Faleiro Rita C, Mancuzo Eliane V, Lanza Fernanda C, Queiroz Mônica V N P, de Oliveira Luciano F L, Ganem Vinicius O, Lasmar Laura B
Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Front Physiol. 2021 Jan 26;11:620736. doi: 10.3389/fphys.2020.620736. eCollection 2020.
Patients with severe refractory asthma (SRA), even when using high doses of multiple controller medications in a regular and appropriate way, can have persistent complaints of exercise limitation.
This was a cross-sectional study involving patients with SRA (treated with ≥ 800 μg of budesonide or equivalent, with ≥ 80% adherence, appropriate inhaler technique, and comorbidities treated), who presented no signs of a lack of asthma control other than exercise limitation. We also evaluated healthy controls, matched to the patients for sex, age, and body mass index. All participants underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer, maximum exertion being defined as ≥ 85% of the predicted heart rate, with a respiratory exchange ratio ≥ 1.0 for children and ≥ 1.1 for adolescents. Physical deconditioning was defined as oxygen uptake (VO) < 80% of predicted at peak exercise, without cardiac impairment or ventilatory limitation. Exercise-induced bronchoconstriction (EIB) was defined as a forced expiratory volume in one second ≥ 10% lower than the baseline value at 5, 10, 20, and 30 minutes after CPET.
We evaluated 20 patients with SRA and 19 controls. In the sample as a whole, the mean age was 12.9 ± 0.4 years. The CPET was considered maximal in all participants. In terms of the peak VO (VO ), there was no significant difference between the patients and controls, ( = 0.10). Among the patients, we observed isolated EIB in 30%, isolated physical deconditioning in 25%, physical deconditioning accompanied by EIB in 25%, and exercise-induced symptoms not supported by the CPET data in 15%.
Physical deconditioning, alone or accompanied by EIB, was the determining factor in reducing exercise tolerance in patients with SRA and was not therefore found to be associated with a lack of asthma control.
重度难治性哮喘（SRA）患者，即使规律且适当地使用高剂量的多种控制药物，仍可能持续存在运动受限的主诉。
这是一项横断面研究，纳入了SRA患者（接受≥800μg布地奈德或等效药物治疗，依从性≥80%，吸入技术正确，合并症得到治疗），这些患者除运动受限外无哮喘控制不佳的迹象。我们还评估了与患者在性别、年龄和体重指数方面相匹配的健康对照者。所有参与者均在功率自行车上进行心肺运动试验（CPET），最大运动强度定义为达到预测心率的≥85%，儿童的呼吸交换率≥1.0，青少年的呼吸交换率≥1.1。身体机能下降定义为运动峰值时摄氧量（VO）低于预测值的80%，且无心脏损害或通气受限。运动诱发的支气管收缩（EIB）定义为CPET后5、10、20和30分钟时一秒用力呼气容积比基线值降低≥10%。
我们评估了20例SRA患者和19例对照者。在整个样本中，平均年龄为12.9±0.4岁。所有参与者的CPET均被视为达到最大运动强度。就峰值VO（VO）而言，患者和对照者之间无显著差异（P = 0.10）。在患者中，我们观察到孤立性EIB占30%，孤立性身体机能下降占25%，身体机能下降伴EIB占25%，以及CPET数据不支持的运动诱发症状占15%。
身体机能下降，单独或伴有EIB，是降低SRA患者运动耐力的决定因素，因此未发现其与哮喘控制不佳相关。
