Gerd J. A. Cropp

Guidelines for the methodology of exercise challenge testing of asthmatics

Peyton A. Eggleston, M.D., Richard R. Rosenthal, M.D., Chairmen, Sandra A. Anderson, Ph.D., Ross Anderton, M.D., C. Warren Bierman, M.D., Eugene R. Bleecker, M.D., Hyman Chai, M.D., Gerd J. A. Cropp, M.D., Ph.D., Jerry D. Johnson, Ph.D., Peter Konig, M.D., John Morse, M.D., Laurie J. Smith, M.D., Richard J. Summers, M.D., and Joseph J. Trautlein, M.D. Study Group on Exercise Challenge, Bronchoprovocation Committee. American Academy of Allergy

The exercise bronchoprovocation test: Standardization of procedures and evaluation of response

Patients with asthma frequently develop acute, reversible, and usually self-terminating airway obstruction after or near the end of strenuous muscle exercise.‘. 2 This response may require quantitative assessment because of the poor correlation that exists between historical and laboratory evidence for exercise-induced bronchospasm (EIB),:’ and it can be used to provoke airway obstruction in patients with suspected, but unconfirmed asthma. During the past few years a number of tests have been developed for the assessment of EIB. The increased utilization of such procedures makes standardization of the methods timely and necessary so that safe and adequate techniques are used and so that results obtained in different laboratories can be compared.

Severe obstructive lung disease in a 14-year-old girl with alpha-1 antitrypsin deficiency☆

Abstract Severe, largely irreversible obstructive lung disease, compatible with emphysema, was found in a 14-yr-old white girl who had been considered to have chronic asthma. She also presented a serum alpha-1 antitrypsin deficiency. Serum values far alpha-1 antitrypsin on two occasions were 95 and 105 mg/100 ml; Pi type was SZ. A family survey disclosed a 13-yr-old brother with the same pattern of alpha-1 antitrypsin deficiency. His serum value was 122.5 mg/100 ml; Pi type was SZ. He was asymptomatic and showed minimal pulmonary function abnormalities.

1635 EFFECTS OF INTENSIVE IN-HOSPITAL THERAPY ON LUNG FUNCTIONS AND EXERCISE TOLERANCE IN CYSTIC FIBROSIS (CF)

There is little information on the objective benefits of inhospital therapy in CF. We, therefore, studied the effects of a 13 day ± 2.6 SD (range 10-18 days) admission on lung functions and exercise capacity in 15 CF patients with moderate to severe disease. Treatment consisted of intravenous antibiotics, postural drainage and exercise therapy. We measured resting vital capacity (VC), residual volume (RV), total lung capacity (TLC), forced expired volume in 1 second (FEV1), specific airway conductance (SG), arterial oxygen saturation (SaO2), and exercise adaptation and tolerance shortly after admission and before discharge. Adaptation to exercise was evaluated by the work capacity (Watts/kg), peak heart rate (PHR), exercise-induced changes in SaO2 and the ratio of PHR to peak W/kg.The results show that our 2-week treatment program brought about significant, objective improvements in lung function, exercise tolerance and exercise adaptation in CF patients.

119 PULMONARY FUNCTION AND EXERCISE RESPONSES IN CHILDREN WITH MITRAL VALVE PROLAPSE (MVP)

A recent report (Zuwallack et al. Chest 76:17, 1979) on 20 adults with MVP showed increased residual volume in 63%, decreased steady state diffusion capacity (DLCO) in 50%, and increased alveolar-arterial O2 gradients in 42%. We evaluated 18 children (mean age 13.52 ± 3.3 SD years) with MVP and no history of lung disease. Lung volumes, forced expiratory flow rates, airway resistance, single breath DLCO, single breath oxygen closing volume and an incremental cycle ergometer exercise test with work loads increasing by 0.3 watts/kg every 3′ were performed. During the last 1′ of each load, heart rate (HR), end-tidal and mixed-expired PO2 and PCO2, minute ventilation, oxygen saturation and blood pressure (BP) were measured. EKG was continuously monitored. Pulmonary function results were normal before and after exercise. Peak work loads, HR, ventilation, oxygen consumption and BP response were all normal; no CO2 retention or O2 desaturation was noted. Four subjects had unifocal premature ventricular contractions at rest, which were abolished with exercise in three. We conclude that children with MVP have normal pulmonary functions and normal cardiorespiratory response to exercise and, therefore, should not be discouraged from exercise based solely on the MVP. The reason for the differences in lung function between children and adults remains unclear.