Elsevier

The Journal of Pediatrics

Volume 162, Issue 4, April 2013, Pages 813-818.e1
The Journal of Pediatrics

Original Article
Exercise-Induced Bronchoconstriction in School-Aged Children Who Had Chronic Lung Disease in Infancy

https://doi.org/10.1016/j.jpeds.2012.09.040Get rights and content

Objectives

To assess for exercise-induced bronchoconstriction in 8- to 12-year-old children who had chronic lung disease (CLD) in infancy, and to evaluate the response of bronchoconstriction to bronchodilation with albuterol in comparison with preterm and term controls.

Study design

Ninety-two children, including 29 with CLD, 33 born preterm at ≤32 weeks' gestation, and 30 born at term, underwent lung spirometry before and after cycle ergometry testing and after postexercise bronchodilation with albuterol.

Results

Doctor-diagnosed asthma and exercise-induced wheeze were reported more frequently in the CLD group than in the preterm and term groups, but only 10% were receiving a bronchodilator. There were no differences among the groups in peak minute ventilation, oxygen uptake, or carbon dioxide output at maximum exercise. After maximal exercise, predicted forced expiratory volume in 1 second (FEV1) decreased from a mean baseline value of 81.9% (95% CI, 76.6-87.0%) to 70.8% (95% CI, 65.5-76.1%) after exercise in the CLD group, from 92.0% (95% CI, 87.2-96.8%) to 84.3% (95% CI, 79.1-89.4%) in the preterm group, and from 97.5% (95% CI, 92.5-102.6%) to 90.3% (95% CI, 85.1-95.5%) in the term group. After albuterol administration, FEV1 increased to 86.8% (95% CI, 81.7-92.0%) in the CLD group, 92.1% (95% CI, 87.3-96.9%) in the preterm group, and 97.1% (95% CI, 92.0-102.3%) in the term group. The decrease in predicted FEV1 after exercise and increase in predicted FEV1 after bronchodilator use were greatest in the CLD group (−11.0% [95% CI, −18.4 to −3.6%] and 16.0% [95% CI, 8.6-23.4%], respectively; P < .005 for both), with differences of <8% in the 2 control groups.

Conclusion

School-age children who had CLD in infancy had significant exercise-induced bronchoconstriction that responded significantly to bronchodilation. Reversible exercise-induced bronchoconstriction is common in children who experienced CLD in infancy and should be actively assessed for and treated.

Section snippets

Methods

Three groups of children aged 8-12 years were studied, including 2 preterm groups (born at ≤32 weeks' gestation) who developed CLD (ie, oxygen-dependent or breathing air by 36 weeks' gestation) and a control term group born at ≥37 weeks' gestation. CLD was diagnosed pragmatically and would have been classified as moderate to severe using the National Institutes of Health's definition of BPD.24 Neonatal clinical records for each preterm-born child were reviewed. Children with a congenital

Results

We studied 92 children, including 29 with CLD, 33 born preterm, and 30 term-born controls, with 1 subject in the CLD reclassified into the preterm group after a detailed review of each subject's neonatal records. Characteristics of the study population and reported symptoms are presented in Tables I and II (Table II; available at www.jpeds.com). As expected, the CLD group was significantly more immature and had a lower mean birth weight compared with the preterm and term groups. They also

Discussion

In this study we studied each child in detail, focusing especially on his or her ability to exercise, and on whether the CLD group exhibited exercise-induced bronchoconstriction that was responsive to bronchodilation. We confirmed previous reports of airway obstruction in the CLD group, but also found that although peak V˙O2 values were similar in the 3 groups after exercise, the children in the CLD group used more ventilatory reserve. In the CLD group, FEV1 decreased significantly after

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    Partially supported by Cardiff and Vale National Health Service Trust Research and Development Small Grants. The authors declare no conflicts of interest.

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