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Asma y Ejercicio
Josep Morera Barcelona. Octubre 2016
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Asma y Ejercicio
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Asma y Ejercicio
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Asma y Ejercicio
1.-‐ Definición/Concepto 2.-‐ Prevalencia/Epidemiologia 3.-‐ Fisiopatología/E@ología 4.-‐ Tratamiento 5.-‐ Diagnós@co Diferencial 6.-‐ Conclusiones
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Asma y Ejercicio
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Asma y Ejercicio
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Asma y Ejercicio
An Official American Thoracic Society Clinical PracCce Guideline: Exercise-‐induced BronchoconstricCon Jonathan P. Parsons, Teal S. Hallstrand, John G. Mastronarde, David A. Kaminsky, Kenneth W. Rundell, James H. Hull, William W. Storms, John M. Weiler, Fern M. Cheek, Kevin C. Wilson, and Sandra D. Anderson;
Volume 187, Issue 9(May 1, 2013)
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Asma y Ejercicio
Volume 63, Issue 8 August 2008 Pages 953–961
Exercise-‐induced hypersensiCvity syndromes in recreaConal and compeCCve athletes: a PRACTALL consensus report (what the general pracCConer should know about sports and allergy) Schwartz LB1, Delgado L, Craig T, Bonini S, Carlsen KH, Casale TB, Del Giacco S, Drobnic F, van Wijk RG, Ferrer M, Haahtela T, Henderson WR, Israel E, Lötvall J, Moreira A, Papadopoulos NG, Randolph CC, Romano A, Weiler JM.
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Asma y Ejercicio
Volume 63, Issue 5 May 2008 Pages 492–505
Treatment of exercise-‐induced asthma, respiratory and allergic disorders in sports and the relaConship to doping: Part II of the report from the Joint Task Force of European Respiratory Society (ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperaCon with GA(2)LEN. Carlsen KH1, Anderson SD, Bjermer L, Bonini S, Brusasco V, Canonica W, Cummiskey J, Delgado L, Del Giacco SR, Drobnic F, Haahtela T, Larsson K, Palange P, Popov T, van Cauwenberge P; European Respiratory Society; European Academy of Allergy and Clinical Immunology; GA(2)LEN.
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Asma y Ejercicio
La broncoconstricción/hiperreacCvidad inducida por ejercicio (EIB),se refiere a un “estrechamiento”de las vías aéreas como resultado del ejercicio. Los asmáCcos con gran frecuencia sufren EIB El asma inducido por ejercicio (EIA) es un concepto que se solapa con el de EIB El asma bronquial en los Atletas de Elite es una situación clínica que se solapa con las anteriores El EIB ha recibido otros nombres como“THERMALLY BRONCHOCONSTRICTION”
An Official American Thoracic Society Clinical Prac5ce Guideline: Exercise-‐induced Bronchoconstric5on
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Asma y Ejercicio
-‐ Clínica suges@va(Tos, disnea,@rantez torácica,sibilantes postejercicio
-‐ FEV1 pre-‐post ejercicio(FEV ≥ al 10%)
-‐ Test específicos de ejercicio
-‐ Test de provocación con Metacolina y/o Manitol
-‐ Otros: PEAK FLOW (gráfica) ÓXIDO NÍTRICO EXHALADO (FENO) Inhalación hiperesmolar de aerosoles 4.5% salinos Hiperepnea eucapníca voluntaria
An Official American Thoracic Society Clinical Prac5ce Guideline: Exercise-‐induced Bronchoconstric5on
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Asma y Ejercicio
An Official American Thoracic Society Clinical Prac5ce Guideline: Exercise-‐induced Bronchoconstric5on
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Asma y Ejercicio
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Asma y Ejercicio
-‐ Muy frecuente
-‐ Variable según países y áreas
-‐ Entre 20-‐50% de asmá@cos @enen asma inducido al esfuerzo
-‐ Entre los depor@stas de Elite varia entre un 15-‐75%
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Asma y Ejercicio
Exercise-‐induced wheeze, urgent medical visits, and neighborhood asthma prevalence.
Map of New York City depicting study subjects’ places of residence overlaying neighborhood asthma prevalence.
