1. Merlin
Jan 15, 7:54 pm show options
Newsgroups: alt.support.asthma
From: "Merlin" <l...@tpg.com.au> - Find messages by this author
Date: 15 Jan 2006 17:54:24 -0800
Local: Sun, Jan 15 2006 7:54 pm
Subject: Salt.
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> http://www.heartinfo.org/ms/news/526322/main.html
> http://www.medscape.com/viewarticle/506810http://general-medicine.jwatch.org/cgi
/content/full/1988/906/1
> http://www.nzherald.co.nz/category/story.cfm?c_id=204&ObjectID=10354170
The second link doesn't show the article, so here's the
cut/pasted version:
In Asthma, Dietary Salt Loading May Decrease Lung Function,
Diffusion Capacity After Exercise CME
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd
Disclosures
To earn CME credit, read the news brief along with the CME
information that follows and answer the post test questions.
Release Date: June 17, 2005; Valid for credit through June 17,
2006
Credits Available
Physicians - up to 0.25 AMA PRA Category 1 continuing
physician education credits
June 17, 2005 - Increased dietary salt decreases lung function
and diffusion capacity after exercise, according to the results
of a randomized, double-blind trial published in the June issue
of Medicine and Science in Sports and Exercise.
"Recent studies have supported a role for dietary salt as a
modifier of the severity of exercise-induced asthma (EIA)," write
Timothy D. Mickleborough, PhD, from Indiana University in
Bloomington, and colleagues. "It has been suggested that
transient dehydration of the airways activates inflammatory
mediators such as histamine, neuropeptides, and the arachidonic
acid metabolites, leukotrienes (LTs), and prostanoids from airway
cells, resulting in bronchial smooth muscle contraction.
Alternatively, it has been suggested that rapid rewarming of the
airways following exercise leads to reactive hyperemia resulting
in vascular engorgement and perivascular edema, which would
further contribute to airway narrowing caused by
bronchoconstriction."
In this crossover study, 24 patients entered the study with their
normal salt diet (NSD) and were then given either a low-salt diet
(LSD) or a high-salt diet (HSD) for two weeks, with a one-week
washout period between diets. Pre- and postexercise spirometry,
pulmonary diffusion capacity (DLCO) and its subdivisions, and
induced sputum were obtained during the NSD and at the end of
each dietary period.
Mean forced expiratory volume in 1 second (FEV1) decreased by
7.9% ± 2.8% with the LSD, 18.3% ± 4.0% with the NSD, and by 27.4%
± 3.2% with the HSD at 20 minutes after exercise. With the NSD
and HSD, DLCO and its subdivisions decreased significantly (P <
.05). Compared with baseline values, postexercise pulmonary
capillary blood volume increased by 6.3 mL with the NSD and by
9.6 mL with the HSD (P < .05 for both comparisons), with no
significant change with the LSD.
Compared with the LSD, the NSD and HSD were associated with
increased exercise-induced sputum neutrophil and eosinophil
differential cell counts and induced sputum supernatant
concentration of eosinophil cationic protein, interleukin
(IL)-1?, IL-8, LTC4 through LTE4, LTB4, and prostaglandin D2 (P <
.05 for all comparisons).
"Our findings indicate that dietary salt loading enhances airway
inflammation following exercise in asthmatic subjects, and that
small salt-dependent changes in vascular volume and microvascular
pressure might have substantial effects on airway function
following exercise in the face of mediator-induced increased
vascular permeability," the authors write.
Med Sci Sports Exerc. 2005;37:904-917
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
a.. Identify potential mechanisms by which exercise may trigger
EIA.
b.. Explain the effect of dietary salt intake on EIA
parameters.
Clinical Context
Up to 90% of those with asthma, 3% to 10% of the general
population, and 11% to 50% of elite athletes may experience EIA,
according to the authors. Significant symptoms that may occur
after a brief period of exercise (5 - 8 minutes) include cough,
wheeze, dyspnea, chest tightness, and chest pain. Symptoms tend
to resolve spontaneously after cessation of exercise. Exercise is
often a powerful trigger for asthma patients and limits the
capacity for physical activity. Mechanisms that have been
proposed for exercise as a trigger for EIA include transient
dehydration of the airways, activating inflammatory mediators and
resulting in bronchial smooth muscle contraction, and rapid
rewarming of airways after exercise, leading to vascular
engorgement and perivascular edema. The authors note that it has
been shown previously that an HSD worsens and an LSD decreases
EIA in asthma. High salt intake may trigger a release of LTs from
eosinophils in airways and activate smooth muscle contraction and
microvascular leakage, with subsequent EIA symptoms. They tested
this hypothesis using three diets with different salt levels in a
double-blind, randomized crossover trial in 24 healthy young
adults with asthma and EIA.
