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. 2022 Jan;33(1):e13702.
doi: 10.1111/pai.13702. Epub 2021 Dec 9.

Self-reported exercise-induced dyspnea and airways obstruction assessed by oscillometry and spirometry in adolescents

Chiara Veneroni  1 , Pasquale Pio Pompilio  1 , Kjell Alving  2 , Christer Janson  3 , Leif Nordang  4 , Raffaele Dellacà  1 , Henrik Johansson  5   6 , Andrei Malinovschi  6
Affiliations

Self-reported exercise-induced dyspnea and airways obstruction assessed by oscillometry and spirometry in adolescents

Chiara Veneroni et al. Pediatr Allergy Immunol. 2022 Jan.

Abstract

Background: Self-reported exercise-induced dyspnea (EID) is common among adolescents. Possible underlying pathologies are exercise-induced bronchoconstriction (EIB) and laryngeal obstruction (EILO). The forced oscillation technique (FOT) may evaluate exercise-induced changes in airway caliber.

Aim: To investigate in adolescents the relationship between EID, EIB (post-exercise fall in forced expiratory volume in 1s (FEV1 )≥10%), EILO, and post-exercise challenge changes in FOT parameters.

Methods: One hundred and forty-three subjects (97 with EID) of 13-15 years old underwent a standardized exercise challenge with FOT measurement and spirometry repeatedly performed between 2 and 30 min post-exercise. EILO was studied in a subset of 123 adolescents. Subjects showing greater changes than the healthy subgroup in the modulus of the inspiratory impedance were considered FOT responders.

Results: EID-nonEIB subjects presented similar post-exercise changes in all FOT parameters to nonEID-nonEIB adolescents. Changes in all FOT parameters correlated with FEV1 fall. 45 of 97 EID subjects responded neither by FEV1 nor FOT to exercise. 19 and 18 subjects responded only by FEV1 (onlyFEV1 responders) or FOT (onlyFOTresponders), respectively. Only a lower baseline forced vital capacity (FVC)%predicted and a higher FEV1 /FVC distinguished the onlyFEV1 responders from onlyFOTresponders. FOT parameters did not present specific post-exercise patterns in EILO subjects.

Conclusion: FOT can be used to identify post-exercise changes in lower airway function. However, EID has a modest relation with both FEV1 and FOT responses, highlighting the need for objective testing. More research is needed to understand whether onlyFEV1 responders and onlyFOTresponders represent different endotypes.

Keywords: exercise-induced bronchoconstriction; exercise-induced dyspnea; exercise-induced laryngeal obstruction; forced oscillation technique.

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Conflict of interest statement

P.P. and R.D. are co‐founders and serve as board members of RESTECH s.r.l., a company that designs, manufactures, and sells devices for lung function testing based on forced oscillation technique (FOT). R. D. also reports grants and others from Restech, personal fees from Philips Healthcare outside the submitted work. In addition, Dellaca' has a patent on the detection of EFL by FOT with royalties paid to Philips Respironics and Restech s.r.l, a patent on monitoring lung volume recruitment by FOT with royalties paid to Vyaire, and a patent on early detection of exacerbations by home monitoring of FOT with royalties paid to Restech s.r.l. The other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Post‐exercise changes from baseline in inspiratory resistance (R5,insp), reactance (X5,insp), impedance modulus (|Z5,insp|), and forced expiratory volume in 1s (FEV1). EID, exercise‐induced dyspnea; EIB, exercise‐induced bronchoconstriction
FIGURE 2
FIGURE 2
Relationship between forced expiratory volume in 1 s (FEV1) fall and maximal change after exercise in the inspiratory impedance modulus (Δ|Z5,insp|) in subjects with (EID, close circles) and without (nonEID, open circles) exercise‐induced dyspnea. Dashed lines represent the thresholds for positive responses to exercise. Four groups are identified groups according to their response to the exercise challenge: subjects that responded to exercise for both FEV1 and FOT (FEV1&FOTresponders), only FEV1 (onlyFEV1responders), only FOT (onlyFOTresponders), and non‐responders. Linear regression (r 2 = .38, p < .001) is also shown (dark gray line)
FIGURE 3
FIGURE 3
Venn diagram depicting the association between exercise‐induced dyspnea (EID), exercise‐induced bronchoconstriction (EIB), and exercise‐induced changes in oscillometry (FOT responders) in adolescents
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