Exercise-induced bronchospasm, asthma control, and obesity.

Exercise-induced bronchospasm (EIB) commonly affects patients with asthma. However, the relationship between EIB and asthma control remains unclear. Exercise limitation due to asthma might lead to reduced physical activity, but little information is available regarding obesity and EIB in asthma. A recent survey evaluated the frequency of EIB and exercise-related respiratory symptoms in a large number of patients with asthma. The survey results were reanalyzed to address any relationship between EIB and asthma control and obesity. A nationwide random sample of children aged 4–12 years (n 250), adolescents aged 13–17 years (n 266), and adults aged 18 years (n 1001) with asthma were interviewed by telephone. Questions in the survey addressed asthma symptoms in general, medication use, and height and weight. Asthma control was categorized using established methods in the Expert Panel Report 3. Body mass index (BMI) was calculated using standard nomograms and obesity was defined as a BMI 30 kg/m. Most children (77.6%), adolescents (71.1%), and adults (83.1%) had either “not well” or “very poorly” controlled asthma. Children with “not well” controlled asthma reported a history of EIB significantly more often than those with “well” controlled” asthma. Asthma patients of all ages who had “not well” and “very poorly” controlled asthma described multiple (four or more) exercise-related respiratory symptoms significantly more often than those with “well-controlled” asthma. Obesity was significantly more common in adolescents with “not well” and “very poorly” controlled asthma and adults with “very poorly” controlled asthma. Children, adolescents, and adults with asthma infrequently have well-controlled disease. A history of EIB and exercise-related respiratory symptoms occur more commonly in patients with not well and very poorly controlled asthma. Obesity was found more often in adolescents and adults, but not children, with asthma, which was not well and very poorly controlled. (Allergy Asthma Proc 34:342–348, 2013; doi: 10.2500/aap.2013.34.3674) E bronchospasm (EIB) has been estimated to affect up to 90% of asthma patients, but this estimate is based on limited data. The EIB Landmark Survey was, to our knowledge, the first effort to evaluate the frequency of EIB in a large number of asthma patients. In that nationwide survey of randomly selected asthma patients, the reporting rates of EIB varied from 16.3% in children aged 4–12 years to 33.9% in adolescents aged 13–17 years, with 22.8% of adults reporting a history of EIB. Respiratory symptoms with exercise were more frequently reported than a history of EIB. Asthma patients noted that respiratory symptoms frequently interfered with their ability to participate in sports, outdoor activities, and even normal physical activity. The EIB Landmark Survey provides the opportunity to address two other issues of clinical concern. First, respiratory symptoms during exercise are often considered a reflection of poor asthma control. EIB is thought to be more common in patients with more severe or poorly controlled asthma. However, information on the relationship between EIB, exercise-related respiratory symptoms and asthma control is limited. Second, many adolescents and adults in the United States perform insufficient physical activity on a regular basis to maintain good health. Reduced exercise is a concern regarding the development of obesity. Consequently, asthma patients with EIB or multiple exercise-related respiratory symptoms and reduced physical activity might more likely be obese. The objective of this study was to reanalyze the results of the EIB Landmark Survey and to evaluate the relationship between asthma control, determined using the Expert Panel Report 3 (EPR 3) recomFrom the Allergy and Asthma Medical Group and Research Center, San Diego, California, Ohio State University Asthma Center, Columbus, Ohio, Department of Pediatric Pulmonology, University of Louisville, Louisville, Kentucky, Penn State University Allergy, Asthma and Immunology, Hershey, Pennsylvania, Department of Family and Community Medicine, University of Nevada School of Medicine, Reno Nevada, Department of Asthma and Allergy, University of Virginia, Charlottesville, Virginia, and Washington Hospital Center and The George Washington University School of Medicine, Washington, D.C. Additional content is available through the online version of this article on Ingenta Connect. http://ingentaconnect.com/content/ocean/aap/ Funded by Teva Respiratory, LLC NK Ostrom received grant support from Alcon, Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, HRA, MedImmune, Novartis, Proctor & Gamble, Schering-Plough, Sunovion, and Teva and is a consultant for AstraZeneca, ISTA, and Teva and Speaker for AstraZeneca, GlaxoSmithKline, and Teva. JP Parsons is a Consultant for Teva. NS Eid is a Consultant for Teva and Speaker for Teva and Merck. TJ Craig received grant support form Forest, Merck, BI, and Genentech and is Speaker for Teva and Genentech and a Consultant for Merck and BI. S Stoloff received grant support from Teva and is a Consultant for Teva. ML Hayden is a Consultant for Teva and Dey and is Speaker for Merck. GL Colice is a Consultant for Merck, Teva, Prairie, Dey, and Vatera and is Speaker’s Bureau for Merck, Teva, and GSK Address correspondence to Gene Colice, MD.,. Pulmonary, Critical Care, and Respiratory Services, Washington Hospital Center, 110 Irving Street NW, Washington,