Exercise-induced asthma is associated with impaired quality of life among children with asthma in Japan

BACKGROUND

Asthma is the most common chronic diseases in school-aged children in Japan. It is important to consider health-related quality of life (QoL) among children with chronic diseases when treatment decisions are made.

METHODS

A school-based survey was conducted in randomly selected public schools in Tokyo by using a KINDL questionnaire for evaluating QoL and the international study of asthma and allergy on childhood (ISAAC) questionnaire, which is designed for comparing the asthma prevalence in various countries, from May to June in 2005. We recruited approximately 10% of the total children 6-7-years-old and 13-14-years-old living in Tokyo for sampling.

RESULTS

Response rate of this questionnaire was 86% (22,645 children) in the 6-7-year-old group and 64% (12,879 children) in the 13-14-year-old group. Comparing asthmatics with non-asthmatics in the same age, QoL of children with asthma was significantly impaired. The severity of QoL of children with asthma was significantly impaired. QoL of children with exercise-induced asthma (EIA) were more significantly impaired than ones without EIA and showed lower scores in the categories of physical functioning, emotional and school activities than those without EIA. Of note, QoL was more impaired in the EIA-positive group among severe asthmatics, suggesting that QoL of children with even severe asthma could be improved when EIA is appropriately controlled.

CONCLUSIONS

Existence of EIA among asthmatic children most strongly impairs their QoL. We should be more cautious about the management of EIA.

Perception of exercise induced asthma by children and their parents

BACKGROUND

Exercise induced asthma (EIA) plays an important role in clinical evaluation. There has been little previous work validating EIA as reported directly by children and indirectly by their parents.

AIMS

(1) To determine the strength of the association between children's symptoms of EIA and their physiological response to exercise in a laboratory setting. (2) To compare parents' perception of EIA with that of their children. (3) To seek factors influencing the perception of EIA.

METHODS

Forty three asthmatic children and their parents answered a questionnaire, which included measures of symptom perception in EIA using visual analogue (VAS) and Likert scales. The children underwent a standardised treadmill exercise challenge, using spirometry to measure the physiological outcome, after which they and their parents independently completed the symptom scores. Twenty four subjects agreed to return for a second visit, in order to assess repeatability.

RESULTS

The VAS and Likert scales were highly correlated. Children's symptom perception as measured by change in VAS scores related weakly to change in FEV(1) after exercise, and was unaffected by confounding factors such as age, gender, medication, and habitual exercise. Parents' perception of symptoms was unrelated to any physiological measure. There was no significant relation between parent and child VAS scores after exercise, and there was poor agreement between the Likert scale scores after exercise. The repeatability of the perception of change in FEV(1) after exercise was poor for both parents and children.

CONCLUSION

Physicians should obtain reports of EIA from children rather than parents, but be aware of their limited accuracy and repeatability.

The influence of lung function information on self-reports of dyspnea by children with asthma

Studied the influence of actual and false peak flow (PEF) information on dyspnea (breathlessness) in two experiments, each with 30 children with and 30 without asthma (7-17 years). Dyspnea, PEF, and lung function were measured before and after standardized physical exercise. Dyspnea was measured with a visual analog scale. PEF was measured with a peak flow meter and used for manipulation of dyspnea. The first experiment showed that the relationship between dyspnea and lung function was not stronger when children had knowledge of PEF values. The second experiment revealed that asthmatic children who received false feedback of 30% below the actual PEF reported significantly more dyspnea. Implications for the management of asthma are discussed.

The impact of asthma in an inner city general practice

This study was undertaken to find out the problems which children with asthma experience at school and at home. Patient interviews with 32 asthmatic children aged between 6 and 16 years using a semi-structured questionnaire were carried out in an inner city practice in Bristol. Twenty-three (71.8%) children experienced exercise-induced bronchospasm which particularly upset them at school. Eleven of 14 (78.5%) secondary schoolchildren said not being able to participate in sport was the worst thing about having asthma. Children seemed to accept that their inability to participate in sport was normal. Fourteen primary schoolchildren (77.7%) had restricted access to their inhalers. Primary schoolchildren were upset most by coughing or wheezing. Of 21 children who said smoke made their asthma worse, 18 lived in households where someone smoked. Children were more distressed by how their asthma affected them at school than at home. Thirty-one (96.8%) of the children viewed their asthma negatively, although 26 (81.2%) felt they were in control of their asthma. School age children may have undiagnosed, exercise-induced bronchospasm causing considerable physical and psychological morbidity and are therefore being inadequately treated. Children's negative views of their asthma may be missed by conventional questioning and asthma clinics should ensure that children are encouraged to reveal the issues that concern them. Children should have easy access to their medication at school. Locally agreed management of asthma in schools may improve morbidity from asthma.

Prevention of asthma induced by cold air by cellulose-fabric face mask

We have tested the effect of a porous cellulose fabric face mask. Nine asthmatic patients, anamnestically sensitive to cold, took part in exercise tests on an ergometer bicycle at a temperature of approximately -10 degrees C, with and without a face mask. For comparison, exercise tests were also performed with breathing taking place through a woolen scarf. Three minutes after finishing the exercise test, there was an average fall in FEV1 of 32% in the group without a face mask. The corresponding fall in FEV1 was 6% with a face mask and 17% with a scarf. In order to get some idea of the patients' attitudes to the face mask, it was used by 25 asthma patients during a period of 2 weeks in winter, after which they were asked to answer a simple questionnaire. Eighty-eight percent of the patients stated that the face mask had provided satisfactory protection against asthma complaints induced by cold air, and 72% reported that they had been able to spend more time out-of-doors. The results show that porous cellulose fabric designed as a face mask offers effective protection against asthma complaints induced by cold air and exercise, and that the patients appear to appreciate this protective aid highly despite the cosmetic disadvantages.

