Henriksen Anne Hildur, Tveit Kjerst Hafstad, Holmen Turid Lingaas, Sue-Chu Malcolm, Bjermer Leif
Department of Lung Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Pediatr Allergy Immunol. 2002 Jun;13(3):203-8. doi: 10.1034/j.1399-3038.2002.01034.x.
Among asthmatics, exercise-induced wheeze (EIW) is a frequent symptom, and 40-77% of asthmatics demonstrate exercise-induced bronchoconstriction (EIB). In the North-Trøndelag population-based survey of 8,571 adolescents (YOUNG-HUNT), 26% reported wheeze during the previous 12 months (current wheeze). Of those subjects, 50% reported EIW. The aim of the present study was to investigate the association between EIW and EIB in randomly selected adolescents with EIW as the only or predominant asthma-like symptom, and to relate our findings to results from methacholine bronchoprovocation tests (MT) and measurements of exhaled nitric oxide (ENO). Sixty-three subjects with current wheeze induced by exercise, but not by allergen exposure, were investigated using a treadmill exercise test (ET) and measurements of ENO. Fifty-eight subjects completed a MT on a separate study day. EIB was defined as a fall of >or= 10% in the forced expiratory volume in 1 second (FEV1) after exercise (DeltaFEV1%ex). Twenty-one subjects (33%) had EIB and 33 (57%) had a positive MT. The degree of reported dyspnea during the ET was not correlated to the DeltaFEV1%ex. The correlation between EIB and methacholine-induced bronchoconstriction (MIB) was poor, and the DeltaFEV1%ex was more pronounced in smokers than in non-smokers. Moreover, ENO was not increased in subjects with positive vs. negative ET. Hence, EIW, when reported as the only or predominant asthma-like symptom, was linked to EIB in only one-third of the patients. We conclude that EIW is a poor predictor of EIB in epidemiological studies. The poor correlation between EIB and MIB indicates that these two tests measure different mechanisms of bronchial hyper-responsiveness.
在哮喘患者中，运动诱发的喘息（EIW）是一种常见症状，40%-77%的哮喘患者存在运动诱发的支气管收缩（EIB）。在北特伦德拉格郡针对8571名青少年开展的基于人群的调查（YOUNG-HUNT）中，26%的青少年报告在过去12个月内有喘息（当前喘息）。在这些受试者中，50%报告有EIW。本研究的目的是调查在随机选择的以EIW作为唯一或主要哮喘样症状的青少年中，EIW与EIB之间的关联，并将我们的研究结果与乙酰甲胆碱支气管激发试验（MT）和呼出一氧化氮（ENO）测量结果相关联。对63名由运动而非过敏原暴露诱发当前喘息的受试者进行了跑步机运动试验（ET）和ENO测量。58名受试者在另一个研究日完成了MT。EIB定义为运动后1秒用力呼气量（FEV1）下降≥10%（ΔFEV1%ex）。21名受试者（33%）有EIB，33名（57%）MT结果为阳性。ET期间报告的呼吸困难程度与ΔFEV1%ex无相关性。EIB与乙酰甲胆碱诱发的支气管收缩（MIB）之间的相关性较差，吸烟者的ΔFEV1%ex比非吸烟者更明显。此外，ET结果阳性与阴性的受试者中ENO均未升高。因此，当EIW作为唯一或主要哮喘样症状报告时，仅三分之一的患者存在EIB。我们得出结论，在流行病学研究中，EIW对EIB的预测价值较差。EIB与MIB之间的相关性较差，表明这两种试验测量的是支气管高反应性的不同机制。
