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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.

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.

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