Chest
Volume 105, Issue 4, April 1994, Pages 1127-1132
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Exercise Testing Revisited: The Response to Exercise in Normal and Atopic Children

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Background

Wide differing criteria are used to define the normal airway response to exercise, and as a consequence the estimated incidence of exercise-induced bronchospasm (EIB) in atopic children is wide. The purpose of this study was to establish normal range for changes in spirometry after exercise in children and then to use these normal values to assess the incidence of EIB in atopic children.

Methods

Pulmonary function was assessed before, and 2, 5, and 10 min after 6 min of free running exercise in a group of 48 normal and 96 atopic children (70 asthmatics, 17 with allergic rhinitis, and 9 with atopic dermatitis/food hypersensitivity).

Results

The EIB (defined as the normal group mean value –2 SD) occurred with a >10 percent fall in FEV1, >17.5 percent fall in peak expiratory flow rate (PEFR), >26 percent fall in mean forced expiratory flow during the middle half of the forced vital capacity (FEF25-75), and >40 percent fall in FEF25. Sixty-three of 70 asthmatic patients had EIB by at least one of these definitions, most marked at 5 min postexercise. The combination of FEV1 and FEF25-75 criteria enabled detection of all subjects with EIB. By FEV1 and FEF25-75 criteria, none of the subjects with allergic rhinitis or dermatitis had EIB. The fall in FEV1 after exercise in children with allergic rhinitis was within the range of normal, but with a significantly lower mean value than control subjects.

Conclusions

EIB should be defined by using more than one maximum expiratory flow-volume curve parameter (ie, FEV1 and FEF25-75). The EIB (defined as a fall in FEV1 and FEF25-75) was only seen in asthmatic children and not in other atopic groups.

Section snippets

Subjects

A sample of 48 normal and 96 atopic children between 6 and 15 years of age participated in the study at the University Children's Hospital, Sarajevo, BosniaHercegovina.

Normal children (n=48; 28 boys and 20 girls, mean age 10.71 [SD 3.12] yr) were selected from the random sample of 55 pupils of 4 primary and 2 secondary schools in Sarajevo. Seven children who had a positive skin prick test or high immunoglobulin E (IgE) levels or both in spite of having no family history, signs, or symptoms of

RESULTS

The results of exercise testing in the normal children are shown in Table 1. For each lung function test there was no significant change in mean value after exercise but there was considerable difference between the ranges of responses across the tests. Chi-square goodness of fit tests were used to confirm that the data follow the normal distribution. Results greater than two standard deviations from the mean were considered abnormal. Using these criteria the normal range was defined as ≤10

DISCUSSION

Exercise testing is an objective method of confirming EIB and is valuable in diagnosing asthma, particularly in pediatric practice. Attempts have been made to standardize exercise testing,20 but widely differing standards are still used to estimate the normal spirometric response to exercise.4, 5, 6, 7, 8, 9 A plea for standardization was made by Godfrey,3 who stated that it is necessary to define the mode of response in a normal population and then to use this distribution to identify those

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    Dr. Adnan Custovic is supported in the United Kingdom by a grant from Allen & Hanburys Ltd.

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