Response to cold air hyperventilation in normal and in asthmatic children

To assess the sensitivity of isocapnic hyperventilation with cold air in detecting airway hyperreactivity in asthmatic children, we studied 13 asthmatic patients (mean age 11.1 years) and 10 normal children. Cold air challenge consisted of 4 minutes of moderate hyperventilation plus another 4 minutes of maximal hyperventilation, both with subfreezing air (-16° to -18°C). Exercise and IHCA tests were done within 5 days and in random sequence. Mean (±SE) maximal %Δ FEV₁ after IHCA was 27±5.1% in the asthmatic children vs 4.5±1.2% in the normal subjects (P<0.01), even though there were no significant differences in the maximal minute ventilation equivalent between the two groups. Mean maximal %Δ FEV₁ after exercise was 31.7±5.6 in the asthmatic group. There was no difference in the sensitivity of the exercise and IHCA tests to detect bronchospasm in asthmatic children. Airway obstruction after IHCA was sharp and brief: maximal at 3 minutes after challenge, and back to 10% of baseline after 11 minutes. In seven asthmatic children the refractoriness to cold air and exercise was studied by repeating each test within 30 minutes; all seven showed significant refractoriness to exercise, and six showed no refractoriness to IHCA. We conclude that exercise and cold air-induced bronchospasm have different physiologic mechanisms, and that cold air testing can be used as a routine challenge to identify airway hyperreactivity in children.