Sex differences in asthma in swimmers and tennis players

Reduced tidal volume-inflection point and elevated operating lung volumes during exercise in females with well-controlled asthma

INTRODUCTION

Individuals with asthma breathe at higher operating lung volumes during exercise compared with healthy individuals, which contributes to increased exertional dyspnoea. In health, females are more likely to develop exertional dyspnoea than males at a given workload or ventilation, and therefore, it is possible that females with asthma may develop disproportional dyspnoea on exertion. The purpose of this study was to compare operating lung volume and dyspnoea responses during exercise in females with and without asthma.

METHODS

Sixteen female controls and 16 females with asthma were recruited for the study along with 16 male controls and 16 males with asthma as a comparison group. Asthma was confirmed using American Thoracic Society criteria. Participants completed a cycle ergometry cardiopulmonary exercise test to volitional exhaustion. Inspiratory capacity manoeuvres were performed to estimate inspiratory reserve volume (IRV) and dyspnoea was evaluated using the Modified Borg Scale.

RESULTS

Females with asthma exhibited elevated dyspnoea during submaximal exercise compared with female controls (p<0.05). Females with asthma obtained a similar IRV and dyspnoea at peak exercise compared with healthy females despite lower ventilatory demand, suggesting mechanical constraint to tidal volume (VT) expansion. VT-inflection point was observed at significantly lower ventilation and V̇O2 in females with asthma compared with female controls. Forced expired volume in 1 s was significantly associated with VT-inflection point in females with asthma (R2=0.401; p<0.01) but not female controls (R2=0.002; p=0.88).

CONCLUSION

These results suggest that females with asthma are more prone to experience exertional dyspnoea, secondary to dynamic mechanical constraints during submaximal exercise when compared with females without asthma.

Sex Differences in Swimming Disciplines-Can Women Outperform Men in Swimming?

In recent years, the interest of female dominance in long-distance swimming has grown where several newspaper articles have been published speculating about female performance and dominance—especially in open-water ultra-distance swimming. The aim of this narrative review is to review the scientific literature regarding the difference between the sexes for all swimming strokes (i.e., butterfly, backstroke, breaststroke, freestyle and individual medley), different distances (i.e., from sprint to ultra-distances), extreme conditions (i.e., cold water), different ages and swimming integrated in multi-sports disciplines, such as triathlon, in various age groups and over calendar years. The influence of various physiological, psychological, anthropometrical and biomechanical aspects to potentially explain the female dominance was also discussed. The data bases Scopus and PUBMED were searched by April 2020 for the terms ’sex–difference–swimming’. Long-distance open-water swimmers and pool swimmers of different ages and performance levels were mainly investigated. In open-water long-distance swimming events of the ’Triple Crown of Open Water Swimming’ with the ’Catalina Channel Swim’, the ’English Channel Swim’ and the ’Manhattan Island Marathon Swim’, women were about 0.06 km/h faster than men. In master swimmers (i.e., age groups 25–29 to 90–94 years) competing in the FINA (Fédération Internationale de Natation) World Championships in pool swimming in freestyle, backstroke, butterfly, breaststroke, individual medley and in 3000-m open-water swimming, women master swimmers appeared able to achieve similar performances as men in the oldest age groups (i.e., older than 75–80 years). In boys and girls aged 5–18 years—and listed in the all-time top 100 U.S. freestyle swimming performances from 50 m to 1500 m—the five fastest girls were faster than the five fastest boys until the age of ~10 years. After the age of 10 years, and until the age of 17 years, however, boys were increasingly faster than girls. Therefore, women tended to decrease the existing sex differences in specific age groups (i.e., younger than 10 years and older than 75–80 years) and swimming strokes in pool-swimming or even to overperform men in long-distance open-water swimming (distance of ~30 km), especially under extreme weather conditions (water colder than ~20 °C). Two main variables may explain why women can swim faster than men in open-water swimming events: (i) the long distance of around 30 km, (ii) and water colder than ~20 °C. Future studies may investigate more detailed (e.g., anthropometry) the very young (<10 years) and very old (>75–80 years) age groups in swimming

Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations

The transient airway narrowing that occurs as a result of exercise is defined as exercise-induced bronchoconstriction (EIB). The prevalence of EIB has been reported to be up to 90% in asthmatic patients, reflecting the level of disease control. However, EIB may develop even in subjects without clinical asthma, particularly in children, athletes, patients with atopy or rhinitis, and following respiratory infections. The intensity, duration, and type of training have been associated with the occurrence of EIB. In athletes, EIB seems to be only partly reversible, and exercise seems to be a causative factor of airway inflammation and symptoms.

Gender aspects and influence of hormones on bronchial asthma - Secondary publication and update

There is good evidence for gender-specific differences in asthma regarding all affected areas, from intra- to extra-cellular mediators to the whole organ structure und functioning of the lung. These result from complex, in parts synergistic, in other parts opposing, effects - especially of female sex hormones, and rather protective effects of male hormones against asthma, which include effects on the cellular immune system. Additionally, there are gender differences of sociocultural origin, regarding presentation, doctor's diagnosis and treatment of asthma symptoms, as well as the undertaken coping strategies concerning the female or male patient's complaints. Taking into account gender-specific differences in asthma would contribute to improved individual diagnosis and therapies.

Asthma symptoms, mannitol reactivity and exercise-induced bronchoconstriction in adolescent swimmers versus tennis players

Background

Strenuous physical activity at an elite level is associated with an increased risk for asthma and, in some sports, also prevalence of allergies. The aim of this study was to investigate the prevalence of asthma and allergy among elite swimmers and tennis players and compare airway hyperreactivity to mannitol and exercise.

Materials and methods

One hundred and one adolescent swimmers and 86 tennis players answered a questionnaire about respiratory symptoms and allergy and performed mannitol challenge and sport-specific exercise challenge. Atopy was assessed and fractional exhaled nitric oxide was measured. Mannitol positivity was defined as drop in FEV₁ ≥15% (ordinary criteria) and/or β₂-reversibility (≥15%) after provocation (extended criteria). A positive exercise test was defined as a drop in FEV₁ ≥10% (ordinary criteria) and/or β₂-reversibility (≥15%) after provocation (extended criteria). Club cell protein (CC16) was measured in urine before and after the challenges.

Results

Asthma symptoms were common in both groups. More swimmers had exercise-induced symptoms (77% versus 50%) and current asthma symptoms (56% versus 38%), compared to the tennis players. More swimmers also had a positive mannitol challenge test both using ordinary (26% versus 6%) and extended criteria (43% versus 17%), while the number of positive exercise tests did not differ. After exercise (but not mannitol) challenge, CC16 level was increased in both groups, but to a higher extent in tennis players. There were no differences in atopy, rhinitis or fractional exhaled nitric oxide.

Conclusion

We found a high prevalence of asthma among elite swimmers and tennis players and a higher frequency of current asthma and positive mannitol challenge tests among the swimmers. This indicates an unfavorable exercise environment.