Delivered by Ingenta to: UCL LIBRARY IP: 91.200.80.33 On: Fri, 03 Jun 2016 17:14:15 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm A Simple "Step-Test" Protocol for Identifying Suspected Unrecognized Exercise-Induced Asthma (EIA) in Children Ronald A. Feinstein, M.D., Coralie S. Hains, M.D., Mary Pat Hemstreet, M.D., Anne Turner-Henson, D.S.N., David 1. Redden, Ph.D., Beverly Martin, R.N., Sue Erwin, C.R.T.1., and William C. Bailey, M.D. ABSTRACT The purpose of this study was to demonstrate that a simple suhmaximal "step-test" could he used as an exercise challenge to identify elementary school students with suspected but undiag- nosed asthma. This article also describes a protocol for exercise testing that can be used in epidemiological evaluations. School age children grades 1-4 with suspected but undiagnosed asthma were identified by a 12-item questionnaire completed by a parent or guardian. Only students identified with suspected asthma by ques- tionnaire were exercise challenged on a step-test if baseline spi- rometry was normal and there was no contraindication for intense aerobic activity. Possible asthma was defined as a i5% or greater decrease in FEV, or a 25% or greater decrease in FEF 2s _ 7s from baseline at either 3 or iO minutes. The exercise protocol included spirometry hefore and after stepping continuously for 5 minutes at an exercise intensity sufficient to maintain a heart rate between i50 and 200 beats per minute. Heart rate was continuously mon- From the Departments of Pediatrics and Medicine, Schools of Medicine and Nursing, University of Alabama at Birmingham, Birmingham, Alabama Presented at the Annual Meeting of the American College of Allergy, Asthma. and immunology, November i997 Supported by a grant from the National Heart, Lung, and Blood institute No. HR-56077 Address correspondence and reprint requests to Dr. Ronald A. Feinstein. Children's Hospital Office Building, Basement, 1630 Sixth Avenue South. Birmingham, AL 35233-0011 Allergy and Asthma Proc. itored throughout the exercise period. Testing was completed at school. No complications occurred during the exercise testing. Exercise testing was completed on 548 students with suspected undiagnosed asthma. Thirty students (6%) had exercise test changes in pulmonary function that met established criteria for suspecting asthma. A board-certified pediatric allergist/immunol- ogist or private physician examined 26 of the 30 students with positive exercise testing. Asthma was diagnosed in 23 (88.89%) of these students. All students with impaired pulmonary function after exercise were able to return to class after a short period of observation. in conclusion, a simple, reproducible school-based exercise protocol can be used to identify students with suspected undiagnosed asthma. (Allergy and Asthma Proc 20: 181-188, ]999) A Pproximately five million children in the United States have asthma. An increased rate of asthma is found in minorities, particularly among African-Americans and in- ner-city children. I Asthma in children is a leading cause of school absenteeism (mean days 8.7/school year), a cause of increased days of restricted or limited activities (mean days 20/school year), and ranks first among the chronic condi- tions limiting activity. Additionally, children in poverty and those from single parent households are more likely to suffer from a higher degree of asthma related disability.2 Unrecognized asthma in pediatric populations can also result in significantly increased rates of morbidity and mor- tality. Recent research has estimated a prevalence rate of 14.3% of students with unrecognized asthma among a population of American urban school children in grades 181