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Venckunas T, Achramavicius J. Higher Blood Lactate with Prolongation of Underwater Section in Submaximal Front-Crawl Swimming. Sports (Basel) 2024; 12:121. [PMID: 38786990 PMCID: PMC11125574 DOI: 10.3390/sports12050121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
The underwater phase (UP) is highly important for overall swimming performance in most swimming events. However, the metabolic effects of the prolonged UP remain unclear. The purpose of this cross-sectional study was to compare the blood lactate response to submaximal front-crawl swimming with short and extended UP. Twelve (four females) junior competitive swimmers (aged 15.4 (1.4) years) undertook 200 m front-crawl swim trials in a 25 m pool at a pre-determined "anaerobic threshold" velocity on two occasions using short (<5 m) and extended (12.5 m) UP after each turn. Pacing and total time were ensured to be identical between the trials. Capillary blood lactate response was measured. Testing for 25 m swim time with <5 m and 12.5 m UP was conducted on a separate occasion. When athletes undertook and extended UP after each propulsion from the wall, their post-exercise blood lactate concentration reached 7.9 (2.1) mmol/L, more than two times higher than the response to trial with short UP (p < 0.001). All-out 25 m swimming with <5 m or 12.5 m UP disclosed no difference in locomotion velocity (p > 0.05). In conclusion, extending UP of submaximal front-crawl swimming close to maximally allowed during the races substantially increases blood lactate accumulation, i.e., increases the reliance on anaerobic metabolism. Therefore, extended UP is most likely counterproductive for the performance in long-distance swimming, at least for the athletes with a FINA score of <800. On the other hand, the extension of UP could be an effective strategy to train 'lactate tolerance', lactate shuttling, removal, and recycling.
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Affiliation(s)
- Tomas Venckunas
- Institute of Sport Science and Innovations, Lithuanian Sports University, LT-44221 Kaunas, Lithuania;
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2
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Ora J, De Marco P, Gabriele M, Cazzola M, Rogliani P. Exercise-Induced Asthma: Managing Respiratory Issues in Athletes. J Funct Morphol Kinesiol 2024; 9:15. [PMID: 38249092 PMCID: PMC10801521 DOI: 10.3390/jfmk9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma is a complex respiratory condition characterized by chronic airway inflammation and variable expiratory airflow limitation, affecting millions globally. Among athletes, particularly those competing at elite levels, the prevalence of respiratory conditions is notably heightened, varying between 20% and 70% across specific sports. Exercise-induced bronchoconstriction (EIB) is a common issue among athletes, impacting their performance and well-being. The prevalence rates vary based on the sport, training environment, and genetics. Exercise is a known trigger for asthma, but paradoxically, it can also improve pulmonary function and alleviate EIB severity. However, athletes' asthma phenotypes differ, leading to varied responses to medications and challenges in management. The unique aspects in athletes include heightened airway sensitivity, allergen, pollutant exposure, and temperature variations. This review addresses EIB in athletes, focusing on pathogenesis, diagnosis, and treatment. The pathogenesis of EIB involves complex interactions between physiological and environmental factors. Airway dehydration and cooling are key mechanisms, leading to osmotic and thermal theories. Airway inflammation and hyper-responsiveness are common factors. Elite athletes often exhibit distinct inflammatory responses and heightened airway sensitivity, influenced by sport type, training, and environment. Swimming and certain sports pose higher EIB risks, with chlorine exposure in pools being a notable factor. Immune responses, lung function changes, and individual variations contribute to EIB in athletes. Diagnosing EIB in athletes requires objective testing, as baseline lung function tests can yield normal results. Both EIB with asthma (EIBA) and without asthma (EIBwA) must be considered. Exercise and indirect bronchoprovocation tests provide reliable diagnoses. In athletes, exercise tests offer effectiveness in diagnosing EIB. Spirometry and bronchodilation tests are standard approaches, but the diagnostic emphasis is shifting toward provocation tests. Despite its challenges, achieving an optimal diagnosis of EIA constitutes the cornerstone for effective management, leading to improved performance, reduced risk of complications, and enhanced quality of life. The management of EIB in athletes aligns with the general principles for symptom control, prevention, and reducing complications. Non-pharmacological approaches, including trigger avoidance and warming up, are essential. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy in athletes. Short-acting beta agonists (SABA) are discouraged as sole treatments. Leukotriene receptor antagonists (LTRA) and mast cell stabilizing agents (MCSA) are potential options. Optimal management improves the athletes' quality of life and allows them to pursue competitive sports effectively.
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Affiliation(s)
- Josuel Ora
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
| | - Patrizia De Marco
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
| | - Mariachiara Gabriele
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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3
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Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports 2024; 34:e14358. [PMID: 36965010 DOI: 10.1111/sms.14358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.
