April | 11 | 9 | 20 |
2015 March | 5 | 11 | 16 |
2015 February | 10 | 33 | 43 |
2015 January | 20 | 1 | 21 |
2014 December | 26 | 3 | 29 |
2014 November | 16 | 3 | 19 |
2014 October | 12 | 3 | 15 |
2014 September | 22 | 1 | 23 |
2014 August | 22 | 2 | 24 |
2014 July | 10 | 3 | 13 |
2014 June | 7 | 0 | 7 |
2014 May | 10 | 0 | 10 |
2014 April | 2 | 3 | 5 |
2014 March | 43 | 9 | 52 |
2014 February | 30 | 6 | 36 |
2014 January | 22 | 8 | 30 |
2013 December | 40 | 10 | 50 |
2013 November | 23 | 8 | 31 |
2013 October | 39 | 8 | 47 |
2013 September | 32 | 13 | 45 |
2013 August | 44 | 12 | 56 |
2013 July | 36 | 6 | 42 |
2013 June | 21 | 3 | 24 |
2013 May | 24 | 10 | 34 |
2013 April | 18 | 7 | 25 |
2013 March | 11 | 8 | 19 |
2013 February | 8 | 6 | 14 |
2013 January | 10 | 2 | 12 |
2012 December | 4 | 3 | 7 |
2012 November | 3 | 2 | 5 |
2012 October | 3 | 1 | 4 |
2009 June | 996 | 0 | 996 |