Timothy R. Mainardi et al. Pediatrics 2013;131:e127-e135
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Asma y Ejercicio
Percentage of athletes no@fying (Sydney) or approved (Salt Lake City, Athens, Torino) for b2-‐agonist use and the percentage of individual medals won by these athletes at the 2000 to 2006 Olympic Games.
FITCH ET AL 260.e7 VOLUME 122,NUMBER 2
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Asma y Ejercicio
K.H. Carlsen et al.
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Asma y Ejercicio
-‐ Enfriamiento de la mucosa -‐ Calentamiento de la mucosa -‐ Aumento de la circulación bronquial submucosa -‐ Atopia/Alergia -‐ Mayor exposición a polen y a otros alérgenos -‐ Exposición a Cloro -‐ Exposición a Ozono/otras poluciones ambientales -‐ Exposición a PM10 por fuel en hielo ar@ficial -‐ Inflamación eosinovlica/neutrovlica -‐ Remodelamiento -‐ Otros
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Asma y Ejercicio
N Engl J Med 1977; 297:743-‐747October 6, 1977
N Engl J Med 1987; 317:502-‐504,
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Asma y Ejercicio
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
Inhala@on Toxicology, 15:237–250, 2003
21
Asma y Ejercicio
Bronchoscopy and bronchoalveolar lavage findings in cross-‐country skiers with and without "ski asthma”.Sue-‐Chu M1, Larsson L, Moen T, Rennard SI, Bjermer L.
Eur Respir J. 1999 Mar;13(3):626-‐32.
22
Asma y Ejercicio
23
Asma y Ejercicio
AM J RESPIR CRIT CARE MED 2000;161:1047–1050.
24
Asma y Ejercicio
Exhaled breath condensate cysteinyl leukotrienes are increased in children with exercise-‐induced bronchoconstricCon. Carraro S1, Corradi M, Zanconato S, Alinovi R, Pasquale MF, Zacchello F, Baraldi E.
2005 Apr;115(4):764-‐70.
25
Asma y Ejercicio
J Allergy Clin Immunol. 2005 Sep; 116(3): 586–593.
Airway immunopathology of asthma with exercise-‐induced bronchoconstricCon. Hallstrand TS1, Moody MW, Aitken ML, Henderson WR Jr.
26
Asma y Ejercicio
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
VOL 161 2000
27
Asma y Ejercicio
28
Asma y Ejercicio
MEDICINE & SCIENCE IN SPORTS & EXERCISE® 2003
29
Asma y Ejercicio
Role of MUC5AC in the pathogenesis of exercise-‐induced bronchoconstricCon. Hallstrand, Debley, Farin, Henderson.
CONCLUSIONS: These data indicate that (1) the predominant gel-‐forming mucin expressed in induced sputum of paCents with asthma with EIB is MUC5AC; (2) an increase in MUC5AC gene expression and release of MUC5AC protein occurs acer exercise challenge; and (3) MUC5AC release may occur through the cysLT-‐associated acCvaCon of sensory airway nerves
J Allergy Clin Immunol. 2007 May;119(5):1092-‐8
30
Asma y Ejercicio
The PotenCal Role of 8-‐Oxoguanine DNA Glycosylase-‐Driven DNA Base Excision Repair in Exercise-‐Induced Asthma. Belanger KK1, Ameredes BT2, Boldogh I3, Aguilera-‐Aguirre L4.
2016 Jul 25
31
Asma y Ejercicio
The PotenCal Role of 8-‐Oxoguanine DNA Glycosylase-‐Driven DNA Base Excision Repair in Exercise-‐Induced Asthma.Belanger KK1, Ameredes BT2, Boldogh I3, Aguilera-‐Aguirre L4.
2016 Jul 25
32
Asma y Ejercicio Transglutaminase 2, a novel regulator of eicosanoid producCon in asthma revealed by genome-‐wide expression profiling of disCnct asthma phenotypes.Hallstrand TS1, Wurfel MM, Lai Y, Ni Z, Gelb MH, Altemeier WA, Beyer RP, Aitken ML, Henderson WR.
Figure 1. Comparison of lung funcCon and gene expression between asthmaCcs with EIB and an asthmaCc control group without EIB.
