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Clinical Reviews in Allergy & Immunology

, Volume 34, Issue 2, pp 205–216 | Cite as

Exercise-induced Bronchospasm In Children

  • Chris Randolph
Article

Abstract

This review will encompass definition, history, epidemiology, pathogenesis, diagnosis, and management of exercise –induced bronchospasm in the pediatric individual with and without known asthma. Exercise induced asthma is the conventional term for transient airway narrowing in a known asthma in association with strenuous exercise usually lasting 5-10 minutes with a decline in pulmonary function by at least 10%. Exercise induced asthma will be referred to as exercise induced bronchospasm in an asthmatic. Exercise–induced bronchospasm (EIB ) is the same phenomenon in an individual without known asthma. EIB can be seen in healthy individuals including children as well as defense recruits and competitive or elite athletes. The diagnosis with objective exercise challenge methods in conjunction with history is delineated. Management is characterized with pharmacotherapy and non pharmacotherapeutic measures for underlying asthma as well as exercise induced bronchospasm and inhalant allergy. Children can successfully participate in all sports if asthma is properly managed.

Keywords

Exercise Asthma Bronchospasm Pulmonary function Pharmacotherapy 

References

  1. 1.
    Jones RS, Buston WH, Wharton MJ (1962) The effect of exercise on ventilatory function in the child with asthma. Br J Dis Chest 56:78–86PubMedGoogle Scholar
  2. 2.
    McFadden ER Jr. (1999) Exercise-induced asthma. Marcel Dekker, Inc., NYGoogle Scholar
  3. 3.
    Karlajalainen EM, Laitinen A, Sue Chu M et al (2000) Evidence of airway inflammation and remodeling in ski athletes with and without bronchial hyperresponsiveness to methacholine. Am J Respir Crit Care Med 161:2086–2091Google Scholar
  4. 4.
    Verges S, Flore P, Blanchi MP et al (2004) A 10 year follow-up study of pulmonary function in symptomatic elite cross-country skiers-athletes and bronchial dysfunction. Scand J Med Sci Sports 14:381–387PubMedGoogle Scholar
  5. 5.
    Helenius I, Lumme A, Haahtela T (2005) Asthma, airway inflammation and treatment in elite athletes. Sports Med 35:565–574PubMedGoogle Scholar
  6. 6.
    Anderson SD (2006) How does exercise cause asthma attacks? Curr Opin Allergy Clin Immunol 6:37–42PubMedCrossRefGoogle Scholar
  7. 7.
    Anderson S (2005) Exercise-induced bronchoconstriction: pathogenesis. Curr Allergy Asthma Rep 5:116–122PubMedGoogle Scholar
  8. 8.
    Parsons JP, Mastronarde JG (2005) Exercised-induced bronchoconstriction in athletes. Chest 128:3966–3974PubMedGoogle Scholar
  9. 9.
    Porsberg C, von Linstrow ML et al (2005) Outcome in adulthood of asymptomatic airway hyperresponsiveness to histamine and exercise-induced bronchospasm in childhood. Ann Allergy Asthma Immunol 95:137–142Google Scholar
  10. 10.
    Anderson S (2002) Exercise-induced asthma in children: a marker of airway inflammation. Med J Aust 177:S61–S63PubMedGoogle Scholar
  11. 11.
    Haby MM, Anderson SD, Peat JK (1994) An exercise challenge protocol for epidemiological studies of asthma in children: comparison with histamine challenge. Eur Respir J 7:43–49PubMedGoogle Scholar
  12. 12.
    Rundell KW, Jenkinson DM (2002) Exercise-induced bronchospasm in the elite athlete. Sports Med 32:583–600PubMedGoogle Scholar
  13. 13.
    Gotshall RW (2002) Exercise-induced bronchoconstriction. Drugs 62:1725–139PubMedGoogle Scholar
  14. 14.
    Holzer K, Brukner P (2004) Screening of athletes for exercise-induced bronchoconstriction. Clin J Sports Med 14:134–138Google Scholar
  15. 15.
