Asthma, exercise and metabolic dysregulation in paediatrics
Main Article Content
Keywords
Asthma, Control, Exercise, Hyperinsulinaemia, Smooth muscle, Obesity
Abstract
Asthma is the most frequent chronic disease in childhood. Chest tightness, cough, wheezing and dyspnoea during or after exercise may be unique manifestations of asthma in up to 90% of subjects. Physical activity may be reduced by uncontrolled asthma symptoms and parental beliefs, impairing physical fitness of asthmatic children. Clinicians working in the field of allergy are aware of evidence supporting the benefits of physical activity for patients with asthma. Treatment of asthma is required in order to obtain its control and to avoid any limitation in sports and active play participation. As exercise performance in children with controlled asthma is not different from that of healthy controls, any exercise limitation cannot be accepted. Overweight and obesity may interfere with asthma and exercise, leading to dyspnoea symptoms. Evidences on the effect of insulin resistance on airway smooth muscle and on bronchial hyperactivity are presented.
Conclusion: Exercise is part of the strategy to obtain the best control of asthma in childhood, but we have to optimise the asthma control therapy before starting exercise programming. Furthermore, it is crucial to give best attention on the effects of obesity and insulin resistance, because they could in turn influence patients’ symptoms.
References
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35. World Health Organization (WHO), requiring urgent interventions. Obesity and overweight. Fact sheet No. 311. Available at: http://www.who.it.mediacentre.
36. Boulet LP. Asthma and obesity. Clin Exp Allergy. 2013;43:8-21.
37. Beuther DA, Sutherland ER. Overweight, obesity and incident asthma: a meta-analysis of prospective epidemiological studies. Am J Respir Crit Care. 2007;175:661-6.
38. Chinn S, Jarvis D, Burney P. European Community Respiratory Health Survey Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey. Thorax. 2002;57:33-1028.
39. Aaron SD, Vandemheen KL, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, et al. Canadian respiratory clinical research consortium overdiagnosis of asthma in obese and non-obese adults. CMAJ. 2008;179:31-1121.
40. Van Leeuven JC, Hoogstrate M, Duiverman EJ, Thio BJ. Effects of dietary-induced weight loss on exercise-induced bronchoconstriction in overweight and obese children. Pediatr Pulmonol. 2014;49:61-1155.
41. Scott HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, Callister R, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized clinical trial. Clin Exp Allergy. 2013;43: 36-49.
42. Shore SA. Obesity and asthma: lesson from animal models. J Appl Physiol. 2007;102:516-28.
43. Yuksel H, Sogut A, Yilmaz O, Onur E, Dinc G. Role of adipokines and hormones of obesity in childhood asthma. Allergy Asthma Immunol Res. 2012;4:98-103.
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46. den Dekker HT, Ross KPI, de Jongste JC, Reiss IK, Jaddoe VW, Duijts L. Body fat mass distribution and interrupter resistance, fractional exhaled nitric oxide, and asthma at school age. J Allergy Clin Immunol. 2017;139:810-8.
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51. Bossè Y. Endocrine regulation of airway contractility is overlooked. J Endocrinol. 2014;222:61-73.
52. Rastogi D, Fraser S, Oh J, Huber AM, Schulman Y, Bhagtani RH, et al. Inflammation, metabolic dysregulation and pulmonary function among obese urban adolescents with asthma. Am J Respir Crit Care Med. 2015;191:149-60.
53. Huang F, del-Rio-Navarro BE, Alcantara ST, Ontiveros JA, Cienfuegos DR, Bello Gonzalez SA, et al. Plasminogen activator inhibitor-1, fibrinogen, and lung function in adolescents with asthma and obesity. Endocr Res. 2012;37:135-44.
54. Ceglia L, Lau J, Pittas AG. Meta-analysis: efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus. Ann Intern Med. 2006;145:665-75.
55. Terzano C, Morano S, Ceccarelli D, Conti V, Paone G, Petroianni A, et al. Effect of insulin on airway responsiveness in patients with type 2 diabetes mellitus: a cohort study. J Asthma. 2009;46:703-7.
56. Karampatakis N, Karampatakis Y, Galli-Tsinopoulou A, Kotanidou EP, Tsergouli K, Eboriadou-Petikopoulou M, et al. Impaired glucose metabolism and bronchial hyperresponsiveness in obese prepubertal asthmatic children. Pediatr Pulmonol. 2017;52:160-6.
57. Nie Z, Jacoby DB, Fryer AD. Hyperinsulinemia potentiates airway responsiveness to parasympathetic nerve stimulation in obese rats. Am J Respir Cell Mol Biol. 2014;51:251-61.
