Efficacy of a Heat Exchanger Mask in Cold Exercise-Induced Asthma

doi:10.1378/chest.129.5.1188

Chest

Volume 129, Issue 5, May 2006, Pages 1188-1193

https://doi.org/10.1378/chest.129.5.1188 Get rights and content

Study objectives

To determine the efficacy of a novel mask device in limiting cold air exercise-induced decline in lung function in subjects with a history of exercise-induced asthma (EIA).

Setting

In spite of appropriate medical therapy, many asthma patients are limited in cold weather activities.

Design

In study 1, 13 asthmatic subjects performed two randomized, single-blind treadmill exercise tests while breathing cold air (− 25 to − 15°C) through a placebo or active heat exchanger mask. In study 2, five subjects with EIA performed three treadmill exercise tests while breathing cold air: one test using the heat exchanger mask, one test without the mask but with albuterol pretreatment, and one test with neither the mask nor albuterol pretreatment (unprotected exercise). For all studies, spirometry was performed before and at 5, 15, and 30 min after exercise challenge.

Patients

For both studies, a total of 15 subjects with a history of asthma symptoms during cold air exercise were recruited.

Results

In study 1, the mean decrease (± SE) in FEV₁ was 19 ± 4.9% with placebo, and 4.3 ± 1.6% with the active device (p = 0.0002). The mean decrease in maximum mid-expiratory flow (FEF_25–75) was 31 ± 5.7% with placebo and 4.7 ± 1.7% with the active device (p = 0.0002). In study 2, the mean decrease in FEV₁ was 6.3 ± 3.9%, 11 ± 3.7%, and 28 ± 10% for the heat exchanger mask, albuterol pretreatment, and unprotected exercises, respectively (p = 0.4375 for mask vs albuterol, p = 0.0625 for mask vs unprotected exercise). The mean decrease in FEF_25–75 was 10 ± 4.8%, 23 ± 6.0%, and 36 ± 11%, respectively (p = 0.0625 for mask vs albuterol, p = 0.0625 for mask vs unprotected exercise).

Conclusions

This heat exchanger mask blocks cold exercise-induced decline in lung function at least as effectively as albuterol pretreatment.

Section snippets

Materials and Methods

All subjects gave consent to participate in this Institutional Review Board-approved protocol. There were two studies. In study 1, 13 subjects with asthma symptoms during cold air exercise were recruited. Inclusion criteria included a postbronchodilator FEV₁ > 70% predicted and a methacholine challenge test with a provocative concentration of methacholine resulting in a 20% drop in FEV₁ ≤ 8 mg/mL. Exclusion criteria included the presence of other lung diseases, use of systemic or inhaled

Results

Study 1 enrolled 13 subjects, and study 2 enrolled 5 subjects. All subjects met inclusion and exclusion criteria, and no subjects dropped out. Of the 15 people who participated in one or both studies, 9 were women, and the average age of participants was 29 years (Table 1). Mean baseline FEV₁ was 3.24 ± 0.17 L (88 ± 4.0% of predicted).

Study 1 subjects demonstrated improved lung function after exercise with the active device, compared to placebo (Fig 2). The mean fall in FEV₁ was 19 ± 4.9% with

Discussion

This heat exchanger mask is highly effective at blocking cold air exercise-induced decline in lung function. The mean decrease in FEV₁ was 19 ± 4.9% with placebo, and 4.3 ± 1.6% with the active device (p = 0.0002). While all subjects had better lung function after exercise with the active device compared to placebo, those individuals who demonstrated a > 10% decline in FEV₁ with placebo exercise had the most dramatic improvement with the active device mask (Fig 2). For example, subject 1 had a

Acknowledgment

The authors thank George Zeman, Martin Carlos, and the staff of the National Jewish Pulmonary Physiology Unit for their assistance with exercise testing, as well as Misoo C. Ellison, PhD, for her contributions to our statistical analysis. We are also indebted to Terri Harper, PA-C, and Mary Gill, RN, BSN, for their excellent help with recruitment and subject visits.

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

Funding was provided by the National Jewish Medical and Research Center.

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Chest

Original Research: AsthmaEfficacy of a Heat Exchanger Mask in Cold Exercise-Induced Asthma

Study objectives

Setting

Design

Patients

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Acknowledgment

Clin Chest Med

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Exercise-induced asthma

N Engl J Med

Role of respiratory heat exchange in production of exercise-induced asthma

J Appl Physiol

Airway cooling as the stimulus to exercise-induced asthma: a re-evaluation

Eur J Respir Dis

Enhancement of exercise-induced asthma by cold air

N Engl J Med

Original Research: Asthma
Efficacy of a Heat Exchanger Mask in Cold Exercise-Induced Asthma