Development of child-centered disease-specific questionnaires for living with asthma

Contemporary developments in the management of chronic diseases such as diabetes and asthma offer possibilities for optimal control, but patients increasingly need to take on responsibilities for self care. Health professionals require comprehensive assessments of outcome that include data reflecting patients' perceptions of their disorder and its management. Disease-specific, patient-centered questionnaires for evaluation of adults' health-related quality of life are available for diabetes and asthma. Little progress is evident in relation to pediatric instruments. This paper describes the development of such an instrument for measurement of 8- to 11-year-olds' perceptions of their asthma--the CAQ-B Psychometric characteristics of the CAQ-B are reported: principal axis factor analysis resulted in the derivation of four subscales reflecting children's perceptions of both active and passive aspects of living with asthma, together with their perceptions of its severity and any associated distress. Preliminary explorations with CAQ-B included comparisons of parents', doctors', and children's ratings of severity; comparisons of data from asthmatic and nonasthmatic children; comparisons of data from boys and girls.

Perception of breathlessness during bronchoconstriction induced by antigen, exercise, and histamine challenges

Perception of breathlessness was studied in eight patients with mild, stable asthma after a histamine and exercise challenge performed before and 24 and 48 hours respectively after an antigen challenge. FEV1 and perception of breathlessness, evaluated by Borg's 10 point category scale, were measured after each administration of doubling antigen or histamine concentrations to achieve a greater than 20% fall in FEV1, and after six minutes of steady state exercise at 80% of maximal oxygen consumption (VO2max). The geometric mean provocative concentration of histamine causing a 20% fall in FEV1 (PC20) fell from 1.67 mg/ml before antigen challenge to 0.52 mg/ml 24 hours after the challenge. The median maximal % fall in FEV1 with exercise was 24.9% (range 10.5-40.5%) before and 30.6% (range 13.8-52.3%) 48 hours after antigen challenge. The median maximum % fall in FEV1 after antigen inhalation was 20.1% (range 13.3-35.2%) within the first hour; only two subjects had a late fall in FEV1 (23% and 58%). The median (range) of Borg scores obtained when FEV1 was reduced by 20% did not differ significantly for the three types of acute challenges: 1.25 (0.5-2.5) and 1.0 (0.5-3.0) after histamine tests, 1.0 (0.5-4.1) and 1.55 (0.5-2.0) after exercise, and 1.5 (0-3.0) after antigen challenge. In the two subjects who had a late response to antigen the Borg score was reduced for the same % fall in FEV1 as with the early response. It is concluded that the perception of breathlessness does not differ appreciably during the early response to histamine, antigen exposure, or exercise, but that it is reduced during the late asthmatic response. It was not influenced by previous antigen exposure, despite an increase in airway responsiveness.

The effect of exercise and induced expectations on visceral perception in asthmatic patients

It is assumed that visceral perception of the asthmatic patient is not only influenced by the physiological response itself but also by cognitions, i.e. specific illness related attitudes and expectations. Thirty-two adult asthmatics were studied in a 2 X 2-factorial design to examine the effect of physical exercise due to an ergometer capacity test (set at a load of 40 and 80 watt respectively) and induced expectations about the consequences of this task on broncho-constriction. Two sets of instructions were used to induce anticipations of harmful and non-harmful consequences respectively. The following dependent variables were registered: airways resistance, skin resistance and visceral perception (rating of physiological changes). Before the experiment the habitual way of reacting to asthma-relevant cues in each subject was assessed. Only small effects of the different ergometer loads on physiological responding and no effects of the experimental variables on visceral perception were found using an analysis of variance approach. A covariance analysis, however, using the trait variable as covariate, demonstrated that the induced 'harmful' anticipation significantly intensified the perception of visceral changes and even had some influence on asthma-relevant physiological responding.

Attitude toward physical education and self-concepts of asthmatic and nonasthmatic children taught by physical education specialists

50 asthmatic and 741 nonasthmatic children in Grades 4 to 6 were compared on attitudes toward physical education and self-concept. Data were collected using the Children's Attitude Inventory Toward Physical Education, a paired-comparison inventory for indicating preferences among 10 school subjects, and the Children's Self-concept Scale. Analysis of variance and X2 indicated no significant differences between asthmatic and nonasthmatic children on the three measures.

A short exercise and living course for asthmatics

A 5-day, non-residential exercise and living course for children with asthma is described as a feature of a programme of outpatient physiotherapy. Eleven children undertaking such a course were compared with 10 asthmatic children in a control group. The subject group showed, in the short term at least, an improvement in bronchial lability, peak flow rates, nocturnal and daytime wheeze, and activity compared with the controls. These findings were statistically significant. There was no difference between the groups in the number of days on which extra medication was taken. A short, sharp course is of benefit physically, socially and psychologically to children with asthma.

The behavioral management of asthma and asthma-related problems in children: a critical review of the literature

This review focuses upon the behavioral approach to childhood asthma. Asthma is defined as intermittent, variable, and reversible airways obstruction with a complex multidimensional etiology. The major measures of asthma include physiological, symptomatic, and collateral measures. The behavioral management of childhood asthma has been restricted to relaxation training, systematic desensitization, assertive training, biofeedback, and deconditioning of exercise-induced asthma. The efficacy of such intervention strategies for asthmatic children is in doubt, although the management of asthma-related problems in children appears to be a more promising area of research. The author suggests that the power of intervention programs for asthmatic children may be strengthened by the development of multifaceted treatment programs contingent upon the antecedents and consequences of the individual case. Also, behavior therapy may be of assistance to mild asthmatic children.