58. Dekkers BCJ, Schaafsma D, Tran T, Zaagsma J, Meurs H. Insulin-induced laminin expression promotes a hypercontractile airway smooth muscle phenotype. Am J Respir Cell Mol Biol. 2009;41:494-504.
59. Forno E, Celedon JC. The effect of obesity, weight gain, and weight loss on asthma inception and control. Curr Opin Allergy Clin Immunol. 2017;17:123-30.
60. Correa Marson E, Sudatti Delevatti R, Prado AKG, Netto N, Kruel LFM. Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: a systematic review and meta-analysis. Prev Med. 2016;93:211-8.
61. Ratnovsky A, Mellema M, An SS, Fredberg JJ, Shore SA. Airway smooth muscle proliferation and mechanics: effects of AMP kinase agonists. Mol Cell Biomech. 2007;4:143-57.
62. Bonini S, Craig T. The elite athlete: yes, with allergy we can. J Allergy Clin Immunol. 2008;122:249-50.
2. Anderson SD, Davis S. The mechanism of exercise-induced asthma is. . .. J Allergy Clin Immunol. 2000;106:453-.
3. Helenius IJ, Tikkanen HO, Sarna S, Haahtela T. Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as a risk factors. J Allergy Clin Immunol. 1998;101:646-52.
4. Dantas FM, Correia MA Jr, Silva AR, Peixoto DM, Sarinho ES, Rizzo JA. Mothers impose physical activity restrictions on their asthmatic children and adolescents: an analytical cross-sectional study. BMC Public Health. 2014;14:287.
5. Fredman S. Exercise as a bronchodilator. Clin Sci. 1992;83:383-9.
6. Jones RS, Buston MH, Wharton MJ. The effect of exercise on ventilatory function in the child with asthma. Br J Dis Chest. 1962;56:78-86.
7. Gump A, Haughney L, Fredberg J. Relaxation of activated airway smooth muscle: relative potency of isoproterenol vs. tidal stretch. J Appl Physiol. 2001;90:2306-10.
8. Crimi E, Pellegrino R, Smeraldi A, Brusasco V. Exercise-induced bronchodilation in natural and induced asthma: effects on ventilatory response and performance. J Appl Physiol. 2002;92:2353-60.
9. Milanese M, Saporiti R, Bartolini S, Pellegrino R, Baroffio M, Brusasco V, et al. Bronchodilator effects of exercise hyperpnea and albuterol in mild-to-moderate asthma. J Appl Physiol. 2009;107:494-9.
10. Pellegrino R, Pompilio P, Quaranta M, Aliverti A, Kayser B, Miserocchi G, et al. Airway responses to methacholine and exercise at high altitude in healthy lowlanders. J Appl Physiol. 2010;108:256-65.
11. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA); 2017. Available from www.ginasthma.org [last accessed June 2017].
12. Williams B, Powell A, Hoskins N, Neville R. Exploring and explaining low participation in physical activity among children and young people with asthma: a review. BMC Fam Pract. 2008;9:40.
13. Ostrom NK, Eid NS, Craig TJ, Colice JL, Haydel ML, Parsons JP, et al. Exercise-induced bronchospasm in children with asthma in the United States: results from the ExerciseInduced Bronchospasm Landmark Survey. Allergy Asthma Proc. 2011;32:425-30.
14. Lang DM, Butz AM, Duggan AK, Serwint JR. Physical activity in urban school-aged children with asthma. Pediatrics. 2004;113:e341-6.
15. Shaaban R, Leynaert B, Soussan D, Antò JM, Heinrich J, Janson C, et al. Physical activity bronchial hyperresponsiveness: European Community Respiratory Health Survey II. Thorax. 2007;62:403-10.
16. Rasmussen S, Lambrechtsen J, Siersted HC, Hansen HS, Hansen NC. Low physical fitness is associated with the development of asthma in young adults. Eur Respir J. 2000;16:866-70.
17. Lochte L, Nielsen KG, Petersen PE, Platts-Mills TA. Childhood asthma and physical activity: a systematic review with meta-analysis and Graphic Appraisal Tool for Epidemiology assessment. BMC Pediatr. 2016;16:50.
18. Moreira A, Bonini M, Pawankar R, Anderson SD, Carlsen KH, Randolph C, et al. World Allergy Organization international survey on physical activity as treatment option for asthma and allergy. World Allergy Organ J. 2014;7:34.
19. Platt-Mills TA. The allergy epidemics: 1870---2010. JACI. 2015;136:3-13.
20. Hark WT, Thompson WM, McLaughling TE, Wheatley LM, PlattMills TA. Spontaneous sigh rates during sedentarly activity: watching television vs reading. Ann Allergy Asthma Immunol. 2005;94:247-50.
