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The Airway and Exercise, An Issue of Immunology and Allergy Clinics of North America, E-Book

The Airway and Exercise, An Issue of Immunology and Allergy Clinics of North America, E-Book

J. Tod Olin | James H. Hull

(2018)

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Book Details

Abstract

This issue of Immunology and Allergy Clinics, guest edited by Drs. J. Tod Olin and James H. Hull, is devoted to Exercise-Induced Bronchospasm and Laryngeal Disorders. Articles in this outstanding issue include: Exercise and the Airway: A Call to Action; Exercise and Sinonasal Disease; Exercise-Induced Laryngeal Obstruction History Background; Exercise-Induced Laryngeal Obstruction Diagnostics; Exercise-Induced Laryngeal Obstruction Speech Speech-language Interventions; Exercise-Induced Laryngeal Obstruction Performance Psychology Interventions; Exercise-Induced Laryngeal Obstruction Surgical Interventions; Excessive Dynamic Airways Collapse (EDAC); Exercise-Induced Bronchospasm Background Prevalence Sport Considerations; Exercise-Induced Bronchospasm Mechanism / Biomarkers; Exercise-Induced Bronchospasm and Environment; Exercise-Induced Bronchospasm Testing; Exercise-Induced Bronchospasm Pharm Therapies with an Eye Towards Athletes; Exercise-Induced Bronchospasm Non- Pharm; and The Future of EIB and Exercise-Induced Laryngeal Obstruction.