    Hallestrand TS, Moody MW, Aitken ML et al (2005) Airway immunopathology of asthma with exercise-induced bronchoconstriction. J Allergy Clin Immunol 116:586–593Google Scholar
  16. 16.
    Becker JM, Rogers J, Rossini G et al (2004) Asthma deaths during sports: report of a 7 year experience. J Allergy Clin Immunol 113(113):264–267PubMedGoogle Scholar
  17. 17.
    Adams F (1856) The extant works of Aretaeus the Cappadocian. Sydenham Society, London, p 316Google Scholar
  18. 18.
    Floyer JA (1698) A treatise of the asthma. R Wilkins, LondonGoogle Scholar
  19. 19.
    Olympic MD (1972) Win some lose some. Med World News 13:27–35Google Scholar
  20. 20.
    Weiler JM, Metzger WJ, Donnelly AL et al (1986) Prevalence of bronchial hyperresponsiveness in highly trained athletes. Chest 90:23–28PubMedGoogle Scholar
  21. 21.
    Wilber RL, Rundell KW, Szmedra L et al (2000) Incidence of exercise-induced bronchspasm in Olympic winter sport athletes. Med Sci Sports Exerc 32:732–737PubMedGoogle Scholar
  22. 22.
    Voy RO (1986) The US Olympic Committee experience with exercise-induced bronchospasm. Med Sci Sports Exerc 18:328–330PubMedGoogle Scholar
  23. 23.
    Weiler JM, Layton T, Hunt M (1998) Asthma in the United States Olympic athletes who participated in the 1996 Summer Games. J Allergy Clin Immunol 102:722–726PubMedGoogle Scholar
  24. 24.
    Weiler JM, Ryan EJ 3rd (2000) Asthma in the United States Olympic athletes who participated in the 1998 Olympic Winter Games. J Allergy Clin Immunol 106:267–271PubMedGoogle Scholar
  25. 25.
    Hammerman SI, Becker JM, Rogers J et al (2002) Asthma screening of high school athletes: identifying the undiagnosed and poorly controlled. Ann Allergy Asthma & Immun 88:380–384Google Scholar
  26. 26.
    Rupp NT (1996) Diagnosis and management of exercise-induced asthma. Phys Sportsmed 24:77–87PubMedCrossRefGoogle Scholar
  27. 27.
    Kawabori I, Pierson WE, Conquest LL et al (1976) Incidence of exercise-induced asthma in children. J Allergy Clin Immunol 58:447–455PubMedGoogle Scholar
  28. 28.
    Seear M, Wensley D, West N (2005) How accurate is the diagnosis of exercise-induced asthma among Vancouver schoolchildren? Arch Dis Child 90:898–902PubMedGoogle Scholar
  29. 29.
    Rupp NT, Guill MF, Brudho DS (1992) Unrecognized exercise-induced bronchospasm in adolescent athletes. Am J Dis Child 146:941–944PubMedGoogle Scholar
  30. 30.
    Vichyanond P, Anuraklekha P, Ruengruk S (2002) Exercise-induced asthma among Thai asthmatic children. J Med Assos Thail 85:S579–S585Google Scholar
  31. 31.
    Labbe A (2000) Asthma in children. Allergy Immunol 32:389–392Google Scholar
  32. 32.
    Mashalane M et al (2006) Prevalence of exercise-induced bronchospasm in Thokoza schoolchildren. S Afr Med J 96:67–70PubMedGoogle Scholar
  33. 33.
    Randolph C, Dreyfus D, Fraser F (2005) Utilization of medication and allergy specialty attention by recreational roadrunners. J Allergy Clin Immunol 115:S153, Abstract #609Google Scholar
  34. 34.
    Rundell RW, Im J, Mayers LB et al (2001) Self-reported symptoms and exercise-induced asthma in the elite athlete. Med Sci Sports Exerc 33:208–213PubMedGoogle Scholar
  35. 35.
