Exercise asthma induced

Chen, W.Y., and Horton, D. J. (1977). Heat and water loss from the airw ays and exercise-induced asthma. Respiration 34, 305-313. 

Intal, Nasalcrom Prophylaxis of severe bronchial asthma prevention of exercise-induced asthma (BA) Nasal preparations prevention and treatment of allergic rhinitis Dizziness, headache, nausea, dry and irritated throat, rash, joint swelling and pain... 

Cromolyn—When taken to prevent exercise-induced asthma, this drug should be taken approximately 15 minutes before activity but no earlier than 1 hour before the expected activity. 

Finnerty, J.P., Wood-Baker, R., Thompson, H. and Holgate, S.T. (1992). Role of leukotrienes in exercise-induced asthma. Inhibitory effect of ICI 204,219, a potent leukotriene D4 receptor antagonist. Am. Rev. Resp. Dis. 145, 746-749. 

A greater than or equal to 15% decrease in FEV, after an exercise test is diagnostic for exercise-induced asthma. 

Patients receiving these agents may notice improvement in 1 to 2 weeks, but maximal benefit may not be seen for 4 to 6 weeks. Cromolyn and nedocromil appear to be similar in efficacy to the leukotriene antagonists and theophylline for persistent asthma.18 Both agents are well tolerated with adverse effects limited to cough and wheezing. Bad taste and headache have also been reported with nedocromil. One dose of cromolyn or nedocromil prior to exercise or allergen exposure will provide effective prophylaxis for 1 to 2 hours. Cromolyn and nedocromil are not as effective as albuterol for prophylaxis of exercise-induced asthma. 

In patients with mild intermittent asthma, long-term control medications are not necessary, and patients should use a short-acting inhaled P2-agonist t° prevent or treat symptoms.2 This classification includes patients with exercise-induced asthma, seasonal asthma, or asthma symptoms associated with infrequent trigger exposure. Patients can pre-treat with two puffs of cromolyn or nedocromil prior to exposure to a known trigger. The treatment of choice for exercise-induced asthma is two inhalations of albuterol 5 minutes prior to exercise.1 Cromolyn and nedocromil are less effective than albuterol for prophylaxis of exercise-induced asthma. 

Exercise is one of the most common precipitants of asthma symptoms, and exercise-induced asthma is commonly seen in children and adolescents. Exercise may be a precipitant in up to 90% of the population with asthma and maybe the first precipitant noticed in an asthma patient.18 Shortness of breath, wheezing, or chest tightness usually occur during or shortly after vigorous exercise and resolve within 30 to 60 minutes. 

Corticosteroids (e.g., beclomethazone, flunisolide, triamcinolone) have anti-inflammatory and immunosuppressant actions. These drugs are used prophylactically to prevent the occurrence of asthma in patients with frequent attacks. Because they are not useful during an acute attack, corticosteroids are prescribed along with maintenance bronchodilators. These drugs are also administered by inhalation. Cromolyn is another anti-inflammatory agent used prophylactically to prevent an asthmatic attack. The exact mechanism of action of cromolyn is not fully understood however, it is likely to involve the stabilization of mast cells. This prevents the release of the inflammatory mast cell mediators involved in inducing an asthmatic attack. Cromolyn has proven effective in patients with exercise-induced asthma. 

Ipratropium bromide and tiotropium bromide are competitive inhibitors of muscarinic receptors they produce bronchodilation only in cholinergic-mediated bronchoconstriction. Anticholinergics are effective bronchodila-tors but are not as potent as /J2-agonists. They attenuate, but do not block, allergen- or exercise-induced asthma in a dose-dependent fashion. 

Q82 Exercise is contraindicated in controlled angina. Sv/imming is greatly associated with exercise-induced asthma. 

Exercise in not contraindicated in controlled angina. However, patients are advised to carry with them glyceryl trinitrate. Swimming is not associated with triggering of exercise-induced asthma. 

Even with this somewhat stricter definition, there is room for discretion. A sportsman who takes an occasional puff of a bronchodilator for exercise-induced asthma but is otherwise asymptomatic may be considered eligible by some. Individuals who have undergone surgery for a congenital condition and are in excellent health may or may not be suitable. Thus, an asymptomatic patient with a hip prosthesis who is taking no medication may be acceptable whereas an equally healthy individual with a prosthetic heart valve should be excluded from a study involving a cannula because of the risk, however remote, of endocarditis. Clearly, whatever definition of a healthy volunteer is used, sensible clinical judgement is still required. 

Cromolyn sodium (disodium cromoglycate) and nedocromil sodium are stable but extremely insoluble salts (see structures below). When used as aerosols (by nebulizer or metered-dose inhaler), they effectively inhibit both antigen- and exercise-induced asthma, and chronic use (four times daily) slightly reduces the overall level of bronchial reactivity. However, these drugs have no effect on airway smooth muscle tone and are ineffective in reversing asthmatic bronchospasm they are only of value when taken prophylactically. 

Anderson SD, Brannan JD. Long-acting beta 2-adrenoceptor agonists and exercise-induced asthma lessons to guide us in the future. Paediatr Drugs. 2004 6 161-175. 

Timmer W, Leclerc V, Birraux G, et al.The new PDE4 inhibitor roflumilast is efficacious in exercise-induced asthma and leads to suppression of LPS-stimulated TNF-alpha ex vivo. J Clin Pharmacol 2002 42(3) 297-303. 

Sodium cromoglicate is effective in extrinsic (allergic) asthma including asthma in children, and in exercise-induced asthma but its use has declined since the efficacy and safety of low dose inhaled corticosteroid have become apparent. 

The manufacturers have on record in the USA several pulmonary adverse effects during isotretinoin therapy, including worsening of asthma (SEDA-21,162), recurrent pneumothorax, pleural effusion, interstitial fibrosis, pulmonary granuloma, and deterioration in lung function tests. Exercise-induced asthma (35) may be caused by a significant reduction in the forced expiratory flow rate (36) and a drying effect of isotretinoin on the mucous membranes of the respiratory tract (37). 

Bierman CW, Pierson WE, Shapiro GG. Exercise-induced asthma. Pharmacological assessment of single drugs and drug combinations. JAMA 1975 234(3) 295-298. 

Eggleston PA, and McMahan S. A. The effects of fenoterol, ephedrine and placebo on exercise-induced asthma. Chest 1978 73(6 Suppl) 1006-1008. 

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