(2010) PLoS ONE 5(1)
33
Asma y Ejercicio
34
Asma y Ejercicio
CombinaCon of budesonide/formoterol on demand improves asthma control by reducing exercise-‐induced bronchoconstricCon.Lazarinis N1, Jørgensen L, Ekström T, Bjermer L, Dahlén B, Pullerits T, Hedlin G, Carlsen KH, Larsson K.
2014 Feb;69(2):130-‐6.
35
Asma y Ejercicio
Nedocromil sodium in the treatment of exercise-‐induced asthma: a meta-‐analysis. Spooner C1, Rowe BH, Saunders LD.
Eur Respir J. 2000 Jul;16(1):30-‐7
36
Asma y Ejercicio
Dietary salt, airway inflammaCon, and diffusion capacity in exercise-‐induced asthma. Mickleborough TD1, Lindley MR, Ray
S.Med Sci Sports Exerc. 2005 Jun;37(6):904-‐14.
37
Asma y Ejercicio
Treatment of exercise-‐induced asthma, respiratory and allergic disorders in sports and the relaConship to doping: Part II of the report from the Joint Task Force of European Respiratory Society (ERS) and European Academy of Allergy and Clinical Immunology (EAACI) in cooperaCon with GA2LEN* K. H. Carlsen1, S. D. Anderson2, L. Bjermer3, S. Bonini4, V. Brusasco5, W. Canonica6, J. Cummiskey7, L. Delgado8, S. R. Del Giacco9, F. Drobnic10, T. Haahtela11, K. Larsson12, P. Palange13, T. Popov14, P. van Cauwenberge15.
Allergy 2008: 63: 492–505
38
Asma y Ejercicio
1.-‐ Disfunción de cuerdas vocales 2.-‐ Anemia 3.-‐ Miocardiopa{a hipertrófica 4.-‐ Obesidad/ no fitness 5.-‐ Disnea Psicógena 6.-‐ Uso de β-bloqueantes 7.-‐ TEP agudo/crónico 8.-‐ Mal de montaña 9.-‐ Edema agudo de pulmón 10.-‐ Otros
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
39
Asma y Ejercicio
Vocal cord dysfuncCon in paCents with exerConal dyspnea.Morris MJ1, Deal LE, Bean DR, Grbach VX, Morgan JA.
PATIENTS:Forty military paCents with complaints of exerConal dyspnea and 12 military asymptomaCc control subjects.
CONCLUSIONS:Paradoxical inspiratory vocal cord closure is a frequent occurrence in paCents with symptoms of exerConal dyspnea and should be strongly considered in their evaluaCon.
1999 Dec;116(6):1676-‐82
40
Asma y Ejercicio
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
Article original
L’œdeme pulmonaire en plongee sous-marine autonome :frequence et gravite a propos d’une serie de 19 cas
Pulmonary oedema in scuba-diving: Frequency and seriousnessabout a series of 19 cases
A. Henckes, F. Lion, G. Cochard *, J. Arvieux, C.-C. ArvieuxPole anesthesie–reanimation–Samu, unite de medecine hyperbare, departement d’anesthesie-reanimation,
hopital de la-Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Recu le 21 fevrier 2008 ; accepte le 19 mai 2008
Disponible sur Internet le 31 juillet 2008
Resume
Objectifs. – L’œdeme pulmonaire en plongee sous-marine en scaphandre autonome est un accident dont les facteurs de risque, les conditions desurvenue et l’incidence sont encore mal connus. Le but de cette etude a ete d’etudier la frequence, les facteurs de risque et l’evolution de cetaccident.Type d’etude. – Etude retrospective des cas et prospective de frequence.Patients et methodes. – Etude en deux volets aux objectifs distincts dans la region Bretagne : premierement, analyse de cas pris en charge de 2002 a2007 ; deuxiemement, etude sur une annee des cas recueillis aupres des medecins de premier recours. Le diagnostic a ete etabli sur des elements del’anamnese, un tableau de detresse respiratoire, une auscultation et une imagerie evocatrices.Resultats. – Dix-neuf cas ont ete analyses, dont un recidivant. La moyenne d’age etait de 49 ans. Des plongeurs indemnes de pathologie cardiaqueetaient concernes, ainsi que des hypertendus (huit cas) et des porteurs de valvulopathie (trois cas). Les plongees en cause etaient sources de stress et/oud’effort. La dyspnee, la toux et l’hemoptysie etaient frequentesmais on relevait deux cas d’arret cardiorespiratoire et trois cas de perte de connaissance.La radiographie pulmonaire manquait de sensibilite (normale dans quatre cas), le scanner thoracique n’etait jamais normal. L’evolution etaitrapidement favorable sous oxygenotherapie sauf pour deux plongeurs qui sont decedes. Cinq cas ont ete recueillis sur un an dont un mortel.Conclusion. – Accident non rare, potentiellement grave a ne pas sous-estimer, touchant preferentiellement le plongeur age en conditions de stresset/ou d’effort.# 2008 Elsevier Masson SAS. Tous droits reserves.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions ofoccurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.Study design. – Retrospective case study and prospective frequency study.Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosedbetween 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress,auscultation and radiologic features.Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease wereinvolved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved.Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousnesswere observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptomsresolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal.
