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Introduction: Exercise intolerance is common in chronic airway diseases (CAD), but its mechanisms are still poorly understood. The aim of this study was to evaluate exercise capacity and its association with lung function, ventilatory limitation, and ventilatory efficiency in children and adolescents with cystic fibrosis (CF) and asthma when compared to healthy controls., Methods: Cross-sectional study including patients with mild-to-moderate asthma, CF and healthy children and adolescents. Anthropometric data, lung function (spirometry) and exercise capacity (cardiopulmonary exercise testing) were evaluated. Primary outcomes were peak oxygen consumption (VO 2 peak), forced expiratory volume in 1 s (FEV 1 ), breathing reserve (BR), ventilatory equivalent for oxygen consumption (V E /VO 2 ) and for carbon dioxide production (V E /VCO 2 ), both at the ventilatory threshold (VT 1 ) and peak exercise., Results: Mean age of 147 patients included was 11.8 ± 3.0 years. There were differences between asthmatics and CF children when compared to their healthy peers for anthropometric and lung function measurements. Asthmatics showed lower VO 2 peak when compared to both healthy and CF subjects, although no differences were found between healthy and CF patients. A lower BR was found when CF patients were compared to both healthy and asthmatic. Both CF and asthmatic patients presented higher values for V E /VO 2 and V E /VCO 2 at VT 1 when compared to healthy individuals. For both V E /VO 2 and V E /VCO 2 at peak exercise CF patients presented higher values when compared to their healthy peers., Conclusion: Patients with CF achieved good exercise capacity despite low ventilatory efficiency, low BR, and reduced lung function. However, asthmatics reported reduced cardiorespiratory capacity and normal ventilatory efficiency at peak exercise. These results demonstrate differences in the mechanisms of ventilatory limitation to maximum exercise testing in children and adolescents with CAD., (© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Purpose: Asthma is associated with abnormal autonomic function, and heart rate variability is considered a simple, accurate, and noninvasive tool for monitoring the autonomic system. Thus, the aim of this study was to investigate the impact of asthma on heart rate variability in children and adolescents., Methods: This systematic review of observational studies and clinical trials evaluated heart rate variability in children and adolescents with asthma compared to healthy controls. The data were extracted independently by two reviewers. The quality of the selected articles was assessed using Agency for Health Care Research and Quality indicators. Random effects meta-analysis was performed for each outcome, with the effect size reported as standardized mean difference., Results: Fifteen studies were included, of which five were classified as having high methodological quality. In the meta-analysis, long-term recording of the standard deviation of all normal-to-normal sinus R-R intervals differed significantly between groups (standardized mean difference [SMD] = -0.46 [95% confidence interval {CI}: -0.79 to -0.14], p < 0.005, I 2  = 0%). Moreover, R-R intervals (long-term) were significantly shorter in asthmatic children than controls (SMD = -0.47 [95% CI: -0.68 to -0.25], p < 0.0001, I 2  = 0). There were no significant differences between adjacent normal R-R intervals that exceed 50 ms (long-term) and the root mean square of successive differences between normal sinus R-R intervals (short-term). Regarding frequency-domain variables, long-term low frequency measurements differed significantly between groups (SMD = -0.34 [95% CI: -0.58 to -0.10], p < 0.005, I 2  = 15%). There were no differences in high frequency measurements or in the ratio between low/high frequency powers (short- or long-term) between groups., Conclusion: The results confirm the impact of asthma on heart rate variability in children and adolescents, indicating lower heart rate variability and sympathetic modulation., (© 2023 Wiley Periodicals LLC.)

