Ninan T K, Russell G
Department of Child Health, University of Aberdeen, Foresterhill.
Thorax. 1993 Dec;48(12):1218-21. doi: 10.1136/thx.48.12.1218.
In hospital clinics exercise challenge is used as a simple, non-invasive, non-pharmacological test for asthma in childhood. Little is known of its value in a community setting. An exercise test was therefore evaluated as an adjunct to a respiratory questionnaire in the course of an asthma survey.
From a cohort of 4003 primary school children, 607 of 799 with respiratory symptoms answered a detailed respiratory questionnaire. From the same cohort 135 of 229 randomly selected asymptomatic children were also interviewed. A stratified selection of one in four of the children interviewed was then invited to take part in a six minute cold air enhanced exercise challenge test; 128 symptomatic and 26 asymptomatic children attended.
Bronchial hyperreactivity, a fall of FEV1 > or = 10% at five, 10, or 15 minutes following the exercise challenge, was identified in 15 of 128 symptomatic children and in one of 26 asymptomatic children. Bronchial hyperreactivity was found in only one of three children with frequent shortness of breath and one of five with frequent wheeze. It was found in 13 of 58 children whose parents were aware of the diagnosis of asthma; in 10 of 26 children who were on regular prophylactic treatment; in only 11 of 70 children with a history of exercise induced symptoms; and seldom in children with mild symptoms. Gestational age and ventilator support in the neonatal period were significant predictors of bronchial hyperreactivity.
Exercise testing enhanced by cold air adds very little to a well designed respiratory questionnaire in community studies of asthma in childhood.
在医院诊所中，运动激发试验被用作一种针对儿童哮喘的简单、无创、非药物性检测方法。其在社区环境中的价值鲜为人知。因此，在一项哮喘调查过程中，对运动试验作为呼吸问卷的辅助手段进行了评估。
在4003名小学生队列中，799名有呼吸道症状的儿童中有607名回答了详细的呼吸问卷。在同一队列中，还对随机选择的229名无症状儿童中的135名进行了访谈。然后，从接受访谈的儿童中按四分之一的比例分层选取部分儿童参加六分钟冷空气增强运动激发试验；128名有症状儿童和26名无症状儿童参加了试验。
运动激发试验后5分钟、10分钟或15分钟时，FEV1下降≥10%，即支气管高反应性，在128名有症状儿童中有15名被检测出，在26名无症状儿童中有1名被检测出。在三名经常气短的儿童中只有一名检测出支气管高反应性，在五名经常喘息的儿童中只有一名检测出。在父母知晓哮喘诊断的58名儿童中有13名检测出；在接受常规预防性治疗的26名儿童中有10名检测出；在有运动诱发症状史的70名儿童中只有11名检测出；在症状轻微的儿童中很少检测出。胎龄和新生儿期的呼吸机支持是支气管高反应性的重要预测因素。
在儿童哮喘的社区研究中，冷空气增强运动试验对精心设计的呼吸问卷几乎没有补充作用。
