Real and Pseudo Late Asthmatic Reactions after Submaximai Exercise Challenge in Patients with Bronchial Asthma: Discussion (3)

In: Asthma

31 Jan 2013

It could be possible that the LAR after EC results from an inflammatory reaction induced by the combination of airway water loss, airway cooling, hyperventilation and its metabolic consequences, and a slow onset of adrenaline release during exercise. Airway inflammation is also an important etiologic factor in LAR after allergen inhalation and in LAR in occupational asthma.” In our study, patients continued using steroids. These agents not only alter the late asthmatic response, but also the normal variation of airway caliber.

The observed variability in airway responses may be quite different when using gluco-corticosteroids (GC) in patients with asthma. In this study, for clinical reasons it was not possible to stop GC. The GC did not prevent a LAR to occur in 14 of the 81 asthmatic patients studied, although they used the steroids for at least three months before the start of the study. Therefore, either the actual prevalence of the LAR after EC may be greater than found in our study or the role of inflammation may play a less important role in the LAR after EC than in the other LARs discussed. Another possible cause could be the dose of steroids, which was perhaps not high enough. buy flovent inhaler
Our results are in contradiction with the hypothesis that the LAR after EC does not exist or is a nonspecific epiphenomenon.

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