engleski

Exercise-induced nasal and bronchial obstruction in atopic asthmatic patient: a case report

Introduction: Exercise-induced bronchial obstruction is one of the most important features in the asthmatics. Simultaneously induced nasal obstruction is less frequent phenomenon. Patient: 16-year-old female has suffered asthmatic symptoms (episodic breathlessness, wheezing, chest tightness and cough) and rhinitic symptoms (nasal obstruction, sneezing, rhinorrhea) since early childhood. Symptoms are present during winter and spring, worsened at night and provoked by exercise. Sometimes she can not perform school gymnastics. Recently she reported symptoms of conjuctivitis. Because of moderately persistant asthma she was receiving salmeterol and fluticasone inhalation twice a day. SPT: positive for dust mites Dermatophagoides pteronyssinus (DP), Dermatophagoides farinae (DF), Lepidoglyphus destructor (LD), Tyrophagus putrescientiae (TP) and grass pollen. Specific IgE: increased for Dactylis glom (class 4), DP, DF, LD (class 3), and TP (class 2). Lung function tests: FVC and FEV1 within normal values, MEF50 and MEF25. bellow 40% of reference values. Non-specific bronchial reactivity to histamine: PC20FEV1 = 0.125 mg/mL. Exercise challenge test (EC): Without salmeterol for 12 hours before EC. Maximal expiratory flow-volume curve (MEFV) and nasal patency (Rocc) were measured by Flowscreen (Jaeger, Germany). Baseline FEV1 was 2, 64 L/s (85% reference values), baseline Rocc was 0, 63 kPa*s/L (121% reference values). Submaximal incremental EC on treadmill was performed. FEV1 and Rocc were measured immediately after the exercise and at 3, 5, 7, 10, 15, 20 and 30 min after cessation of exercise. The peak decrease in FEV1 (26% of baseline value) developed 3 min after EC and peak increase in Rocc (250% of baseline value) developed 20 min after EC. These changes spontaneously returned to normal after 30 min. She also reported breathlessness, watery rhinorrhea, sneezing and nasal obstruction. Conclusion: Exercise can induce bronchial and nasal obstruction, suggesting the unique response of the respiratory system to EC. Therefore in patient with asthmatic and rhinitic symptoms we recommend measurements of bronchial and nasal patency.

exercise-induced rhinitis; exercise induced asthma; atopy; dust mites

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