Some people with asthma find their symptoms are worse when they exercise, or restrict their physical activity for fear that this will be so. Others report that their asthma symptoms are better when they are fit. Several reviews from the Cochrane Airways Group have recently been published on aspects of exercise for people with asthma.
Firstly, there’s a new review considering beta2-agonists for exercise-induced asthma (EIA). The review used this term to describe asthma-like symptoms brought on by exercise, in people with or without underlying asthma. Beta2-agonists are drugs that open up the airways, making breathing easier. There are short-acting beta2-agonists (SABA) such as salbutamol, and long-acting beta2-agonists (LABA) such as formoterol.
There were 53 relevant Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. with 1139 people. Most looked at giving a single beta2-agonist Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. as a preventive measure before exercise and recorded lung function after exercise. Lung function fell, as would be expected, but it fell less for people taking SABA or LABA compared with An intervention that appears to be the same as that which is being assessed but does not have the active component. For example, a placebo could be a tablet made of sugar, compared with a tablet containing a medicine. (dummy medicine) and there were no differences in the number of side effects noted, but there remains a need to assess whether these treatments are harmful over the longer term as few trials looked at this. The The certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty. Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of evidence. Find out more here: https://training.cochrane.org/grade-approach isn’t great and although the authors conclude that this is an effective preventive treatment for EIA they also comment that the meaning for patients of the degree of change in FEV1 (a measure of lung function), which was the primary outcome of interest, and how it relates to their well-being, is unclear. Future research should focus on patient-important Outcomes are measures of health (for example quality of life, pain, blood sugar levels) that can be used to assess the effectiveness and safety of a treatment or other intervention (for example a drug, surgery, or exercise). In research, the outcomes considered most important are ‘primary outcomes’ and those considered less important are ‘secondary outcomes’..
Next, a review on physical training for asthma has been updated and includes 21 trials with 772 people; most included small numbers of people and none looked at long term benefits. Exercise, including gymnastics, cycling, swimming, running, weights and walking, was well tolerated with no worsening of asthma symptoms reported. Improvements were seen in maximum oxygen uptake but not in other measures of lung function. There are indications that physical training may improve health-related quality of life too.
Earlier this year I wrote a blog on the review which looked specifically at swimming for children with asthma. You can read the blog here but here’s the bottom line in our six second Vine video – a first for Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research.!
How about breathing exercises for people with asthma, which have been widely used worldwide as a complementary therapy alongside asthma medicines? A review on this has been updated and now relates only to adults. Thirteen trials are included but, dear oh dear, the trends for improvement come from a rag-bag of evidence. Trials differed considerably from each other, which meant that results could not be combined for most outcomes. Most had small numbers of participants and other problems with trial design, and poor reporting was common. This low quality evidence means that no reliable conclusions could be drawn about the use of breathing exercises for asthma. The reviewers rightly whipped out their red pens and, in their plea for well-conducted Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). A trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). on this therapy, noted that ‘much more attention needs to be paid to good reporting and high-quality An investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. design’. Not half. It’s a pity that I can’t even say that this state of affairs is rare; it’s not.
All in all, this leaves us, I think, with plenty to be addressed by current and future trialists and some encouragement for people with asthma. If you’re looking for more information about exercise and asthma, Asthma UK has a useful section on their website on this topic, which you can find here.
Bonini M, Di Mambro C, Calderon MA, Compalati E, Schünemann H, Durham S, Canonica GW. Beta2-agonists for exercise-induced asthma. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2013, Issue 10. Art. No.: CD003564. DOI: 10.1002/14651858.CD003564.pub3.
Carson KV, Chandratilleke MG, Picot J, Brinn MP, Esterman AJ, Smith BJ. Physical training for asthma. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD001116. DOI: 10.1002/14651858.CD001116.pub4.
Cochrane summary and podcast http://summaries.cochrane.org/CD001116/physical-training-for-asthma
Beggs S, Foong YC, Le HCT, Noor D, Wood-Baker R, Walters JAE. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009607. DOI: 10.1002/14651858.CD009607.pub2.
Evidently Cochrane blog. Swimming and asthma: well-tolerated and beneficial finds new review. 7 May 2013.
Freitas DA, Holloway EA, Bruno SS, Chaves GSS, Fregonezi GAF, Mendonça KMPP. Breathing exercises for adults with asthma. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD001277. DOI: 10.1002/14651858.CD001277.pub3.