    Thole RT, Sallis RE, Rubin AI et al (2001) Exercise-induced bronchospasm prevalence in collegiate cross-country runners. Med Sci Sports Exerc 33:1641–1646PubMedGoogle Scholar
  36. 36.
    Storms WW (2005) Asthma associated with exercise. Immunol Allergy Clin North Am 25:31–43PubMedGoogle Scholar
  37. 37.
    Anderson SD, Sue -Chu M, Perry CP et al (2006) Bronchial challenges in athletes applying to inhale a beta-2 agonist at the 2004 Summer Olympics. J Allergy Clin Immunol 117(4):767–773Google Scholar
  38. 38.
    Nystad W, Harria J, Borgen JS (2000) Asthma and wheezing among Norwegian elite athletes. Med Sci Sports Exerc 32:266–270PubMedGoogle Scholar
  39. 39.
    Bonsignore MR, Morici G, Vignola AM et al (2003) Increased airway inflammatory cells in endurance athletes: what do they mean? Clin Exp Allergy 33:14–21PubMedGoogle Scholar
  40. 40.
    Helenius IJ, Lumme A, Qunap J et al (2004) No effect of montelukast on asthma-like symptoms in elite ice hockey players. Allergy 59:39–44 (p 2)Google Scholar
  41. 41.
    Sue Chu M, Karjalainen EM, Laitinen A et al (2000) Placebo-controlled study of inhaled budesonide on indices of airway inflammation in bronchoalaveolar lavage fluid and bronchial biopsies in cross-country skiers. Respiration 67:417–425PubMedGoogle Scholar
  42. 42.
    Hilberg T et al (2005) Transcription in response to physical–stress-clues to the molecular mechanisms of exercise-induced asthma. FASEB J 19:1492–1494PubMedGoogle Scholar
  43. 43.
    Ki HB et al (2006) The leukotriene C4synthase (A-444C)promoter polymorphism is associated with the severity of exercise-induced asthma in Korean children. J Allergy Clin Imm 117:1191–1192Google Scholar
  44. 44.
    Rupp NT, Brudno DS, Guill MF (1993) The value of screening for risk of exercise –induced asthma in high school athletes. Ann Allergy 70:339–342PubMedGoogle Scholar
  45. 45.
    Weiler JM (1996) Exercise-induced asthma: a practical guide to definitions, diagnosis, prevalence and treatment. Allergy Asthma Proc 17:315–325PubMedGoogle Scholar
  46. 46.
    Weins L, Sabath R, Ewing L, Gowdamarajan R, Portnoy J, Scagliotti D (1992) Chest pain in otherwise healthy children and adolescents is frequently caused by exercise-induced asthma. Pediatrics 90:350–353Google Scholar
  47. 47.
    Abu-Hassan M, Weinberger M (2005) Exercise-induced dyspnea in children and adolescents: if not asthma then what? Ann Allergy Asthma & Immunol 99:366–371Google Scholar
  48. 48.
    Godfrey S et al (1977) In: Dempsey J (ed.) Muscular exercise and the lung. The University of Wisconsin Press, Madison, WI, pp 247–288Google Scholar
  49. 49.
    Brudhno DS, Wagner JM, Rupp NT (1994) Length of postexercise assessment in the determination of exercise-induced bronchospasm. Ann Allergy 73:227–231Google Scholar
  50. 50.
    Bronsky EA, Yegen U, Yeh CM et al (2002) Formoterol provides long-lasting protection against exercise-induced bronchospasm. Ann Allergy Asthma & Immunol 89:407–412Google Scholar
  51. 51.
    Eliasson AH, Phillips YY, Rajagopal KR et al (1992) Sensitivity and specificity of bronchial provocation testing. An evaluation of four techniques in exercise-induced bronchospasm. Chest 102:347–355 (p17)PubMedGoogle Scholar
  52. 52.
    Rabe KF, Adachi M, Lai CK et al (2004) Worldwide severity and control of asthma in children and adults: The global asthma insights and reality surveys. J Allergy Clin Immunol 114:40–47PubMedGoogle Scholar
  53. 53.