21. Fredberg JJ. Airway smooth muscle in asthma: flirting with disaster. Eur Respir J. 1998;12:1252-6.
22. Bonsignore MR, La Grutta S, Cibella F, Scichilone N, Cuttitta G, Interrante A, et al. Effects of exercise training and montelukast in children with mild asthma. Med Sci Sports Ex. 2008;40:405-12.
23. Scichilone N, Morici G, Zangla D, Arrigo R, Cardillo I, Bellia V, et al. Effects of exercise training on airway closure in asthmatics. J Appl Physiol. 2012;113:714-8.
24. Franca-Pinto A, Mendes FA, de Carvalho-Pinto RM, Agondi RC, Cukier A, Stelmach R, et al. Aerobic training decreases bronchial hyperesponsivenss and systemic inflammation in patients with moderate or severe asthma: a randomized controlled trial. Thorax. 2015;70:732-9.
25. Eijkemans M, Mommers M, Draaisma JM, Thijs C, Prins MH. Physical activity and asthma: a systematic review and meta-analysis. PLoS ONE. 2012;7:e5077.
26. Mendes FA, Almeida FM, Cukier A, Stelmach R, Jacob-Filho W, Martins MA. Effects of aerobic training on airway inflammation in asthmatic patients. Med Sci Sports Exerc. 2011;43: 197-203.
27. Fredberg JJ, Inouye D, Miller B, Nathan M, Jafari S, Raboudi SH, et al. Airway smooth muscle, tidal stretches, and dynamically determined contractile states. Am J Respir Crit Care Med. 1997;156:1752-9.
28. Crosbie A. The effect of physical training in children with asthma on pulmonary function, aerobic capacity and health-related quality of life: a systematic review of randomized control trials. Pediatr Exerc Sci. 2012;24:472-89.
29. Fanelli A, Cabral AL, Neder JA, Martins MA, Carvalho CL. Exercise training on disease control and quality of life in asthmatic children. Med Sci Sports Exerc. 2007;39:1474-80.
30. Counil FP, Varray A, Matecki S, Beurey A, Marchal P, Voisin M, et al. Training of aerobic and anaerobic fitness in children with asthma. J Pediatr. 2003;142:179-84.
31. Counil FP, Karila C, Varray A, Guillaumont S, Voisin M, Préfaut C. Anaerobic fitness in children with asthma: adaptation to maximal intermittent short exercise. Pediatr Pulmonol. 2001;31:198-204.
32. Bacon SL, Lemiere C, Moullec G, Ninot G, Pepin V, Lavoie KL. Association between pattern of leisure-time physical activity and asthma control in adult patients. BMJ Resp Res. 2015;2:e000083.
33. Westergren T, Fegran L, Nilsen T, Haraldstad K, Kittang OB, Bemsten S. Active play exercise intervention in children with asthma: a pilot study. BMJ Open. 2016;6:e009721.
34. Russel J, Searle A, Henderson AJ, Turner KM. Designing a physical activity intervention for children with asthma: a qualitative study of the views of healthcare professionals, parents and children with asthma. BMJ Open. 2017;7:e014020.
35. World Health Organization (WHO), requiring urgent interventions. Obesity and overweight. Fact sheet No. 311. Available at: http://www.who.it.mediacentre.
36. Boulet LP. Asthma and obesity. Clin Exp Allergy. 2013;43:8-21.
37. Beuther DA, Sutherland ER. Overweight, obesity and incident asthma: a meta-analysis of prospective epidemiological studies. Am J Respir Crit Care. 2007;175:661-6.
38. Chinn S, Jarvis D, Burney P. European Community Respiratory Health Survey Relation of bronchial responsiveness to body mass index in the ECRHS. European Community Respiratory Health Survey. Thorax. 2002;57:33-1028.
39. Aaron SD, Vandemheen KL, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, et al. Canadian respiratory clinical research consortium overdiagnosis of asthma in obese and non-obese adults. CMAJ. 2008;179:31-1121.
40. Van Leeuven JC, Hoogstrate M, Duiverman EJ, Thio BJ. Effects of dietary-induced weight loss on exercise-induced bronchoconstriction in overweight and obese children. Pediatr Pulmonol. 2014;49:61-1155.
41. Scott HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, Callister R, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized clinical trial. Clin Exp Allergy. 2013;43: 36-49.
42. Shore SA. Obesity and asthma: lesson from animal models. J Appl Physiol. 2007;102:516-28.
43. Yuksel H, Sogut A, Yilmaz O, Onur E, Dinc G. Role of adipokines and hormones of obesity in childhood asthma. Allergy Asthma Immunol Res. 2012;4:98-103.
