Asthma diagnosis and treatmentPhysical activity and exercise in asthma: Relevance to etiology and treatment
Section snippets
Epidemiology of the increased prevalence and severity of asthma
Asthma prevalence, severity, and hospitalization have increased over the last 4 decades. Although there seems to have been a slight plateau in asthma incidence in recent years, the prevalence remains very high, and true causes of the epidemic remain an enigma. The increase has affected many different populations, but the increase has disproportionately affected African Americans and Latinos living in poverty in the United States. By contrast, rural areas that have maintained a traditional
Allergen sensitization
There have been strong and consistent associations between aeroallergen sensitization, especially to dust mites, and asthma. Supported by bronchial challenge and avoidance studies, these are strongly suggestive of a causal relationship between sensitization and asthma.4 Subsequently, many different perennial allergens from other parts of the world have been implicated as determinants of inflammation and bronchial hyperreactivity (BHR). The hygiene hypothesis proposes that decreased exposure to
Exercise conditioning for patients with asthma
Orenstein's 2002 literature review of exercising patients with pulmonary disease concluded that asthmatic subjects can improve cardiopulmonary fitness with exercise conditioning.21 In addition to decreased risk of cardiovascular disease and diabetes, the benefits of conditioning on asthma are both subjective (increased participation in activities, improved emotional status, and decreased intensity of wheezing attacks) and objective (improved running performance and increased aerobic fitness).
Deep inspiration and smooth muscle
There are many factors influencing the patency of bronchioles (Fig 1). There has been a lot of speculation that collagen deposition or airway remodeling plays a significant role in decreased airway patency or compliance. Some authors have speculated that increased smooth muscle is the cause of excessive bronchoconstriction or changed compliance. Thomson and colleagues,31 however, evaluated cross-sectional airway muscle in axial airway sections at high resolution and found no evidence of
Exercise prescription for asthmatic subjects
Both the ACSM1 and the ATS2 guidelines recommend exercise for patients with asthma. Exercise training is the key component to pulmonary rehabilitation. The ACSM guidelines state that “current evidence suggests that the standard principles of exercise prescription (mode, frequency, intensity, and duration) can be applied to patients with respiratory diseases, including asthma.” The recommended mode of aerobic exercise is walking or any mode of aerobic exercise with large muscles. The optimal
Conclusion
There is little doubt that the cause of increased prevalence and severity of asthma is multifactorial. Although allergen exposure and some levels of hygiene might be necessary for its development, there is a growing body of literature that implicates decreased physical activity as a contributor to the increase in asthma prevalence and severity.
Exercise conditioning of asthmatic subjects has been endorsed in the literature for decades. Although it is true that fitness levels are lower among
References (44)
- et al.
Pulmonary physiologic changes of morbid obesity
Am J Med Sci
(1999) - et al.
Atopy, asthma, and antibodies to Ascaris among rural and urban children in Kenya
J Pediatr
(2002) Pulmonary problems and management concerns in youth sports
Pediatr Clin North Am
(2002)- et al.
Aerobic conditioning in mild asthma decreases the hyperpnea of exercise and improves exercise and ventilatory capacity
Chest
(2000) - et al.
Individualized aerobic and high intensity training for asthmatic children in an exercise readaptation program—Is training always helpful for better adaptation to exercise?
Chest
(1991) - et al.
Asthma in exercising children exposed to ozone: a cohort study
Lancet
(2002) - et al.
Spontaneous sigh rates during sedentary activity: watching television vs reading
Ann Allergy Asthma Immunol
(2005) ACSM's guidelines for exercise testing and prescription
(2000)Pulmonary rehabilitation
Am J Respir Crit Care Med
(1999)Expert panel report: guidelines for the diagnosis and management of asthma: update on selected topics, 2002
J Allergy Clin Immunol
(2002)
House dust mite exposure as a cause of asthma
Clin Exp Allergy
Complex interactions in complex traits: obesity and asthma
Thorax
Mechanisms of citric acid-induced bronchoconstriction
Am J Med
Association between obesity and asthma in 4-11 year old children in the UK
Thorax
Obesity is a risk factor for asthma and wheeze but not airway hyperresponsiveness
Thorax
Elevated C-reactive protein levels in overweight and obese adults
JAMA
Low-grade systemic inflammation in overweight children
Pediatrics
Immediate and longterm effects of weight reduction in obese people with asthma: randomized controlled study
BMJ
Prospective study of Body Mass Index, weight change, and risk of adult-onset asthma in women
Arch Intern Med
Low physical fitness in childhood is associated with the development of asthma in young adulthood: the Odense schoolchild study
Eur Respir J
Social predictor of adult asthma: a co-twin case-control study
Thorax
Cited by (196)
Diet and asthma
2023, Asthma in the 21st Century: New Research AdvancesRecommendations for Physical Activity in Asthma: A Work Group Report of the AAAAI Sports, Exercise, and Fitness Committee
2022, Journal of Allergy and Clinical Immunology: In PracticePsychological Treatment Considerations in Medical Comorbidity
2022, Comprehensive Clinical Psychology, Second EditionChildhood Asthma Risk with Moderate Exercise: Good News for Most!
2022, Journal of Allergy and Clinical Immunology: In PracticeSelf-Reported Physical Activity and Asthma Risk in Children
2022, Journal of Allergy and Clinical Immunology: In Practice
Supported by National Institutes of Health grants no. AI-20565 and AI/EHS-P01-AI-50989.
Disclosure of potential conflict of interest: T. A. E. Platts-Mills—none disclosed. S. R. Lucas—none disclosed.