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Paed Asthma – Improvement in peak flow readings

Evidence Summary
Several studies including systematic reviews commented on the effect of physical activity on lung function measurements in asthmatic groups. The spirometric values looked at were forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in six seconds (FEV6) and peak expiratory flow (PEF).

Some cross-sectional studies showed no difference in spirometric values in asthmatic children and adolescents between those who self-reported themselves as either sedentary, active and very active. In physical activity intervention-based studies, improvements (from small to significant) were seen in spirometric values across all measurements compared to control groups however some studies also showed no significant changes. Respiratory muscle strength increased significantly in one study within the exercise intervention group. Maximum inspiratory and expiratory pressures were used as a surrogate marker.

No studies commented on a worsening of spirometry results in exercise groups or asthma exacerbation in the physical activity intervention groups. Most studies only assessed mild to moderate asthmatics and excluded those with severe or unstable disease.


Quality of Evidence
Grade B – moderate quality
Strength of Recommendation
1C. Strong recommendation, low quality evidence due to contradictory statements regarding the level of improvement in spirometric results seen from no improvement to significant.


Conclusion
Spirometric readings are a standardised, commonly used clinical assessment tool for the assessment of asthma. Studies looking at the effect of physical activity on spirometric values have not shown any worsening of these levels and in some studies have shown significant improvements. Strength based protocols such as FEV1, FEV6, and PEF were shown to be improved more so than a lung capacity assessment (FVC) possibly due to an increase in respiratory muscle strength. No study showed a negative effect on spirometric values suggesting there is no harmful effect of lung function with physical activity.


References
Andrade, L. B., M. C. Britto, N. Lucena-Silva, R. G. Gomes and J. N. Figueroa (2014). “The efficacy of aerobic training in improving the inflammatory component of asthmatic children. Randomized trial.” Respir Med 108(10): 1438-1445.
Beggs, S., Y. C. Foong, H. C. Le, D. Noor, R. Wood-Baker and J. A. Walters (2013). “Swimming training for asthma in children and adolescents aged 18 years and under.” Paediatr Respir Rev 14(2): 96-97.
Geiger, K. R. and N. Henschke (2015). “Swimming for children and adolescents with asthma.” Br J Sports Med 49(12): 835-836.
Joschtel, B., S. R. Gomersall, S. Tweedy, H. Petsky, A. B. Chang and S. G. Trost (2018). “Effects of exercise training on physical and psychosocial health in children with chronic respiratory disease: a systematic review and meta-analysis.” BMJ Open Sport Exerc Med 4(1): e000409.
Latorre-Roman, P. A., A. V. Navarro-Martinez and F. Garcia-Pinillos (2014). “The effectiveness of an indoor intermittent training program for improving lung function, physical capacity, body composition and quality of life in children with asthma.” J Asthma 51(5): 544-551.
Matsunaga, N. Y., M. S. Oliveira, A. M. Morcillo, J. D. Ribeiro, M. Ribeiro and A. Toro (2017). “Physical activity and asthma control level in children and adolescents.” Respirology 22(8): 1643-1648.
Onur, E., C. Kabaroglu, O. Gunay, A. Var, O. Yilmaz, P. Dundar, C. Tikiz, Y. Guvenc and H. Yuksel (2011). “The beneficial effects of physical exercise on antioxidant status in asthmatic children.” Allergol Immunopathol (Madr) 39(2): 90-95.
Wang, J. S. and W. P. Hung (2009). “The effects of a swimming intervention for children with asthma.” Respirology 14(6): 838-842.
Wanrooij, V. H., M. Willeboordse, E. Dompeling and K. D. van de Kant (2014). “Exercise training in children with asthma: a systematic review.” Br J Sports Med 48(13): 1024-1031.
Zhang, Y. F. and L. D. Yang (2019). “Exercise training as an adjunctive therapy to montelukast in children with mild asthma: A randomized controlled trial.” Medicine (Baltimore) 98(2): e14046.

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