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Affiliation(s)
- Morten Hostrup
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erik S H Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Søren Jessen
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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4
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Anderson SD, Kippelen P. A proposal to account for the stimulus, the mechanism, and the mediators released in exercise-induced bronchoconstriction. FRONTIERS IN ALLERGY 2023; 4:1004170. [PMID: 38026130 PMCID: PMC10657894 DOI: 10.3389/falgy.2023.1004170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Exercise induced bronchoconstriction (EIB) describes the transient narrowing of the airways that follows vigorous exercise. It commonly occurs in children and adults who have asthma and in elite athletes. The primary stimulus is proposed to be loss of water, by evaporation, from the airway surface due to conditioning inspired air. The mechanism, whereby this evaporative loss of water provokes contraction of the bronchial smooth muscle, is thought to be an increase in osmolarity of the airway surface liquid. The increase in osmolarity causes mast cells to release histamines, prostaglandins, and leukotrienes. It is these mediators that contract smooth muscle causing the airways to narrow.
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Affiliation(s)
- Sandra D. Anderson
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Pascale Kippelen
- Division of Sport, Health and Exercise Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
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5
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Reier-Nilsen T, Stang JS, Flatsetøy H, Isachsen M, Ljungberg H, Bahr R, Nordlund B. Unsupervised field-based exercise challenge tests to support the detection of exercise-induced lower airway dysfunction in athletes. BMJ Open Sport Exerc Med 2023; 9:e001680. [PMID: 37520311 PMCID: PMC10373716 DOI: 10.1136/bmjsem-2023-001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/01/2023] Open
Abstract
Background Athletes are at risk for developing exercise-induced lower airway narrowing. The diagnostic assessment of such lower airway dysfunction (LAD) requires an objective bronchial provocation test (BPT). Objectives Our primary aim was to assess if unsupervised field-based exercise challenge tests (ECTs) could confirm LAD by using app-based spirometry. We also aimed to evaluate the diagnostic test performance of field-based and sport-specific ECTs, compared with established eucapnic voluntary hyperpnoea (EVH) and methacholine BPT. Methods In athletes with LAD symptoms, sensitivity and specificity analyses were performed to compare outcomes of (1) standardised field-based 8 min ECT at 85% maximal heart rate with forced expiratory volume in 1 s (FEV1) measured prechallenge and 1 min, 3 min, 5 min, 10 min, 15 min and 30 min postchallenge, (2) unstandardised field-based sport-specific ECT with FEV1 measured prechallenge and within 10 min postchallenge, (3) EVH and (4) methacholine BPT. Results Of 60 athletes (median age 17.5; range 16-28 years.; 40% females), 67% performed winter-sports, 43% reported asthma diagnosis. At least one positive BPT was observed in 68% (n=41/60), with rates of 51% (n=21/41) for standardised ECT, 49% (n=20/41) for unstandardised ECT, 32% (n=13/41) for EVH and methacholine BPT, while both standardised and unstandardised ECTs were simultaneously positive in only 20% (n=7/35). Standardised and unstandardised ECTs confirmed LAD with 54% sensitivity and 70% specificity, and 46% sensitivity and 68% specificity, respectively, using EVH as a reference, while EVH and methacholine BPT were both 33% sensitive and 85% specific, using standardised ECTs as reference. Conclusion App-based spirometry for unsupervised field-based ECTs may support the diagnostic process in athletes with LAD symptoms. Trial registration number NCT04275648.
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Affiliation(s)
- Tonje Reier-Nilsen
- The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Julie Sørbø Stang
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Hanne Flatsetøy
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Martine Isachsen
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Henrik Ljungberg
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Roald Bahr
- The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Björn Nordlund
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Stockholm, Sweden
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6
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Verhey JT, Poon SK. General Medical Emergencies in Athletes. Clin Sports Med 2023; 42:427-440. [PMID: 37208057 DOI: 10.1016/j.csm.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article focuses on the management of the most common on-field medical emergencies. As with any discipline in medicine, a well-defined plan and systematic approach is the cornerstone of quality health care delivery. In addition, the team-based collaboration is necessary for the safety of the athlete and the success of the treatment plan.
