Effect of Physical Training in Bronchial Asthma
Effect of Physical Training in Bronchial Asthma
Asthma is a multifactorial disease with genetic, environmental and inflammatory components in its etiology. The principal pathophysiology of asthma is chronic inflammation of the lower respiratory tract. Pharmacotherapy and avoidance of allergens are the primary therapies emphasized in all asthma guidelines. Anti-inflammatory agents such as inhaled steroids and leukotriene receptor antagonists along with long acting bronchodilators are the mainstay of asthma pharmacotherapy; however, persistent inflammatory cell infiltration has been demonstrated even after a course of oral steroids (methyl-prednisone 40 mg daily for 14 days). In addition, airway remodeling in established asthma responds poorly to current medicinal therapies. Current asthma therapies have not achieved asthma prevention or asthma cure and there are currently no medications that can alter the natural history of the disease. Potential long term side-effects, prohibitive costs, and suboptimal adherence to asthma medications are on-going challenges to optimal asthma control. Even for the newer and expensive asthma therapies, such as omalizumab, only a very small subpopulation of refractory or severe asthma appears to respond. Treatment options are therefore quite limited for asthma and the need to search for other therapies has been recognized by many experts in the field.
Physical exercise training is thought to be beneficial in asthma management, at least in children, but it has not been extensively studied. There are no specific recommendations on physical training type, intensity, duration, or frequency in any asthma guidelines. Moreover, low physical activity in asthmatics is a reality because they usually avoid exercise. Asthma and chronic obstructive pulmonary disease (COPD) are, according to the 'Dutch hypothesis', different manifestations of the same disease entity. In addition, asthma and COPD might share common pathogenetic pathways. Positive impacts of physical exercise training and rehabilitation in COPD have been extensively studied; therefore, physical training is recommended in COPD guidelines. Given that asthma and COPD may share a common pathogenesis, and that both diseases are manifested by chronic airway inflammation, it is imperative that we discern the role of physical training in asthma management. This systematic review represents an endeavour to shed light on this relationship, as we assess the effects of physical training on markers of airway inflammation in asthmatics.
To the best of our knowledge, there exists no systematic review to date focusing on the effects of physical training on airway inflammation in asthmatics. A Cochrane review published in 2012 summarized the effects of physical training on asthma and included only randomized controlled trials (RCTs). The objective of this review was to extend the evidence base by using all types of observational epidemiologic research in combination with RCTs to summarize effects of physical training on airway inflammation in asthmatics.
Background
Asthma is a multifactorial disease with genetic, environmental and inflammatory components in its etiology. The principal pathophysiology of asthma is chronic inflammation of the lower respiratory tract. Pharmacotherapy and avoidance of allergens are the primary therapies emphasized in all asthma guidelines. Anti-inflammatory agents such as inhaled steroids and leukotriene receptor antagonists along with long acting bronchodilators are the mainstay of asthma pharmacotherapy; however, persistent inflammatory cell infiltration has been demonstrated even after a course of oral steroids (methyl-prednisone 40 mg daily for 14 days). In addition, airway remodeling in established asthma responds poorly to current medicinal therapies. Current asthma therapies have not achieved asthma prevention or asthma cure and there are currently no medications that can alter the natural history of the disease. Potential long term side-effects, prohibitive costs, and suboptimal adherence to asthma medications are on-going challenges to optimal asthma control. Even for the newer and expensive asthma therapies, such as omalizumab, only a very small subpopulation of refractory or severe asthma appears to respond. Treatment options are therefore quite limited for asthma and the need to search for other therapies has been recognized by many experts in the field.
Physical exercise training is thought to be beneficial in asthma management, at least in children, but it has not been extensively studied. There are no specific recommendations on physical training type, intensity, duration, or frequency in any asthma guidelines. Moreover, low physical activity in asthmatics is a reality because they usually avoid exercise. Asthma and chronic obstructive pulmonary disease (COPD) are, according to the 'Dutch hypothesis', different manifestations of the same disease entity. In addition, asthma and COPD might share common pathogenetic pathways. Positive impacts of physical exercise training and rehabilitation in COPD have been extensively studied; therefore, physical training is recommended in COPD guidelines. Given that asthma and COPD may share a common pathogenesis, and that both diseases are manifested by chronic airway inflammation, it is imperative that we discern the role of physical training in asthma management. This systematic review represents an endeavour to shed light on this relationship, as we assess the effects of physical training on markers of airway inflammation in asthmatics.
To the best of our knowledge, there exists no systematic review to date focusing on the effects of physical training on airway inflammation in asthmatics. A Cochrane review published in 2012 summarized the effects of physical training on asthma and included only randomized controlled trials (RCTs). The objective of this review was to extend the evidence base by using all types of observational epidemiologic research in combination with RCTs to summarize effects of physical training on airway inflammation in asthmatics.