Objective: Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma., Study Design: Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7-17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated., Results: Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p < .05) lower in the asthmatic group when compared to healthy peers, as well as the cardiorespiratory fitness, muscle strength, lifestyle and functionality. Moreover, asthmatic children were more likely to have atopic dermatitis, allergic reactions, food allergies, and a family history of asthma when compared to healthy children., Conclusions: Children with mild-to-moderate asthma presenting exercise symptoms show a reduction in cardiorespiratory fitness, muscle strength, lung function, functionality, and lifestyle when compared to healthy peers. The study provides data for pediatricians to support exercise practice aiming to improve prognosis and quality of life in asthmatic children., (© 2021 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Objective: To evaluate the reproducibility of the modified shuttle test (MST) and to determine whether the test needs to be performed more than once to assess the exercise capacity of children and adolescents with cystic fibrosis (CF)., Methods: This was a longitudinal study including patients diagnosed with CF aged more than 6 years. The participants were followed for a period of 9 months and were evaluated at three different time points (visits 1, 2, and 3). Spirometric, anthropometric, clinical, and genetic data were collected, and two MSTs were performed at each visit., Results: Forty-eight clinically stable volunteers with a mean age of 10.1 ± 2.7 years were initially included. The reproducibility of the test was evaluated using the distance achieved (DA) as the main variable. There were no significant differences in the DA (visit 1, p = .23; visit 2, p = .24; visit 3, p = .85), baseline heart rate (HR) (visit 1, p = .35; visit 2, p = .20; visit 3, p = .98), and peak HR (visit 1, p = .16; visit 2, p = .94; visit 3, p = .23) between the tests performed at each visit. The test-retest reliability demonstrated a high intraclass correlation coefficient at all visits (visit 1, 2, and 3: 0.83, 0.90, and 0.80, respectively) and the variation in HR was the main factor associated with the DA in the MST over time., Conclusion: The MST was found to be a reproducible and reliable test. The data presented here support the use of a single MST to evaluate and monitor exercise capacity of patients with CF during clinic visits., (© 2021 Wiley Periodicals LLC.)

Coronavirus (SARS-CoV-2) outbreak leading to the coronavirus disease (Covid-19) has become a global pandemic. Patients with Cystic fibrosis are considered of major risk, as respiratory tract infections are more severe than in the general population, with a higher risk of complications and a negative impact on lung function. The performance of physical exercise is considered as key for its well-known general benefits and also as a complementary method to help airway clearance. Therefore, physical exercise is also considered as key in the therapeutic strategy during the quarantine period. However, the impossibility to perform exercise with appropriate prescription and monitoring is of considerable worry to health care professionals. Thus, alternative strategies, such as online measures to monitor this therapy and, consequently, to achieve a safe and effective dose are highly needed. Exercise regimens should include strength and endurance, as well as balance and flexibility exercises. Patients are highly encouraged to participate in exercise programs to maintain fitness and exercise should be continued during the quarantine period. This commentary provides a summary of the main effects and benefits of physical exercise, as well as the main recommendations for its adequate execution, including exercise modality, frequency, intensity, and volume., (© 2020 Wiley Periodicals LLC.)

Acute lung injury (ALI) is an inflammatory process, and has high incidence and mortality. ALI and the acute respiratory distress syndrome are two common complications worldwide that result in acute lung failure, sepsis, and death. Pro-inflammatory substances, such as cytokines and chemokines, are responsible for activating the body's defense mechanisms and usually mediate inflammatory processes. Therefore, the research of substances that decrease the uncontrolled response of organism is seen as potential for patients with ALI. Octyl gallate (OG) is a phenolic compound with therapeutic actions namely antimicrobial, antiviral, and antifungal. In this study, we evaluated its action on lipopolysaccharide (LPS)-activated alveolar macrophages RAW 264.7 cells and ALI in male mice. Our results demonstrated protective effects of OG in alveolar macrophages activated with LPS and mice with ALI. The OG treatment significantly decreased the inflammatory markers in both studies in vitro and in vivo. The data suggested that OG can act as an anti-inflammatory agent for ALI., (© 2020 Wiley Periodicals, Inc.)

Background: Studies have shown that sleep disorders occur in cystic fibrosis (CF) patients and may be present before daytime clinical manifestations., Objectives: To evaluate the presence of sleep disorders among children and adolescents with CF, attempting to identify associations with pulmonary function, nutritional status, days in hospital, and days taking antibiotics., Methods: Individuals with a diagnosis of CF aged between 6 and 18 years were included. Information on sociodemographic, clinical profile, history of hospitalizations, and use of antibiotics in the last year were collected. Spirometry, bioimpedance, and polysomnography were performed. The presence of nocturnal hypoxemia and obstructive sleep apnea syndrome (OSAS) were evaluated and participants divided according to their presence., Results: Thirty-one patients were included. The prevalence of OSAS was 32.3% and nocturnal hypoxemia was 29.0%. Average nocturnal peripheral oxyhemoglobin saturation (SpO 2 ) correlated (P < .001) with forced vital capacity (r = .55) and forced expiratory volume in the first second (r = .62). The higher the percentage of total sleep time (TST) with SpO 2 less than 90%, the lower the pulmonary function. Individuals with OSAS and nocturnal hypoxemia had lower spirometric values compared to patients without these disorders, but the nocturnal hypoxemia group also had lower Shwachman-Kulczycki score, longer hospitalization time and antibiotic use. TST with SpO 2 less than 90% was associated with length of hospitalization (r 2  = .53)., Conclusion: Children and adolescents with CF have sleep disorders, including OSAS (32.3%) and nocturnal hypoxemia (29%). Individuals with nocturnal hypoxemia presented lower lung function, worse clinical score, and higher morbidity. TST with SpO 2 less than 90% was associated with length of hospitalization., (© 2020 Wiley Periodicals, Inc.)