http://france.elsevier.com/direct/ANNFAR/
Disponible en ligne sur www.sciencedirect.com
Annales Francaises d’Anesthesie et de Reanimation 27 (2008) 694–699
* Auteur correspondant.
Adresse e-mail : [email protected] (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits reserves.doi:10.1016/j.annfar.2008.05.011
Article original
L’œdeme pulmonaire en plongee sous-marine autonome :frequence et gravite a propos d’une serie de 19 cas
Pulmonary oedema in scuba-diving: Frequency and seriousnessabout a series of 19 cases
A. Henckes, F. Lion, G. Cochard *, J. Arvieux, C.-C. ArvieuxPole anesthesie–reanimation–Samu, unite de medecine hyperbare, departement d’anesthesie-reanimation,
hopital de la-Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Recu le 21 fevrier 2008 ; accepte le 19 mai 2008
Disponible sur Internet le 31 juillet 2008
Resume
Objectifs. – L’œdeme pulmonaire en plongee sous-marine en scaphandre autonome est un accident dont les facteurs de risque, les conditions desurvenue et l’incidence sont encore mal connus. Le but de cette etude a ete d’etudier la frequence, les facteurs de risque et l’evolution de cetaccident.Type d’etude. – Etude retrospective des cas et prospective de frequence.Patients et methodes. – Etude en deux volets aux objectifs distincts dans la region Bretagne : premierement, analyse de cas pris en charge de 2002 a2007 ; deuxiemement, etude sur une annee des cas recueillis aupres des medecins de premier recours. Le diagnostic a ete etabli sur des elements del’anamnese, un tableau de detresse respiratoire, une auscultation et une imagerie evocatrices.Resultats. – Dix-neuf cas ont ete analyses, dont un recidivant. La moyenne d’age etait de 49 ans. Des plongeurs indemnes de pathologie cardiaqueetaient concernes, ainsi que des hypertendus (huit cas) et des porteurs de valvulopathie (trois cas). Les plongees en cause etaient sources de stress et/oud’effort. La dyspnee, la toux et l’hemoptysie etaient frequentesmais on relevait deux cas d’arret cardiorespiratoire et trois cas de perte de connaissance.La radiographie pulmonaire manquait de sensibilite (normale dans quatre cas), le scanner thoracique n’etait jamais normal. L’evolution etaitrapidement favorable sous oxygenotherapie sauf pour deux plongeurs qui sont decedes. Cinq cas ont ete recueillis sur un an dont un mortel.Conclusion. – Accident non rare, potentiellement grave a ne pas sous-estimer, touchant preferentiellement le plongeur age en conditions de stresset/ou d’effort.# 2008 Elsevier Masson SAS. Tous droits reserves.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions ofoccurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.Study design. – Retrospective case study and prospective frequency study.Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosedbetween 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress,auscultation and radiologic features.Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease wereinvolved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved.Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousnesswere observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptomsresolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal.
http://france.elsevier.com/direct/ANNFAR/
Disponible en ligne sur www.sciencedirect.com
Annales Francaises d’Anesthesie et de Reanimation 27 (2008) 694–699
* Auteur correspondant.
Adresse e-mail : [email protected] (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits reserves.doi:10.1016/j.annfar.2008.05.011
41
Asma y Ejercicio
Swimming-‐induced pulmonary edema: clinical presentaCon and serial lung funcCon. Adir Y1, Shupak A, Gil A, Peled N, Keynan Y, Domachevsky L, Weiler-‐Ravell D. Chest. 2004 Aug;126(2):394-‐9.
