phenylephrine-hydrochloride and Asthma--Exercise-Induced

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.. The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.. There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.. Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

Topics: Asthma, Exercise-Induced; Athletes; Exercise; Humans; Immunity, Mucosal; Nasal Cavity; Nasal Obstruction; Nose; Respiratory Tract Infections; Rhinitis

The response of asthmatic patients to exercise differs from that of healthy subjects, and the mechanisms responsible for the exercise-induced bronchoconstriction in the former group remain uncertain. The severity of bronchospasm may be related to water loss from the respiratory tree, but there are conflicting explanations for this. The response of the nose to exercise, in healthy subjects or in patients with asthma and rhinitis, has been the subject of few investigations, but a recent study found that the nose responds in a different fashion to the bronchi in patients with rhinitis and asthma. The bronchial tree responds by narrowing, while the nose becomes more patent. There is evidence that the bronchi are the main sites of airway narrowing in exercise-induced bronchoconstriction, while there can also be simultaneous tracheal dilatation. In addition, it now appears that the nasal response to exercise in all subjects parallels that of the trachea. In total, the results suggest that different mechanisms are responsible for regulating the patency of the upper and lower airways.

Topics: Asthma, Exercise-Induced; Bronchi; Bronchial Hyperreactivity; Exercise; Humans; Nose; Rhinitis

The effect of intranasally administered corticosteroid (budesonide) on nasal symptoms, mode of respiration (nasal versus mouth breathing), and asthma was investigated in 37 asthmatic children who were mouth breathers because of chronic nasal obstruction. After a 2-wk run-in period, the children were allocated randomly to 4 wk of intranasal therapy with either budesonide (400 micrograms/day) or placebo spray. A double-blind, parallel design was used. Diaries for peak expiratory flow, asthma, and rhinitis symptom scores and degree of mouth breathing were recorded at home. Nasal eosinophilia, nasal airway resistance at a flow of 0.2 L/s (NAR0.2), and lung function at rest and after exercise challenge were assessed at the clinic immediately before and at end of the 4-wk treatment. Budesonide, when compared with placebo, significantly decreased nasal obstruction (p less than 0.05), secretion (p less than 0.01), and eosinophilia (p less than 0.02), as well as NAR0.2 (p less than 0.05) and mouth breathing (p less than 0.01). The improvement in nasal obstruction correlated closely to the changes in mouth breathing (r = 0.80, n = 17, p less than 0.001). Furthermore, intranasally administered budesonide resulted in less exercise-induced asthma (EIA) (p less than 0.02) and decreased cough and asthma severity significantly. Pulmonary mechanics were only marginally improved. The present study showed that intranasally administered budesonide is effective in the treatment of perennial allergic rhinitis. An attenuation of EIA and a tendency to less asthma after budesonide therapy suggest a decrease in bronchial reactivity, but the results gave no clear evidence of an association between nasal airway function and asthma.

Topics: Administration, Intranasal; Adolescent; Airway Obstruction; Airway Resistance; Asthma; Asthma, Exercise-Induced; Budesonide; Child; Double-Blind Method; Eosinophilia; Female; Humans; Male; Mouth Breathing; Nose; Nose Diseases; Peak Expiratory Flow Rate; Pregnenediones; Respiratory Function Tests

When ventilating large volumes of air during exercise, airway fluid secretion is essential for airway function. Since these are impaired in cystic fibrosis and exercise-induced asthma, it was the aim of this study to determine how exercise affects airway Na(+) and Cl(-) transport and whether changes depend on exercise intensity. Nasal potential was measured in Ringer's solution, with amiloride to block Na(+) transport, and in low chloride-containing isoproterenol to assess Cl(-) channels. Nasal potential was measured at rest and during submaximal and maximal bicycle ergometer exercise in individuals with cystic fibrosis, exercise-induced asthma and controls. At rest, nasal potential was significantly higher in cystic fibroses than in the others. Maximal exercise decreased nasal potentials in cystic fibrosis and controls but not in exercise asthma. Submaximal exercise decreased nasal potentials only in cystic fibrosis. Cl(-) transport was not affected. Our results indicate that nasal potentials and Na(+) transport were decreased by maximal exercise in healthy and cystic fibrosis, whereas submaximal exercise decreased potentials in cystic fibrosis only. Exercise did not affect nasal potentials in asthmatics. Decreased reabsorption during exercise might favour airway fluid secretion during hyperpnoea. This protective effect appears blunted in patients with exercise-induced asthma.

