Short term eVects of aerobic training in the clinical management of moderate to severe asthma in children

Background—Aerobic training has a number of well known beneficial eVects in both normal and asthmatic children. However, the impact of training on the clinical management of the underlying bronchial asthma remains controversial, particularly in the most severe patients. Methods—Clinical evaluation, spirometric tests, symptom limited maximum exercise testing, and exercise challenge tests were performed in a group of children with stable moderate to severe asthma. Forty two patients (24 boys) aged 8–16 were evaluated twice: before and after supervised aerobic training (group 1, n = 26) and two months apart (untrained group 2, n = 16). Results—Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 (p<0.05) but medication and clinical scores and the occurrence of exercise induced bronchospasm (EIB) did not diVer between the two groups. Aerobic improvement with training (maximal oxygen uptake and/or anaerobic threshold increment >10% and 100 ml) was inversely related to the baseline level of fitness and was independent of disease severity. Although the clinical score and the occurrence of EIB did not change after training, aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids (p<0.05). Conclusions—Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids, independent of the severity of the disease. (Thorax 1999;54:202–206)