42
Asma y Ejercicio
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
Article original
L’œdeme pulmonaire en plongee sous-marine autonome :frequence et gravite a propos d’une serie de 19 cas
Pulmonary oedema in scuba-diving: Frequency and seriousnessabout a series of 19 cases
A. Henckes, F. Lion, G. Cochard *, J. Arvieux, C.-C. ArvieuxPole anesthesie–reanimation–Samu, unite de medecine hyperbare, departement d’anesthesie-reanimation,
hopital de la-Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Recu le 21 fevrier 2008 ; accepte le 19 mai 2008
Disponible sur Internet le 31 juillet 2008
Resume
Objectifs. – L’œdeme pulmonaire en plongee sous-marine en scaphandre autonome est un accident dont les facteurs de risque, les conditions desurvenue et l’incidence sont encore mal connus. Le but de cette etude a ete d’etudier la frequence, les facteurs de risque et l’evolution de cetaccident.Type d’etude. – Etude retrospective des cas et prospective de frequence.Patients et methodes. – Etude en deux volets aux objectifs distincts dans la region Bretagne : premierement, analyse de cas pris en charge de 2002 a2007 ; deuxiemement, etude sur une annee des cas recueillis aupres des medecins de premier recours. Le diagnostic a ete etabli sur des elements del’anamnese, un tableau de detresse respiratoire, une auscultation et une imagerie evocatrices.Resultats. – Dix-neuf cas ont ete analyses, dont un recidivant. La moyenne d’age etait de 49 ans. Des plongeurs indemnes de pathologie cardiaqueetaient concernes, ainsi que des hypertendus (huit cas) et des porteurs de valvulopathie (trois cas). Les plongees en cause etaient sources de stress et/oud’effort. La dyspnee, la toux et l’hemoptysie etaient frequentesmais on relevait deux cas d’arret cardiorespiratoire et trois cas de perte de connaissance.La radiographie pulmonaire manquait de sensibilite (normale dans quatre cas), le scanner thoracique n’etait jamais normal. L’evolution etaitrapidement favorable sous oxygenotherapie sauf pour deux plongeurs qui sont decedes. Cinq cas ont ete recueillis sur un an dont un mortel.Conclusion. – Accident non rare, potentiellement grave a ne pas sous-estimer, touchant preferentiellement le plongeur age en conditions de stresset/ou d’effort.# 2008 Elsevier Masson SAS. Tous droits reserves.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions ofoccurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.Study design. – Retrospective case study and prospective frequency study.Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosedbetween 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress,auscultation and radiologic features.Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease wereinvolved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved.Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousnesswere observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptomsresolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal.
http://france.elsevier.com/direct/ANNFAR/
Disponible en ligne sur www.sciencedirect.com
Annales Francaises d’Anesthesie et de Reanimation 27 (2008) 694–699
* Auteur correspondant.
Adresse e-mail : [email protected] (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits reserves.doi:10.1016/j.annfar.2008.05.011
Article original
L’œdeme pulmonaire en plongee sous-marine autonome :frequence et gravite a propos d’une serie de 19 cas
Pulmonary oedema in scuba-diving: Frequency and seriousnessabout a series of 19 cases
A. Henckes, F. Lion, G. Cochard *, J. Arvieux, C.-C. ArvieuxPole anesthesie–reanimation–Samu, unite de medecine hyperbare, departement d’anesthesie-reanimation,
hopital de la-Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Recu le 21 fevrier 2008 ; accepte le 19 mai 2008
Disponible sur Internet le 31 juillet 2008
Resume