    Arygos GJ, Roach JM, Hurowitz KM et al (1996) Eucapneic voluntary hyperventilation as a bronchoprovocation technique: development of a standardized dosing schedule in asthmatics.Chest 109:1520–1524Google Scholar
  54. 54.
    Mannix ET, Roberts MA, Dukes HJ et al (2004) Airway hyperresponsiveness in high school athletes. J Asthma 41:567–574PubMedGoogle Scholar
  55. 55.
    Holzer K, Anderson SD, Chan HK, Douglass J (2003) Mannitol as a challenge test to identify exercise-induced bronchoconstriction in the athletes. Am J Respir Crit Care Med 167:534–537PubMedGoogle Scholar
  56. 56.
    Randolph C (2005) Making the diagnosis of asthma in the athlete. Clin Rev Allergy 29:112–123Google Scholar
  57. 57.
    Rundell KW, Anderson SD, Spierling BA et al (2004) Field exercise vs laboratory eucapnic voluntary hyperventilation to identify airway hyperresponsiveness in elite cold weather athletes. Chest 125:909–915PubMedGoogle Scholar
  58. 58.
    Crapo RO, Casaburi R, Coates AL et al (2000) Guidelines for methacholine and exercise challenge testing-1999. Am J Respir Crit Care Med 161:309–329PubMedGoogle Scholar
  59. 59.
    Buckvald F, Hermansen MN, Nelson KG, Bisgaard H. (2005) Exhaled nitric oxide predicts exercise-induced bronchoconstriction in asthmatic children. Chest 128(4):1964–1969Google Scholar
  60. 60.
    Song DJ et al (2006) Applicability of interrupter resistance measurements for evaluation of exercise-induced bronchoconstriction in children. Pediatr Pulmonol 41:228–233PubMedGoogle Scholar
  61. 61.
    Rundell KW, Wilber RL, Szmedra L et al (2000) Exercise induced asthma screening of elite athletes: field versus laboratory exercise challenge. Med Sci Sports Exerc 32:309–316PubMedGoogle Scholar
  62. 62.
    Bonini S, Brusasco V, Carlsen KH et al (2004) Diagnosis of asthma and permitted use of beta2-agonists in athletes. Allergy 59:33–36PubMedGoogle Scholar
  63. 63.
    Joos GF, O’Connor B, Anderson SD et al (2003) Indirect airway challenges. Eur Respir J 21:1050–1068PubMedGoogle Scholar
  64. 64.
    Beaudouin E, Renaudin JM, Morisset M, Codreanu F, Kanny G, Moneret-Vautrin DA (2006) Food dependent exercise-induced anaphylaxis: update and current data. Allergie et Immunologie 38(2):45–51Google Scholar
  65. 65.
    Powell DM, Karanfilov BI, Beechler KB, Treole K, Trudeau MD, Forrest LA (2000) Paradoxical vocal cord dysfunction in juveniles. Arch Otolaryngol Head Neck Surg 126:29–34PubMedGoogle Scholar
  66. 66.
    Bjornsdottir US, Gudmundsson K, Hjartarson H, Brondbo K, Magnusson B, Juliusson S (2000) Exercise induced laryngochalasia: an imitator of exercise induced bronchospasm. Ann Allergy Asthma & Immunol 85:387–391Google Scholar
  67. 67.
    Chemery L, Le Clech G, Delaval P, Carre F, Gogibu J, Dassonville J (2002) Execise-induced laryngomalacia. Rev Mal Respir 19(5pt1):641–643PubMedGoogle Scholar
  68. 68.
    Rundell KW, Spiering BA (2003) Inspiratory stridor in the elite athlete. Chest 123:468–474PubMedGoogle Scholar
  69. 69.
    Landwehr LP, Wood RP 2nd, Blager FB, Milgrom H (1996) Vocal cord dysfunction mimicking exercise –induced bronchospasm in adolescents. Pediatrics 98:971–974PubMedGoogle Scholar
  70. 70.
