The effect of nose clip on exercise-induced bronchoconstriction in adolescents

Ilia Spivak, Guy Gut, Moneera Hanna, Michal Gur, George Shallufi, Yael Ben-David, Vered Nir, Fahed Hakim, Lea Bentur, Ronen Bar-Yoseph

Research output: Contribution to journalArticlepeer-review


Background: Oral breathing is considered to increase hyper-responsiveness of the airways. Data on the need for nose clip (NC) during exercise challenge test (ECT) in children and adolescents is scarce. Ouraim was to evaluate the role of NC during ECT in children and adolescents. Methods: A prospective, cohort study; children referred for ECT were evaluated on two separate visits, with and without a NC. Demographic, clinical data and measurements of lung functions were recorded. Allergy and asthma control were evaluated by Total Nasal Symptoms Score (TNSS) and Asthma Control Test (ACT) questionnaires. Results: Sixty children and adolescents (mean age 16.7 ± 1.1 years, 38% Female,) performed ECT with NC and 48 (80%) completed visit 2 (ECT without NC), 8.7 ± 7.9 days after visit 1. Following exercise, 29/48 patients (60.4%) with NC had a decline of ≥12% in forced expiratory volume in the first second (FEV1) (positive ECT) compared to only 16/48 (33.3%) positive tests without NC (p = 0.0008). Test result was changed in 14 patients from positive ECT (with NC) to negative ECT (no NC) and in only one patient from negative to positive. The use of NC resulted in greater FEV1 decline (median 16.3% predicted, IQR 6.0−19.1% predicted vs. median 4.5% predicted, IQR 1.6−18.4% predicted, p = 0.0001), and better FEV1 increase after bronchodil at or inhalation compared to ECT without NC. Higher TNSS scores did not predict higher probability to positive ECT. Conclusions: The use of NC during ECT increases detection rate of exercise induced bronchoconstriction during ECT in the pediatric population. These findings strengthen the recommendation of nasal blockage during ECT in children and adolescents.

Original languageEnglish
Pages (from-to)2647-2655
Number of pages9
JournalPediatric Pulmonology
Issue number9
StatePublished - Sep 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.


  • exercise challenge test
  • exercise-induced bronchoconstriction
  • nose clip


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