Abstract
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 language | English |
|---|---|
| Pages (from-to) | 2647-2655 |
| Number of pages | 9 |
| Journal | Pediatric Pulmonology |
| Volume | 58 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2023 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.
Funding
R. B. Y. is the guarantor of the content of the manuscript, including the data and analysis. M. H., M. G., G. S., Y. B. D., and F. H. contributed substantially to data acquisition and analysis and interpretation and revised the work critically for important intellectual content. I. S., G. G., L. B., and R. B. Y. contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript. I. S. drafted the manuscript and G. G., L. B., and R. B. Y. revised it critically for important intellectual content. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The authors acknowledge the statistical help of Mrs. R. Leiba from the Medical Statistics Unit, Rambam Health Care Campus.
Keywords
- exercise challenge test
- exercise-induced bronchoconstriction
- nose clip