44. Torchio R, Gulotta C, Ciacco C, Perboni A, Guglielmo M, Crosa F, et al. Effects of chest wall strapping on mechanical response to methacholine in humans. J Appl Physiol. 2006;101: 430-8.
45. Forno E. Childhood obesity and asthma: to BMI or not to BMI? J Allergy Clin Immunol. 2017;139:767-8.
46. den Dekker HT, Ross KPI, de Jongste JC, Reiss IK, Jaddoe VW, Duijts L. Body fat mass distribution and interrupter resistance, fractional exhaled nitric oxide, and asthma at school age. J Allergy Clin Immunol. 2017;139:810-8.
47. Forno E, Acosta-Perez E, Brehm JM, Han YY, Alvarez M, ColonSemidey A, et al. Obesity and adiposity indicators, asthma and atopy in Puerto Rican children. J Allergy Clin Immunol. 2014;133:1308-14.
48. Chen YC, Tu YK, Huang KC, Chen PC, Chu DC, Lee YL. Pathway from central obesity to childhood asthma physical fitness and sedentary time are leading factors. Am J Respir Crit Care Med. 2014;189:1194-203.
49. Vijayakanthi N, Greally JM, Rastogi D. Pediatric obesity-related asthma: the role of metabolic dysregulation. Pediatrics. 2016;137:e20150812.
50. Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab. 2010;95:5189-98.
51. Bossè Y. Endocrine regulation of airway contractility is overlooked. J Endocrinol. 2014;222:61-73.
52. Rastogi D, Fraser S, Oh J, Huber AM, Schulman Y, Bhagtani RH, et al. Inflammation, metabolic dysregulation and pulmonary function among obese urban adolescents with asthma. Am J Respir Crit Care Med. 2015;191:149-60.
53. Huang F, del-Rio-Navarro BE, Alcantara ST, Ontiveros JA, Cienfuegos DR, Bello Gonzalez SA, et al. Plasminogen activator inhibitor-1, fibrinogen, and lung function in adolescents with asthma and obesity. Endocr Res. 2012;37:135-44.
54. Ceglia L, Lau J, Pittas AG. Meta-analysis: efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus. Ann Intern Med. 2006;145:665-75.
55. Terzano C, Morano S, Ceccarelli D, Conti V, Paone G, Petroianni A, et al. Effect of insulin on airway responsiveness in patients with type 2 diabetes mellitus: a cohort study. J Asthma. 2009;46:703-7.
56. Karampatakis N, Karampatakis Y, Galli-Tsinopoulou A, Kotanidou EP, Tsergouli K, Eboriadou-Petikopoulou M, et al. Impaired glucose metabolism and bronchial hyperresponsiveness in obese prepubertal asthmatic children. Pediatr Pulmonol. 2017;52:160-6.
57. Nie Z, Jacoby DB, Fryer AD. Hyperinsulinemia potentiates airway responsiveness to parasympathetic nerve stimulation in obese rats. Am J Respir Cell Mol Biol. 2014;51:251-61.
58. Dekkers BCJ, Schaafsma D, Tran T, Zaagsma J, Meurs H. Insulin-induced laminin expression promotes a hypercontractile airway smooth muscle phenotype. Am J Respir Cell Mol Biol. 2009;41:494-504.
59. Forno E, Celedon JC. The effect of obesity, weight gain, and weight loss on asthma inception and control. Curr Opin Allergy Clin Immunol. 2017;17:123-30.
60. Correa Marson E, Sudatti Delevatti R, Prado AKG, Netto N, Kruel LFM. Effects of aerobic, resistance, and combined exercise training on insulin resistance markers in overweight or obese children and adolescents: a systematic review and meta-analysis. Prev Med. 2016;93:211-8.
61. Ratnovsky A, Mellema M, An SS, Fredberg JJ, Shore SA. Airway smooth muscle proliferation and mechanics: effects of AMP kinase agonists. Mol Cell Biomech. 2007;4:143-57.
62. Bonini S, Craig T. The elite athlete: yes, with allergy we can. J Allergy Clin Immunol. 2008;122:249-50.
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Milanese, M., del Giudice, E. M., & G. Peroni, D. (2019). Asthma, exercise and metabolic dysregulation in paediatrics. Allergologia Et Immunopathologia, 47(3), 289-294. https://www.all-imm.com/index.php/aei/article/view/311
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How to Cite
Milanese, M., del Giudice, E. M., & G. Peroni, D. (2019). Asthma, exercise and metabolic dysregulation in paediatrics. Allergologia Et Immunopathologia, 47(3), 289-294. https://www.all-imm.com/index.php/aei/article/view/311