    Bittleman DB, Smith RJ, Weiler JM (1994) Abnormal movement of the arytenoid region during exercise presenting as exercise-induced asthma in an adolescent athlete. Chest 106:615–616PubMedGoogle Scholar
  71. 71.
    Fahey JT, Bryant NJ, Karas D, Goldberg B, Destefano R, Gracco LC (2005) Exercise-induced stridor due to abnormal movement of the arytenoid area: videoendoscopic diagnosis and characterization of the at risk group. Pediatr Pulmonol 39(1):51–5PubMedGoogle Scholar
  72. 72.
    Mandell DL, Arjmand EM (2003) Laryngomalacia induced by exercise in a pediatric patient. Int J Pediatr Otorhinolaryngol 67:999–1003PubMedGoogle Scholar
  73. 73.
    Morris MJ, Deal LE, Bean DR, Grbach VX, Morgan JA (1999) Vocal cord dysfunction in patients with exertional dyspnea. Chest 116:1676–1682PubMedGoogle Scholar
  74. 74.
    Patel NJ, Jorgensen C, Kuhn J, Merati AL (2004) Concurrent laryngeal abnormalities in patients with paradoxical vocal cord dysfunction. Otolaryngol Head Neck Surg 130:686–689 (P21)PubMedGoogle Scholar
  75. 75.
    Ford CN (2005) Evaluation and management of laryngopha-ryngeal reflux. JAMA 294:1534–1540PubMedGoogle Scholar
  76. 76.
    Hammo AH, Weinberger MM (1999) Exercise-induced hyperventilation: a pseudoasthma syndrome. Ann Allergy Asthma & Immunol 82:574–578Google Scholar
  77. 77.
    Jack S, Rossiter HB, Pearson MG, Ward SA, Warburton CJ, Whipp BJ (2004) Ventilatory responses to inhaled carbon dioxide, hypoxia, and exercise in idiopathic hyperventilation. Am J Respir Crit Care Med 170:118–125PubMedGoogle Scholar
  78. 78.
    Palosuo K, Varjonen E, Nurkkala J et al (2003) Transglutaminase-mediated cross-linking of a peptic fraction of omega-5 gliadin enhances IgE reactivity. J Allergy Clin Immunol 111:1386–1392PubMedGoogle Scholar
  79. 79.
    Storms WW (2003) Review of exercise-induced asthma. Med Sci Sports Exerc 35:1464–1470PubMedGoogle Scholar
  80. 80.
    Pearlman D et al (2006) Effects of formoterol fumarate treatment on exercise-induced bronchoconstriction in children. Ann Allergy Asthma & Immunol 97:382–388Google Scholar
  81. 81.
    Jonasson G, Carlsen KH, Hultquist C (2000) Low dose budesonide improves exercise-induced bronchospasm in schoolchildren. Pediatr Allergy Immunol 11:120–125PubMedGoogle Scholar
  82. 82.
    Global Initiative for Asthma (2003) Global Stragedy for Asthma Management and Prevention. NIH publication 02-3659, Bethesda Maryland: National Heart, Lung, and Blood InstituteGoogle Scholar
  83. 83.
    Miller MG, Weiler JM, Baker R, Collins J, D’Alonzo G (2005) National Athletic Trainer’s Association position statement: management of asthma in athletes. J Athl Train 40:224–245PubMedGoogle Scholar
  84. 84.
    Hallestrand TS, Curtis JR, Koepsell TD et al (2002) Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction. J Pediatr 141:343–348Google Scholar
  85. 85.
    Anderson S (2004) Single dose agents in the prevention of exercise-induced asthma: a descriptive review. Treat Respir Med 3:365–379PubMedGoogle Scholar
  86. 86.
    Expert Panel Report (2003) National Asthma Education and Prevention Program. National Institutes of Health, NHLBI, NIH Publication #02-5074Google Scholar
  87. 87.
    Bierman CW, Spiro SG, Petheram I (1984) Characterization of the late response in exercise-induced asthma. J Allergy Clin Imunol 74:701–706Google Scholar
  88. 88.
