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Seasonal effect on exercise challenge tests for the diagnosis of exercise-induced bronchoconstriction

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Exercise challenge test (ECT) may help in the diagnosis of asthma. Asthma is season dependent (relative summer nadir).This study was designed to prospectively show that ECT sensitivity decreases when performed in summer and/or out of personal asthma season. We performed two ECTs in 49 patients with suspected asthma, at baseline and at least 6 months later. Test positivity was defined as a ≥10% drop of forced expiratory volume in 1 second after exercise. Patients were defined as having exercise-induced bronchoconstriction (EIB) if at least one of the two tests was positive. We analyzed the impact of season and of patient-reported asthma season on ECT sensitivity. We performed 21 ECTs in the summer and 77 in other seasons. Summer tests were positive in 14.3% of patients versus 33.8% in other seasons (p = 0.11). In patients with confirmed EIB, the sensitivity (95% CI) of a summer test was 0.25 (0.007‐0.57), compared with 0.76 (0.58‐0.89) in other seasons. Tests performed out of personal asthma season were positive in 10.0% of tests compared with 37.1% of tests during personal asthma season (p = 0.007). In patients with confirmed EIB, the sensitivity (95% CI) of a test performed out of asthma season was 0.27 (0.07‐0.61), compared with 0.74 (0.55‐0.87) during season. The sensitivity of ECT performed in the summer or outside of the personal asthma season is about one-third of ECT performed not in the summer or during personal asthma season. We suggest performing ECTs during personal asthma season and not in the summer if there is no asthma season known.
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Keywords: Airway hyperresponsiveness; asthma; exercise challenge test; exercise-induced bronchoconstriction; seasonality; sensitivity; summer

Document Type: Research Article

Affiliations: Pediatric Pulmonology, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel

Publication date: September 1, 2012

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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