Lecture 7: Exercise-Induced Dyspnoea Flashcards
Explain why elite-level athletes may be more susceptible to the development of EIB?
Repeated exercise at vigorous intensities or in noxious environments results in an increase of airway injury-recycling due to chronic inflammation. In turn this results in structural airway-remodelling due to epithelial damage. This is concept is supported by (Price et al, 2013) as elite endurance swimmers and ‘cold air’ athletes both had increased levels of Airway Hyper-responsiveness and decreased levels of lung function.
What are the impacts of EIB within an athletic population?
Poor Asthma control (exacerbations)
Psychological impact
Physical Deconditioning
Mortality
What are the drawbacks of only using spirometry within an athletic population?
Athletes often present spirometry results of 100-120% of ‘normal’ even when there is a pathology present. The reason being is due to draining adaptions meaning they have a much greater lung capacity.
CPET must be introduced to induce EIB.
Describe the application and differences between direct + indirect bronchoprovocation challenges?
Direct and indirect bronchoprovocation challenges are used in clinical practice for the diagnosis of asthma and exercise-induced bronchoconstriction (EIB) (1).
Direct bronchoprovocation challenges act directly on specific airway smooth muscle receptors (acetylcholine receptors) to induce constriction independent of inflammation (1).
Indirect bronchoprovocation challenges) are thought to cause inflammatory cells to release endogenous mediators that provokes smooth muscle constriction (1).
What is considered the ‘gold standard’ in terms of diagnosing EIB?
Eucapnic voluntary hyperpnoea. This test replicates high intensity exercise and requires inhaling a compressed gas mixture. This test is less likely to produce false-negative results of EIB. A positive diagnosis e >10% fall in FEV1 when comparing PRE and POST results.