Topics: Adult; Amiloride; Asthma, Exercise-Induced; Chloride Channels; Cystic Fibrosis; Exercise; Exercise Test; Female; Humans; Ion Transport; Isoproterenol; Male; Membrane Potentials; Nose; Sodium; Sodium Channel Blockers; Treatment Outcome; Young Adult

The major cause of exercise-induced asthma (EIA) is thought to be the drying and cooling of the airways during the 'conditioning' of the inspired air. Nasal breathing increases the respiratory system's ability to warm and humidity the inspired air compared to oral breathing and reduces the drying and cooling effects of the increased ventilation during exercise. This will reduce the severity of EIA provoked by a given intensity and duration of exercise. The purpose of the study was to determine the exercise intensity (%VO2 max) at which healthy subjects, free from respiratory disease, could perform while breathing through the nose-only and to compare this with mouth-only and mouth plus nose breathing. Twenty subjects (11 males and 9 females) ranging from 18-55 years acted as subjects in this study. They were all non-smokers and non-asthmatic. At the time of the study, all subjects were involved in regular physical activity and were classified, by a physician, as free from nasal polyps or other nasal obstruction. The percentage decrease in maximal ventilation with nose-only breathing compare to mouth and mouth plus nose breathing was three times the percentage decrease in maximal oxygen consumption. The pattern of nose-only breathing at maximal work showed a small reduction in tidal volume and large reduction in breathing frequency. Nasal breathing resulted in a reduction in FEO2 and an increase in FECO2. While breathing through the nose-only, all subjects could attain a work intensity great enough to produce an aerobic training effect (based on heart rate and percentage of VO2 max).

Topics: Adolescent; Adult; Asthma, Exercise-Induced; Carbon Dioxide; Exercise Tolerance; Female; Heart Rate; Humans; Male; Maximal Voluntary Ventilation; Middle Aged; Mouth Breathing; Nose; Oxygen; Oxygen Consumption; Physical Exertion; Pulmonary Ventilation; Respiration; Running; Spirometry; Tidal Volume; Vital Capacity

Topics: Asthma; Asthma, Exercise-Induced; Bronchi; Humans; Nose

Exercise-induced change of nasal resistance and forced expiratory volume in 1 second (FEV1.0) were studied in 30 asthmatic children and seven normal children. Exercise-induced asthma (EIA) was diagnosed in 19 (63%) of the 30 asthmatic patients. Unilateral complete nasal blockage after exercise (exercise-induced nasal obstruction [EINO]) was found in nine (30%) of the 30 asthmatic patients. A marked decrease in nasal resistance took place immediately or 4 minutes after exercise in all cases. EIA is most severe 5 minutes after exercise, and EINO took place 14 or 19 minutes after exercise. The seven normal children had neither EIA nor EINO. The pathophysiologic relationship between EIA and EINO is discussed.

Topics: Adolescent; Airway Resistance; Asthma; Asthma, Exercise-Induced; Child; Female; Forced Expiratory Volume; Humans; Male; Nose

The effect of nasal as well as oral breathing during level-ground running for 6 min on the post exercise bronchial response was studied in fifteen people (five asthmatics with exercise liability, five asthmatics with no such liability and five normals). Each patient did the exercise twice; once with the nose clipped and once with the mouth closed. FEV1 was measured before exercise, immediately after exercise and at 5, 10, 15, 20 and 30 min thereafter. A fall in FEV1 of 20% or more from the basal level was taken as evidence of bronchoconstriction. When the patients were required to breath only through the nose during the exercise, the post-exercise bronchoconstrictive response was markedly reduced as compared with the response obtained by oral breathing during exercise, indicating a beneficial effect of nasal breathing. Nasal breathing was beneficial as compared with oral breathing in normals as well. In the five asthmatics with no exercise liability no appreciable difference was observed. This study suggests that the oropharynx and nasopharynx play important roles in the causation of exercise-induced asthma.

Topics: Adolescent; Adult; Asthma; Asthma, Exercise-Induced; Child; Female; Forced Expiratory Volume; Humans; Male; Mouth; Nose; Respiration