Study Highlights
a.. Study subjects were 24 (15 male and 9 female) volunteer
university students with a mean age of 24 years and mean weight
of 71.4 kg, with physician-documented EIA and clinically treated
chronic persistent asthma.
b.. All participants were atopic, as shown by skin test, and
had a history of shortness of breath, chest tightness, and
wheezing after exercise, which was relieved by bronchodilator.
c.. EIA was confirmed by a decrease of more than 10% in
postexercise FEV1. Exercise consisted of treadmill walking at a
1% gradient until volitional exhaustion.
d.. Exclusion factors were pregnancy, history of
hyperlipidemia, diabetes, hypertension, bleeding disorders, and
aspirin therapy.
e.. ?-agonists were discontinued 12 hours before exercise
testing; coffee and alcohol were prohibited within 24 hours; and
the participants' physicians were informed. Maintenance
medications were discontinued during the trial.
f.. Participants were randomized to a sequence of salt diets
(NSD followed by HSD or LSD, then the remaining diet) in 2-week
blocks, separated by 1-week washout periods, for a total of 5
weeks of the study.
g.. The base diet (normal or NSD) consisted of 1,500 mg per day
of sodium and 2,250 mg per day of chloride provided in a fixed
menu plan. The HSD consisted of supplementation with ten 1-g salt
capsules per day, comprising a daily total of 4,000 mg of sodium
and 6,000 mg of chloride. For the LSD, the base diet was
supplemented with placebo sucrose tablets.
h.. Dietary intake was recorded, and all study subjects
recorded daily bronchodilator use during the study period.
i.. Study subjects demonstrated dietary compliance during the
study.
j.. At baseline, spirometry, exercise challenge, DLCO, induced
sputum production, cellular component analysis, inflammatory
mediators, plasma volume, and anthropometry were measured or
performed.
k.. Outcomes were pulmonary function, DLCO, induced sputum cell
counts, inflammatory mediator levels, and plasma volume.
l.. Study subjects demonstrated greater airway obstruction with
the NSD and HSD vs the LSD. Decrease in FEV1 at 20 minutes after
exercise was 18.3% with the HSD vs 7.9% with the LSD (P < 0.05).
A similar pattern was seen with forced vital capacity (FVC)
changes, with greater severity of EIA measures seen with the HSD
than with the LSD.
m.. DLCO was not significantly different at baseline. However,
DLCO was significantly reduced during the HSD phase vs the LSD
phase at 10 and 25 minutes after exercise, with a difference of
25% between the 2 diets (P < 0.05).
n.. Total cell counts in induced sputum were similar at
baseline. During the HSD phase, eosinophil and neutrophil levels
were significantly elevated and macrophages were significantly
suppressed, compared with both the LSD and NSD phases.
o.. Percentage of neutrophils in induced sputum after exercise
correlated with severity of EIA (percentage of decrease in FEV1).
p.. Induced sputum supernatant concentrations of inflammatory
mediators were significantly higher during the HSD and NSD phases
than during the LSD phase.
q.. Plasma volume during the LSD phase was significantly
reduced (by 11.1%), whereas it was significantly increased (by
12.2%) during the HSD phase.
Pearls for Practice
a.. Mechanisms by which exercise triggers EIA include transient
dehydration of the airways, activating inflammatory mediators and
resulting in bronchial smooth muscle contraction, and rapid
rewarming of airways after exercise, leading to vascular
engorgement and perivascular edema.
b.. In experimental subjects with EIA, an HSD compared with an
LSD is associated with worse postexercise pulmonary function;
higher levels of sputum eosinophils, neutrophils, and
inflammatory mediators; and higher plasma volume.
--------------------------------------------------------------------------------
aroberts - 19 Jan 2006 23:47 GMT
>The second link doesn't show the article, so here's the
>cut/pasted version
Sorry about that...next time, TinyURL!!!!
Mild salt water thru the nebulizer a great boon to my sinuses.
Merlin - 21 Jan 2006 01:41 GMT
Good Day Jack, yes the reason was not made apparent as to why this had
effect, whether it was a germicidal or calmative. Of course in the
case of dental procedures it has always been normal to use it.
But this nebuliser trick has a few people interested in how it might
affect the lung situation.
I will pass your sinus effect finding on.
Tnx.
Cheers, Merlin.
ARoberts - 21 Jan 2006 03:27 GMT
> Mild salt water thru the nebulizer a great boon to my sinuses.
Mine too, but that's not the suggested dietary salt...
I have used a mild saline solution in my nebuliser for years, but my
daughter put too much salt in once, and it caused me to have an attack..so
please use only a VERY small amount of salt if you try this.
It does help. and reduces my need for so much ventolin.
> 1. Merlin
> Jan 15, 7:54 pm show options
[quoted text clipped - 18 lines]
> http://www.medscape.com/viewarticle/506810http://general-medicine.jwatch.org/cgi
/content/full/1988/906/1
> http://www.nzherald.co.nz/category/story.cfm?c_id=204&ObjectID=10354170