Background: Asthmatic patients may benefit from exercise training, although the effects of a combined aerobic and resistance training program are still poorly investigated in children and adolescents., Objective: To analyze the effects of a combined exercise training (resistance and aerobic) program on aerobic fitness, lung function, asthma control and quality of life in a group of mild-moderate asthmatic children with exercise symptoms., Methods: This was a 12-week randomized controlled trial including children and adolescents diagnosed with mild-moderate asthma and presenting exercise-induced symptoms. The intervention group (IG) performed the exercise training (resistance and aerobic) 3 days/week, for 60 minutes. The control group (CG) followed routine clinical orientations. The main outcomes were cardiorespiratory fitness, muscle strength, lung function, quality of life, asthma control, and functional tests after 3 months of the intervention., Results: Fifty-three patients (IG = 25 and CG = 28) with a mean age of 11.5 ± 2.6 years were included. No significant differences were found between groups regarding lung function, asthma control, quality of life, and functional tests. Ventilatory equivalent for oxygen consumption at ventilatory threshold (P = .025; η p 2  = 0.083), peak oxygen consumption (P = .008; η p 2  = 0.116) and test duration (P = .014; η p 2  = 0.1) presented greater improvements in the IG. In addition, improvements were observed in leg press (P < .001; η p 2  = 0.36), hamstring curl (P = .001; η p 2  = 0.217), high row (P = .003; η p 2  = .167), low row (P = .009; η p 2  = 0.128) and quadriceps leg extension (P = .015; η p 2  = 0.108) in the IG., Conclusion: Combined exercise training (resistance and aerobic) improved cardiorespiratory fitness and muscle strength in children and adolescents with controlled asthma and exercise symptoms., (© 2020 Wiley Periodicals, Inc.)

Background: Several tests may be used to assess exercise intolerance in cystic fibrosis (CF), including the gold standard cardiopulmonary exercise test (CPET) and the Modified Shuttle Test (MST)., Objective: To evaluate the use of the MST as a predictor of peak oxygen uptake (VO 2 peak) and to compare VO 2 peak and maximal heart rate (HRmax) obtained in both tests., Methods: Cross-sectional study including individuals with CF aged between 6 and 20 years old. Participants who were unable to perform the tests and/or presented signs of pulmonary exacerbation were excluded. Demographic, anthropometric, clinical and spirometric values ​​were collected. CPET and the MST were performed in two consecutive outpatient visits. HRmax, peripheral oxygen saturation, dyspnea, and VO 2 peak measured and estimated were compared., Results: Twenty-four patients, mean age 15.7 ± 4.2 years and FEV 1 (% predicted) 76.4 ± 23.8, were included. Mean values ​​of HRmax (bpm) and HRmax in percent of predicted (HRmax%) were lower (P = 0.01) in the MST (171.6 ± 14.5 and 87.1 ± 7.5) compared to CPET (180.9 ± 10.0 and 91.9 ± 5.4). However, there was no significant differences between tests in the variation (delta) for HRmax and HRmax% (P = 0.17). A strong correlation (r = 0.79; P < 0.0001) was found between distance achieved (MST) and VO 2 peak (CPET). The regression model to estimate VO 2 peak resulted in the following equation: VO 2 (mL · kg -1  · min -1 ) = 20.301 + 0.019 × MST distance (meters). There was no difference (P = 0.50) between VO 2 peak measured (CPET) and estimated by the equation., Conclusion: The MST may be an alternative method to evaluate exercise capacity and to predict VO 2 peak in children and adolescents with CF., (© 2019 Wiley Periodicals, Inc.)