Objectifs. – L’œdeme pulmonaire en plongee sous-marine en scaphandre autonome est un accident dont les facteurs de risque, les conditions desurvenue et l’incidence sont encore mal connus. Le but de cette etude a ete d’etudier la frequence, les facteurs de risque et l’evolution de cetaccident.Type d’etude. – Etude retrospective des cas et prospective de frequence.Patients et methodes. – Etude en deux volets aux objectifs distincts dans la region Bretagne : premierement, analyse de cas pris en charge de 2002 a2007 ; deuxiemement, etude sur une annee des cas recueillis aupres des medecins de premier recours. Le diagnostic a ete etabli sur des elements del’anamnese, un tableau de detresse respiratoire, une auscultation et une imagerie evocatrices.Resultats. – Dix-neuf cas ont ete analyses, dont un recidivant. La moyenne d’age etait de 49 ans. Des plongeurs indemnes de pathologie cardiaqueetaient concernes, ainsi que des hypertendus (huit cas) et des porteurs de valvulopathie (trois cas). Les plongees en cause etaient sources de stress et/oud’effort. La dyspnee, la toux et l’hemoptysie etaient frequentesmais on relevait deux cas d’arret cardiorespiratoire et trois cas de perte de connaissance.La radiographie pulmonaire manquait de sensibilite (normale dans quatre cas), le scanner thoracique n’etait jamais normal. L’evolution etaitrapidement favorable sous oxygenotherapie sauf pour deux plongeurs qui sont decedes. Cinq cas ont ete recueillis sur un an dont un mortel.Conclusion. – Accident non rare, potentiellement grave a ne pas sous-estimer, touchant preferentiellement le plongeur age en conditions de stresset/ou d’effort.# 2008 Elsevier Masson SAS. Tous droits reserves.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions ofoccurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.Study design. – Retrospective case study and prospective frequency study.Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosedbetween 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress,auscultation and radiologic features.Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease wereinvolved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved.Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousnesswere observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptomsresolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal.
http://france.elsevier.com/direct/ANNFAR/
Disponible en ligne sur www.sciencedirect.com
Annales Francaises d’Anesthesie et de Reanimation 27 (2008) 694–699
* Auteur correspondant.
Adresse e-mail : [email protected] (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits reserves.doi:10.1016/j.annfar.2008.05.011
2013 Jan 19;381(9862):242-‐55. Br J Sports Med 2012;46(Suppl I):i69–i77.
43
Asma y Ejercicio
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
2088
AMERICAN JOURNAL O F RESPIRATORY AN D CRITICAL CARE MEDICINE VOL 161 2000
RESULTS
Subject characteristics are presented in Table 1. The bron-chodilator test was negative in all control subjects (change inFEV
1
: 5.4
�
4.1% [mean
�
SD]) and positive in all asthmaticsubjects (29.3
�
17.4%). Thirty (75%) skiers were hyperre-sponsive to methacholine (median PD
20
FEV
1
: 1,246
�
g [IQR:
866 to 1,523]
�
g). Asthmatic symptoms were reported by 21hyperresponsive and five nonhyperresponsive skiers. Of these,six subjects had consulted their physicians and reported theuse of inhaled
�
2
-agonists. Coughing in episodes or in relationto exercise was reported by 26 (65%) skiers. Of 15 (38%) ski-ers with atopy, 12 were hyperresponsive to methacholine.
Inflammatory Cell Counts
Assessable bronchial biopsy specimens were obtained from allsubjects. Because of unavailability of cryosections, neutrophilcounts were not performed in control subjects and in three ski-ers. Data with cell counts are presented in Table 2 and Figures1 and 2
Group analysis showed that skiers had 43-fold (p
�
0.001),26-fold (p
�
0.001), and twofold (p
�
0.001) greater T-lym-phocyte, macrophage, and eosinophil counts, respectively, thandid controls. The skiers’ neutrophil count was significantlygreater than that of the asthmatic subjects, whereas the lympho-cyte count was not significantly different, and the macrophage,eosinophil, and mast cell counts were lower. On subgroupanalysis by nonatopic status, the neutrophil count in skiers wasnot significantly different and the eosinophil count was signifi-cantly lower than in asthmatic subjects. The mast cell countwas greater in skiers than in controls. There were no signifi-cant differences in cell counts in nonhyperresponsive and hy-perresponsive skiers. Both skier groups had greater macroph-age and lymphocyte counts than controls (Figure 3A), whereas
Figure 1. Density (cells/mm�2) ofmacrophages, T lymphocytes, mastcells, and eosinophils in bronchialbiopsy specimens from controls,skiers with and without BHR andasthmatic subjects. Horizontal bar �median value.
Figure 2. Density (cells/mm�2) of neutrophils in bronchial biopsy spec-imens from skiers w ith and w ithout BHR and from asthmatic subjects.Horizontal bar � median value.
