摘要
運動誘發氣喘並不只限於氣喘的病人，只是發生在氣喘病人情形較多影響更大，常是在6-8分鐘較高強度分運動後氣道發生急性、不同嚴重程度但可逆轉的氣道狹窄，臨床上常以用力呼氣第一秒鐘的量(forced expiratory volume at 1 sec, FEV1)及最大呼氣氣流速度(peak expiratory flow rate, PEFR)做為評估，其下降值會較運動前之值下降10%以上。所引起氣道過敏反應的刺激可能是由運動引起的過度換氣，氣道上熱量或水份的喪失，或是運動導致熱量和水份的喪失，也可能與運動後呼吸空氣的溫濕度有關。總之，運動會使氣道上的肥大細胞釋出某些介質，經此介質作用使氣道腫脹狹窄，或經由反射作用使得平滑肌收縮，而致氣道狹窄，引起氣喘。運動誘發氣喘後30至90分鍾後，再給運動刺激，氣道反應會較第一次反應爲小，或甚至完全沒有氣窄的現象，此即所謂的不反應期，不反應期可長達2-4小時。第一次運動刺激後，某些病人會在運動後4-10小時內發生氣喘反應，症狀較為第一次發作嚴重且持續時間較長。本文就運動誘發氣喘的相關現象及其機轉做簡單回顧，並討論對此運動誘發氣喘有效的藥物控制及對有這種現象者其運動計劃的擬定和訓練的效果。
關鍵字
無資料並列摘要
Exercise is the nonpharmacological or nonallergic stimulus to bronchoconstriction in asthmatics. Most asthmatics will experience bronchocnstriction after 6-8 minute exercise. A fall of greater than 10% in forced expiration volume at 1 second (FEV1) or peak expiratory flow rate (PEFR) is usually taken as the evidence of exercise induced asthma (EIA). EIA usually occurs 5-12 minutes after the exercise and disappears in 30-60 minutes spontaneously. The initiating stimulus of EIA has been proposed as exercise-induced hyperventilation, heat loss or/and water loss from the airways during the exercise or the rewarming of the airways after the exercise. The mediators release from the activated mast cell or through the vagal reflex causes airway narrowing and induces asthma attack. EIA is usually followed by a refractory period which the further exercise challenge cause less or no bronchoconstriction. Late asthmatic response has been documented in some patients which occurs hours after exposure. This article provides an overall review of these phenomena and the possible underlying mechanisms. The exercise performance in the asthmatics was usually reduced compared to the normal controls partly because of the inactivity resulted from the fear of the EIA. The exercise induced asthma can be prevented or minimized with appropriate premedication and an proper exercise training program. The asthmatic patients can then improve their functional capacities after exercise training. A decrease in the frequency and duration of asthma attack in daily activities or even the severity of the EIA has also been reported after training.
延伸閱讀
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