Table of Contents

Section Title Page Action Price
Front Cover Cover
The Airway and\rExercise\r i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents vii
Foreword: Exercise-Induced Airway Dysfunction in Athletes vii
Preface: Exercise and the Total Airway: A Call to Action vii
Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction vii
Exercise-Induced Bronchoconstriction and the Air We Breathe vii
Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations vii
Testing for Exercise-Induced Bronchoconstriction viii
Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes viii
Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction viii
Exercise and Sinonasal Disease viii
Exercise-Induced Laryngeal Obstruction—An Overview ix
Working Towards a Common Transatlantic Approach for Evaluation of Exercise-Induced Laryngeal Obstruction ix
Speech-Language Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction ix
Exercise-Induced Laryngeal Obstruction and Performance Psychology: Using the Mind as a Diagnostic and Therapeutic Target ix
Surgical Intervention for Exercise-Induced Laryngeal Obstruction x
Exertional Dyspnea and Excessive Dynamic Airway Collapse x
The Future of Exertional Respiratory Problems: What Do We Know About the Total Airway Approach and What Do We Need to Know? x
Food Allergy Point of Care Pearls xi
IMMUNOLOGYAND ALLERGY\rCLINICS OF NORTH AMERICA\r xii
FORTHCOMING ISSUES xii
August 2018 xii
November 2018 xii
February 2019 xii
RECENT ISSUES xii
February 2018 xii
November 2017 xii
August 2017 xii
Foreword:\rExercise-Induced Airway Dysfunction in Athletes xiii
Preface:\rExercise and the Total Airway: A Call to Action xv
REFERENCES xviii
Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction 165
Key points 165
INTRODUCTION 165
CONDITIONING THE AIR INSPIRED DURING EXERCISE 166
Heat Loss as a Stimulus to Airway Narrowing 166
Water Loss as a Stimulus to Airway Narrowing 167
Temperature as a Modulator of Time Course and Severity of Exercise-Induced Bronchoconstriction 168
EPITHELIAL DYSFUNCTION IN EXERCISE-INDUCED BRONCHOCONSTRICTION 168
Breaking Through the Epithelial Barrier 169
Disturbance of the Airway Surface Liquid 169
Mucus Dysfunction 170
Epithelial Damage Restitution 170
LEUKOCYTE ACTIVATION AS A FUNDAMENTAL MECHANISM OF EXERCISE-INDUCED BRONCHOCONSTRICTION 170
The Acute Response 170
The Cellular and Molecular Phenotype Associated with Exercise-Induced Bronchoconstriction 171
Refractoriness to Repeated Exercise 174
NEUROGENIC FACTORS AND EXERCISE-INDUCED BRONCHOCONSTRICTION 174
Sensory Nerve Activation 174
THE ROLE OF REGIONAL ALTERATIONS IN THE AIRWAYS AND THE DEVELOPMENT OF EXERCISE-INDUCED BRONCHOCONSTRICTION 176
SUMMARY AND FUTURE CONSIDERATIONS 176
REFERENCES 176
Exercise-Induced Bronchoconstriction 205
Key points 205
BACKGROUND 205
PREVALENCE 207
SPORT CONSIDERATIONS 209
SUMMARY 211
REFERENCES 211
Testing for Exercise-Induced Bronchoconstriction 215
Key points 215
INTRODUCTION 215
MECHANISMS OF BRONCHIAL PROVOCATION TESTS TO IDENTIFY EXERCISE-INDUCED BRONCHOCONSTRICTION 217
Indirect Bronchial Provocation Tests 217
Direct Bronchial Provocation Tests 218
BRONCHIAL PROVOCATION TESTS FOR EXERCISE-INDUCED BRONCHOCONSTRICTION: COMMON FEATURES AND CONSIDERATIONS 219
LABORATORY EXERCISE PROVOCATION 223
EUCAPNIC VOLUNTARY HYPERPNEA 224
MANNITOL BRONCHIAL PROVOCATION TEST 226
SUMMARY AND FUTURE INVESTIGATIONS 226
REFERENCES 227
Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes 231