    Vilsik J, Ankerst J, Palmqvist M et al (2001) Protection against cold air and exercise-induced bronchoconstriction while on regular treatment with Oxis. Respir Med 95:484–490Google Scholar
  89. 89.
    Ferrari M, Balestrieri F, Baratieri S, Biasin C, Oldani V, Lo Cascio V (2000) Evidence of the rapid protective effect of formeterol dry powder inhalation against exercise-induced bronchospasm in athletes with asthma. Respiration 67:510–513PubMedGoogle Scholar
  90. 90.
    Ferrari M, Segattini C, Zanon R et al (2002) Comparison of the protective effect of formoterol and of salmeterol against exercise-induced bronchospasm when given immediately before a cycloergometric test. Respiration 69:509–512PubMedGoogle Scholar
  91. 91.
    Hancox RJ, Subbarao P, Kamada D, Watson RM, Hargreave FE, Inman MD (2002) Beta-2 agonist tolerance and exercise-induced bronchospasm. Am J Respir Crit Care Med 165:1068–1070PubMedGoogle Scholar
  92. 92.
    Yates DH, Worsdell M, Barnes PJ (2002) Regular salmetrol treatment on albuterol bronchoprotection in mild asthma. Am J RespCrit Care Med 165(8):1068–1070Google Scholar
  93. 93.
    Ramage L, Lipworth BJ, Ingram CG, Cree IA, Dhillon DP (1994) Reduced protection against exercise induced bronchoconstriction after chronic dosing with salmeterol.. Respir Med 88:36–38Google Scholar
  94. 94.
    Israel E, Chinchilli VM, Ford JG et al (2004) Use of regularly scheduled albuterol treatment in asthma: genotype stratified,randomized, placebo-controlled trial. Lancet 364:1505–1512PubMedGoogle Scholar
  95. 95.
    Thio BJ, Slingerland GL, Nagelkerke AF et al (2001) Effects of single-dose fluticasone on exercise-induced asthma in asthmatic children: a pilot study. Pediatr Pulmonol 32:115–121PubMedGoogle Scholar
  96. 96.
    Peterson R et al (2004) Treatment of exercise-induced asthma with beclomethasone propionate in children with asthma. Eur Resp J 24:932–937Google Scholar
  97. 97.
    Subbarro P, Duong M, Adelroth E et al (2006) Effect of ciclesonide dose and duration of therapy on exercise-induced bronchoconstriction in patients with asthma. J Allergy Clin Immunol 117:1008–1013Google Scholar
  98. 98.
    Leff JA, Busse WW, Pearlman D, Bronsky EA, Kemp J, Hendeles L et al (1998) Montelukast, a leukotriene-receptor antagonist, for the treatment of mild asthma and exercise-induced bronchoconstriction. N Engl J Med 339:147–152PubMedGoogle Scholar
  99. 99.
    Tan RA, Spector SL (2002) Exercise-induced asthma: diagnosis and management. Ann Allergy Immunol 89:226–235Google Scholar
  100. 100.
    Peroni DG et al (2002) Time efficacy of a single dose of montelukast on exercise-induced asthma in children. Pediatr Allergy Immunol 13:433–437Google Scholar
  101. 101.
    Pearlman DS, van Adelsberg J, Philip G et al (2006) Onset and duration of protection against exercise-induced bronchoconstriction by a single oral dose of montelukast. Ann Allergy Asthma & Immunol 97:98–104Google Scholar
  102. 102.
    Rundell KW, Spierling BA, Baumann JM et al (2005) Effects of airway narrowing from eucapneic voluntary hyperventilation and cold air exercise. Br J Sports Med 39:232–236PubMedGoogle Scholar
  103. 103.
    Vidal C, Fernandez-Ovide E, Pineiro J, Numez R, Gonzalez-Quintela A (2001) Comparison of montelukast versus budesonide in treatment of exercise –induced bronchoconstriction. Ann Allergy Asthma & Immunol 86:655–658Google Scholar
  104. 104.