Article original
L’œdeme pulmonaire en plongee sous-marine autonome :frequence et gravite a propos d’une serie de 19 cas
Pulmonary oedema in scuba-diving: Frequency and seriousnessabout a series of 19 cases
A. Henckes, F. Lion, G. Cochard *, J. Arvieux, C.-C. ArvieuxPole anesthesie–reanimation–Samu, unite de medecine hyperbare, departement d’anesthesie-reanimation,
hopital de la-Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Recu le 21 fevrier 2008 ; accepte le 19 mai 2008
Disponible sur Internet le 31 juillet 2008
Resume
Objectifs. – L’œdeme pulmonaire en plongee sous-marine en scaphandre autonome est un accident dont les facteurs de risque, les conditions desurvenue et l’incidence sont encore mal connus. Le but de cette etude a ete d’etudier la frequence, les facteurs de risque et l’evolution de cetaccident.Type d’etude. – Etude retrospective des cas et prospective de frequence.Patients et methodes. – Etude en deux volets aux objectifs distincts dans la region Bretagne : premierement, analyse de cas pris en charge de 2002 a2007 ; deuxiemement, etude sur une annee des cas recueillis aupres des medecins de premier recours. Le diagnostic a ete etabli sur des elements del’anamnese, un tableau de detresse respiratoire, une auscultation et une imagerie evocatrices.Resultats. – Dix-neuf cas ont ete analyses, dont un recidivant. La moyenne d’age etait de 49 ans. Des plongeurs indemnes de pathologie cardiaqueetaient concernes, ainsi que des hypertendus (huit cas) et des porteurs de valvulopathie (trois cas). Les plongees en cause etaient sources de stress et/oud’effort. La dyspnee, la toux et l’hemoptysie etaient frequentesmais on relevait deux cas d’arret cardiorespiratoire et trois cas de perte de connaissance.La radiographie pulmonaire manquait de sensibilite (normale dans quatre cas), le scanner thoracique n’etait jamais normal. L’evolution etaitrapidement favorable sous oxygenotherapie sauf pour deux plongeurs qui sont decedes. Cinq cas ont ete recueillis sur un an dont un mortel.Conclusion. – Accident non rare, potentiellement grave a ne pas sous-estimer, touchant preferentiellement le plongeur age en conditions de stresset/ou d’effort.# 2008 Elsevier Masson SAS. Tous droits reserves.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions ofoccurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.Study design. – Retrospective case study and prospective frequency study.Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosedbetween 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress,auscultation and radiologic features.Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease wereinvolved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved.Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousnesswere observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptomsresolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal.
http://france.elsevier.com/direct/ANNFAR/
Disponible en ligne sur www.sciencedirect.com
Annales Francaises d’Anesthesie et de Reanimation 27 (2008) 694–699
* Auteur correspondant.
Adresse e-mail : [email protected] (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits reserves.doi:10.1016/j.annfar.2008.05.011
Article original
L’œdeme pulmonaire en plongee sous-marine autonome :frequence et gravite a propos d’une serie de 19 cas
Pulmonary oedema in scuba-diving: Frequency and seriousnessabout a series of 19 cases
A. Henckes, F. Lion, G. Cochard *, J. Arvieux, C.-C. ArvieuxPole anesthesie–reanimation–Samu, unite de medecine hyperbare, departement d’anesthesie-reanimation,
hopital de la-Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France
Recu le 21 fevrier 2008 ; accepte le 19 mai 2008
Disponible sur Internet le 31 juillet 2008
Resume
Objectifs. – L’œdeme pulmonaire en plongee sous-marine en scaphandre autonome est un accident dont les facteurs de risque, les conditions desurvenue et l’incidence sont encore mal connus. Le but de cette etude a ete d’etudier la frequence, les facteurs de risque et l’evolution de cetaccident.Type d’etude. – Etude retrospective des cas et prospective de frequence.Patients et methodes. – Etude en deux volets aux objectifs distincts dans la region Bretagne : premierement, analyse de cas pris en charge de 2002 a2007 ; deuxiemement, etude sur une annee des cas recueillis aupres des medecins de premier recours. Le diagnostic a ete etabli sur des elements del’anamnese, un tableau de detresse respiratoire, une auscultation et une imagerie evocatrices.Resultats. – Dix-neuf cas ont ete analyses, dont un recidivant. La moyenne d’age etait de 49 ans. Des plongeurs indemnes de pathologie cardiaqueetaient concernes, ainsi que des hypertendus (huit cas) et des porteurs de valvulopathie (trois cas). Les plongees en cause etaient sources de stress et/oud’effort. La dyspnee, la toux et l’hemoptysie etaient frequentesmais on relevait deux cas d’arret cardiorespiratoire et trois cas de perte de connaissance.La radiographie pulmonaire manquait de sensibilite (normale dans quatre cas), le scanner thoracique n’etait jamais normal. L’evolution etaitrapidement favorable sous oxygenotherapie sauf pour deux plongeurs qui sont decedes. Cinq cas ont ete recueillis sur un an dont un mortel.Conclusion. – Accident non rare, potentiellement grave a ne pas sous-estimer, touchant preferentiellement le plongeur age en conditions de stresset/ou d’effort.# 2008 Elsevier Masson SAS. Tous droits reserves.