Key points 231
INTRODUCTION 231
OVERVIEW OF PHARMACOLOGIC THERAPY FOR EXERCISE-INDUCED BRONCHOCONSTRICTION 232
Short-Acting Beta2 Agonists: First-Line Therapy for Exercise-Induced Bronchoconstriction 233
Alternative First-Line Therapies and Additions to Short-Acting Beta-Agonist Therapy 233
Inhaled corticosteroids 233
Long-acting beta2 agonists 234
Leukotriene receptor antagonists and 5-lipoxyenase inhibitors 234
MAST CELL STABILIZING AGENTS 235
ANTICHOLINERGIC AGENTS 235
SCIENTIFIC EXPERIENCE WITH MULTIDRUG THERAPY FOR EXERCISE-INDUCED BRONCHOCONSTRICTION 236
APPROACH TO PATIENTS WITH DIFFICULT-TO-MANAGE EXERCISE-INDUCED BRONCHOCONSTRICTION 236
EXERCISE-INDUCED BRONCHOCONSTRICTION THERAPY STRATIFIED BY ENDO-TYPE 237
TREATMENT OF ACUTE EXACERBATION IN ELITE ATHLETES AND THE DOPING PERSPECTIVE 238
SUMMARY 238
REFERENCES 238
Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction 245
Key points 245
INTRODUCTION 245
PRE-EXERCISE WARM-UP 246
AVOIDANCE OF TRIGGERS 246
Heat and Moisture Exchanger Face Masks 246
Air Pollution 248
Swimming 248
DIETARY STRATEGIES 249
Omega-3 Fatty Acid Supplementation 249
Caffeine 250
Vitamins and Antioxidants 251
STRATEGIES TO REDUCE PERCEPTION OF EXERTIONAL DYSPNEA 251
Breathing Control 251
Respiratory Muscle Training 252
SUMMARY AND FUTURE CONSIDERATIONS 252
REFERENCES 253
Exercise and Sinonasal Disease 259
Key points 259
INTRODUCTION 259
PREVALENCE OF SINO-NASAL DISEASE IN ATHLETES AND DISEASE SUBTYPES 260
Infectious Rhinitis in Athletes 260
Allergic Rhinitis in Athletes 261
Nonallergic/Noninfectious Rhinitis and Exercise-Induced Rhinitis in Athletes 261
Rhinosinusitis in Athletes 262
MECHANISMS LEADING TO EXERCISE-INDUCED RHINITIS 262
DIAGNOSIS OF SINO-NASAL DISEASE IN ATHLETES 262
TREATMENT OF SINO-NASAL DISEASE IN ATHLETES 263
Avoidance of Environmental Triggers 263
Antihistamines and Mast Cell Stabilizers 264
Antileukotrienes 265
Intranasal Corticosteroids 265
Decongestants 265
Immunotherapy 265
SUMMARY 265
ACKNOWLEDGMENTS 266
REFERENCES 266
Exercise-Induced Laryngeal Obstruction—An Overview 271
Key points 271
BACKGROUND AND HISTORICAL OVERVIEW 271
NOMENCLATURE 273
EPIDEMIOLOGY 273
NORMAL UPPER AIRWAY FUNCTION AND PROPOSED EXERCISE-INDUCED LARYNGEAL OBSTRUCTION PATHOPHYSIOLOGY 273
SUMMARY 277
REFERENCES 278
Working Towards a Common Transatlantic Approach for Evaluation of Exercise-Induced Laryngeal Obstruction 281
Key points 281
PRESENTATION AND HISTORY 283
DIAGNOSTIC EVALUATION OF EXERTIONAL DYSPNEA WITH A FOCUS ON EXERCISE-INDUCED LARYNGEAL OBSTRUCTION 284
SPIROMETRY AND BRONCHOPROVOCATION TESTS 284
RESTING LARYNGOSCOPY 285
EXERCISE LARYNGOSCOPY 285
CONTINUOUS LARYNGOSCOPY DURING EXERCISE 285
PROCEDURAL CONSIDERATIONS 286
Exercise Mode 287
Protocol Considerations 287
Data Interpretation: What Is Normal? 287
Anatomic Descriptions of Exercise-Induced Laryngeal Obstruction 287
Thresholds of Disease 288
Reporting Findings 288
Why Has Continuous Laryngoscopy During Exercise Been Slowly Integrated into Clinical Care? 288
AREAS FOR FUTURE GROWTH 288
SUMMARY 289
REFERENCES 289
Speech-Language Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction 293
Key points 293
INTRODUCTION 293
TREATMENT OVERVIEW 294
Education and Reassurance 294
Traditional Rescue Breathing: Pursed Lip Breathing and Laryngeal Control Therapy 295
Relaxation Techniques 298
ADDITIONAL TREATMENT APPROACHES FOR REFRACTORY EXERCISE-INDUCED LARYNGEAL OBSTRUCTION 298