    Spahn J, Szefler SJ (2002) Childhood asthma: new insights into management. J Allergy Clin Imm 109:3–13Google Scholar
  105. 105.
    Capristo C et al (2006) Update on the use of montelukast in pediatric asthma. Allergy Asthma Proc 27:312–318PubMedGoogle Scholar
  106. 106.
    Sveum RJ (2005) Childhood asthma: balancing efficacy and adherence for optimum management. Postgrad Med 118:43–50PubMedGoogle Scholar
  107. 107.
    Meltzer SS, JD, H, Cohn J, Bleecker ER (1996) Inhibition of exercise-induced bronchospasm by zileuton: a 5-lipoxygenase inhibitor. Am J Respir Crit Care Med 153(3):931–935PubMedGoogle Scholar
  108. 108.
    Albazzaz MK, Neade MG, Patel KR (1992) Dose duration of nebulized nedocromil in exercise-induced asthma. Eur Resp J 5:967–969Google Scholar
  109. 109.
    deBenedictis FM, Tuteri G, Pazzelli P et al (1995) Cromolyn versus nedocromil: duration of action in exercise-induced asthma in children. J Allergy Clin Immunol 96:510–514Google Scholar
  110. 110.
    Kelly K, Spooner CH, Rowe BH (2000) Nedocromil sodium vs sodium cromoglycate for preventing exercise-induced bronchoconstriction in asthmatics. Cochrane Data Base Syst Rev, Issue 4Google Scholar
  111. 111.
    Weiler JM, Rupp NT, Kalberg CJ et al (2005) Effect of fluticasone/salmeterol administered via a single device on exercise-induced bronchospasm in patients with persistent asthma. Ann Allergy Asthma & Immunol 94:65–72CrossRefGoogle Scholar
  112. 112.
    Weiler JM, Malloy C (2005) Asthma and athletes: therapy to compete. Clin Rev Allergy Immunol 29:139–149PubMedGoogle Scholar
  113. 113.
    Weinberger M, Abu-Hasan M (2006) Life threatening asthma during treatment with salmeterol. N Engl J Med 355:852–853PubMedGoogle Scholar
  114. 114.
    McKenzie DC, McLuckie SL, Stirling DR (1994) The protective effects of continuous and interval exercise in athletes with exercise-induced asthma. Med Sci Sports Exerc 26:951–956PubMedGoogle Scholar
  115. 115.
    Schnall RP, Landau LI (1980) The protective effects of continuous and interval exercise in athletes with exercise-induced asthma. Thorax 35:828–832PubMedCrossRefGoogle Scholar
  116. 116.
    Rundell KW, Spierling BA, Judelson DA et al (2003) Bronchoconstriction during cross country skiing. Med Sci Sports Exerc 35:18–26PubMedGoogle Scholar
  117. 117.
    Witek TJ Jr, Schacter EN, Dean NL (1983) A review of the hospital course of asthmatic children and adults. Ann Allergy 12–16Google Scholar
  118. 118.
    Shturman-Ellstein R, Zeballos RJ, Buckley JM, Souhrada JF (1978) The beneficial effect of nasal breathing on exercise-induced bronchoconstriction. Am Rev Respir Dis 118:65–73PubMedGoogle Scholar
  119. 119.
    Helenius IJ, Rytila P, Metso T et al (1988) Respiratory symptoms, bronchial responsiveness and cellular characteristics of induced sputum in elite swimmers. Allergy 53:346–352Google Scholar
  120. 120.
    Mannix ET, Roberts M, Fagin DP et al (2003) The prevalence of airways hyperresponsiveness in members of an exercise training facility. J Asthma 40:349–355PubMedGoogle Scholar
  121. 121.
    Holzer K, Anderson SD, Douglass JJ (2002) Exercise in elite summer athletes: challenges for diagnosis. Allergy Clin Immunol 110:374–380Google Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  1. 1.Center for Allergy, Asthma, ImmunologyWaterburyUSA

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