Abstract
Objectives. – Pulmonary oedema in self-contained underwater breathing apparatus diving is an accident whose risk factors, conditions ofoccurrence and incidence are not well-known. The aim of this study was to evaluate the frequency, the risk factors and the evolution of this accident.Study design. – Retrospective case study and prospective frequency study.Patients and methods. – Study covering the Brittany region and performed in two steps with distinct objectives: a review of cases diagnosedbetween 2002 and 2007, and a one-year study of cases reported by emergency physicians. Diagnosis was based on the history, a respiratory distress,auscultation and radiologic features.Results. – Nineteen cases were reported, of which one was recurrent. The mean age of patients was 49 years. Divers without heart disease wereinvolved, as well as divers with hypertension (eight cases) or valve abnormalities (three cases). Stress and/or physical exertion were involved.Dyspnoea, cough and haemoptysis were the most common symptoms; in addition, two cases of cardiac arrest and three of loss of consciousnesswere observed. Chest radiography was unsensitive (normal in four cases), contrasting with abnormal thoracic CT scan in all cases. Symptomsresolved rapidly with oxygen, except for two divers who died. We identified five cases over one year, one of which lethal.
http://france.elsevier.com/direct/ANNFAR/
Disponible en ligne sur www.sciencedirect.com
Annales Francaises d’Anesthesie et de Reanimation 27 (2008) 694–699
* Auteur correspondant.
Adresse e-mail : [email protected] (G. Cochard).
0750-7658/$ – see front matter # 2008 Elsevier Masson SAS. Tous droits reserves.doi:10.1016/j.annfar.2008.05.011
[Severe forms of effort-‐induced asthma]. [ArCcle in French]Marotel C1, Natali F, Heyraud JD, Vaylet F, L'Her P, Bonnet D, Allard P.Allerg Immunol (Paris). 1989 Feb;21(2):61-‐4.
Abstract Severe reacCons in exercise-‐induced asthma (EIA) seem to be underesCmated in the published literature. We report two cases of near-‐miss death from EIA that occurred acer a short run. We review 364 exercise tests that were performed between September 1987 and October 1988 by a standardised protocol on a treadmill, on paCents with possible EIA. A posiCve test, defined by a fall of FEV1 of at least 20% was found in 173 paCents. From 21 paCents with a fall of greater than 50%, 4 presented severe signs of: Cyanosis. Intense dyspnea with impediment of speech. General malaise with hypertension. These 4 paCents were not greatly different from paCents of the 50% fall group when compared for FEV1 before the test and for heart-‐rate during the test. They differed in the duraCon of the asthma atack, which was more protracted, despite the use of beta-‐2 agonists. The onset of severe reacCons is 2.3% of posiCve tests and seems to be unpredictable.
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Asma y Ejercicio
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Asma y Ejercicio
1.-‐ Existen ma@ces entre EIB y EIA 2.-‐ Ambos, EIB y EIA son muy prevalentes con prevalencias variables 3.-‐ La prevalencia en atletas es mas alta especialmente en esquí de fondo y natación 4.-‐ Los mecanismos fisiopatológicos son varios e históricamente ha predominado la hipótesis de “enfriamiento” de la mucosa 5.-‐ El tratamiento fundamental son los β-‐adrenérgicos SABA
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