Inspiratory Muscle Training 299
Biofeedback 299
Heliox 299
FUTURE CONSIDERATIONS 300
SUMMARY 300
REFERENCES 300
Exercise-Induced Laryngeal Obstruction and Performance Psychology 303
Key points 303
INTRODUCTION 303
CASE 1 304
CASE 2 305
BEHAVIORAL HEALTH DOMAINS AND EXERCISE-INDUCED LARYNGEAL OBSTRUCTION 305
MENTAL HEALTH CONCERNS: DID EARLY LITERATURE MISREPRESENT PATIENTS WITH EXERCISE-INDUCED LARYNGEAL OBSTRUCTION? 305
PERSONALITY TYPES 306
BELIEFS, ATTRIBUTIONAL STYLES, AND THE RESPONSE TO STRESS 307
RELATING COGNITIVE–BEHAVIORAL PHENOMENA TO DISEASE MECHANISM 308
ASSESSING BEHAVIORAL MAKEUP AND BELIEFS 308
ASSESSMENT OF DEPRESSION AND ANXIETY 308
PERSONALITY ASSESSMENT 308
BELIEF SYSTEMS ASSESSMENT 309
PERFORMANCE PSYCHOLOGY INTERVENTION AS A THERAPY FOR EXERCISE-INDUCED LARYNGEAL OBSTRUCTION 309
GOAL SETTING 309
BASELINE STRESS REDUCTION 310
VISUALIZATION AND THE USE OF IMAGERY 310
COGNITIVE RESTRUCTURING 310
CASE RESOLUTIONS AND REFLECTIONS 311
SUMMARY 312
REFERENCES 312
Surgical Intervention for Exercise-Induced Laryngeal Obstruction 317
Key points 317
INTRODUCTION 317
LITERATURE REVIEW 318
Initial Case Reports 319
SUPRAGLOTTOPLASTY AS A TREATMENT FOR EXERCISE-INDUCED LARYNGEAL OBSTRUCTION-SUPRAGLOTTIC TYPE: TECHNICAL CONSIDERATIONS 319
SURGICAL INDICATIONS 320
PUBLISHED OUTCOMES 321
COMPLICATIONS 321
CURRENT CHALLENGES AND AREAS FOR FUTURE RESEARCH REGARDING SURGICAL MANAGEMENT OF EXERCISE-INDUCED LARYNGEAL OBSTRUCTION 321
SUMMARY 322
SUPPLEMENTARY DATA 323
REFERENCES 323
Exertional Dyspnea and Excessive Dynamic Airway Collapse 325
Key points 325
INTRODUCTION 325
EXCESSIVE DYNAMIC AIRWAY COLLAPSE DEFINITION 326
PATHOPHYSIOLOGY 326
EXCESSIVE DYNAMIC AIRWAY COLLAPSE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA 327
EXCESSIVE DYNAMIC AIRWAY COLLAPSE AND FUNCTIONAL CAPACITY 328
EXERCISE-ASSOCIATED EXCESSIVE DYNAMIC AIRWAY COLLAPSE 328
EXCESSIVE DYNAMIC AIRWAY COLLAPSE EVALUATION 328
AIRWAY IMAGING (DYNAMIC COMPUTED TOMOGRAPHY) 329
FUNCTIONAL BRONCHOSCOPY 329
TREATMENT OPTIONS 330
SUMMARY 330
REFERENCES 331
The Future of Exertional Respiratory Problems 333
Key points 333
THE IMPORTANCE OF A TOTAL AIRWAY APPROACH TO EXERTIONAL DYSPNEA 333
TOTAL AIRWAY APPROACH: WHAT DO WE KNOW? 334
TOTAL AIRWAY APPROACH: WHAT DO WE NEED TO KNOW? 335
THE FUTURE OF “TOTAL AIRWAY” RESEARCH 337
SUMMARY 337
ACKNOWLEDGMENTS 337
REFERENCES 337
Food Allergy Point of Care Pearls e1
Key points e1
TERMINOLOGY e1
Clinical Clarification e1
Classification e1
DIAGNOSIS e2
Clinical Presentation e2
Causes and Risk Factors e2
Diagnostic Procedures e3
Differential Diagnosis e4
TREATMENT e5
Goals e5
Disposition e5
Treatment Options e5
Monitoring e6
COMPLICATIONS AND PROGNOSIS e6
Complications e6
Prognosis e6
SCREENING AND PREVENTION e6
Screening e6
Prevention e7
SYNOPSIS e7
Key Points e7
Urgent Action e7
Pitfalls e7
REFERENCES e8
Exercise-Induced Bronchoconstriction and the Air We Breathe 183
Key points 183
INTRODUCTION 183
GENERAL PATHOGENESIS OF POLLUTION-INDUCED AIRWAY DYSFUNCTION 184
Oxidative Stress 184
Inflammation 184
Glutathione Depletion 184
Nitric Oxide 186
EXPOSURE-SPECIFIC PATHOPHYSIOLOGY 186
Exercise-Induced Bronchospasm and Environmental Humidity and Temperature 186
Particulate Matter 188
Ozone 189
Nitrogen Dioxide 191
Sulfur Dioxide 192
Trichloramines 192
Simultaneous Exposure to Multiple Environmental Triggers 193
SUMMARY AND PUBLIC HEALTH RECOMMENDATIONS 194
REFERENCES 194