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Affiliation(s)
- Jens T Verhey
- Orthopaedic Surgery Residency, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Steven K Poon
- Sports Medicine Section, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
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7
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Reier-Nilsen T, Sewry N, Chenuel B, Backer V, Larsson K, Price OJ, Pedersen L, Bougault V, Schwellnus M, Hull JH. Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'. Br J Sports Med 2023; 57:481-489. [PMID: 36717213 DOI: 10.1136/bjsports-2022-106059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To compare the performance of various diagnostic bronchoprovocation tests (BPT) in the assessment of lower airway dysfunction (LAD) in athletes and inform best clinical practice. DESIGN Systematic review with sensitivity and specificity meta-analyses. DATA SOURCES PubMed, EBSCOhost and Web of Science (1 January 1990-31 December 2021). ELIGIBILITY CRITERIA Original full-text studies, including athletes/physically active individuals (15-65 years) who underwent assessment for LAD by symptom-based questionnaires/history and/or direct and/or indirect BPTs. RESULTS In 26 studies containing data for quantitative meta-analyses on BPT diagnostic performance (n=2624 participants; 33% female); 22% had physician diagnosed asthma and 51% reported LAD symptoms. In athletes with symptoms of LAD, eucapnic voluntary hyperpnoea (EVH) and exercise challenge tests (ECTs) confirmed the diagnosis with a 46% sensitivity and 74% specificity, and 51% sensitivity and 84% specificity, respectively, while methacholine BPTs were 55% sensitive and 56% specific. If EVH was the reference standard, the presence of LAD symptoms was 78% sensitive and 45% specific for a positive EVH, while ECTs were 42% sensitive and 82% specific. If ECTs were the reference standard, the presence of LAD symptoms was 80% sensitive and 56% specific for a positive ECT, while EVH demonstrated 65% sensitivity and 65% specificity for a positive ECT. CONCLUSION In the assessment of LAD in athletes, EVH and field-based ECTs offer similar and moderate diagnostic test performance. In contrast, methacholine BPTs have lower overall test performance. PROSPERO REGISTRATION NUMBER CRD42020170915.
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Affiliation(s)
- Tonje Reier-Nilsen
- The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway .,Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre of South Africa, University of Pretoria, Pretoria, South Africa
| | - Bruno Chenuel
- Centre Hospitalier Régional Universitaire de Nancy, Department of Lung function and Exercise Physiology - University Center of Sports Medicine and Adapted Physical Activity, Université de Lorraine, Nancy, France.,Université de Lorraine, DevAH, Nancy, France
| | - Vibeke Backer
- Department of ENT, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.,CFAS, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Kjell Larsson
- Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Lars Pedersen
- Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| | - Valerie Bougault
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre of South Africa, University of Pretoria, Pretoria, South Africa
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,Institute of Sport, Exercise and Health (ISEH), Division of surgery and Interventional science, University College London, London, UK
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8
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Rasmussen SM, Hansen ESH, Backer V. Asthma in elite athletes - do they have Type 2 or non-Type 2 disease? A new insight on the endotypes among elite athletes. FRONTIERS IN ALLERGY 2022; 3:973004. [PMID: 36340019 PMCID: PMC9633848 DOI: 10.3389/falgy.2022.973004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Asthma and exercise-induced bronchoconstriction are highly prevalent in elite athletes compared with the general population. Some athletes have classic asthma with allergic sensitization; however, it seems that a proportion of athletes develop asthma as a result of several years of intensive training. It leads us to believe that asthma in athletes consists of at least two distinct endotypes - classic early-onset, Type 2 mediated asthma, and asthma with later onset caused by exercise which might be classified as non-Type 2 asthma. The purpose of this review is to evaluate the current literature on asthma in athletes focusing on inflammation and examine if asthma in athletes could be characterized as either Type 2- or non-Type 2 asthma.
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Affiliation(s)
- Søren Malte Rasmussen
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark,Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark,Correspondence: Søren Malte Rasmussen
| | - Erik Sören Halvard Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark,Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Hospital, Hvidovre, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark,Department of Otorhinolaryngology Head / Neck surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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9
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Price OJ, Walsted ES, Bonini M, Brannan JD, Bougault V, Carlsen K, Couto M, Kippelen P, Moreira A, Pite H, Rukhadze M, Hull JH. Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper. Allergy 2022; 77:2909-2923. [PMID: 35809082 PMCID: PMC9796481 DOI: 10.1111/all.15431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimize health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in structured exercise and/or physical activity to maintain health and well-being across the lifespan. This EAACI Task Force was therefore established, to develop an up-to-date, research-informed position paper, detailing the optimal approach to the diagnosis and management of common exercise-related allergic and respiratory conditions. The recommendations are informed by a multidisciplinary panel of experts including allergists, pulmonologists, physiologists and sports physicians. The report is structured as a concise, practically focussed document, incorporating diagnostic and treatment algorithms, to provide a source of reference to aid clinical decision-making. Throughout, we signpost relevant learning resources to consolidate knowledge and understanding and conclude by highlighting future research priorities and unmet needs.
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Affiliation(s)
- Oliver J. Price
- School of Biomedical SciencesFaculty of Biological Sciences, University of LeedsLeedsUK,Leeds Institute of Medical Research at St James'sUniversity of LeedsLeedsUK
| | - Emil S. Walsted
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK,Department of Respiratory MedicineBispebjerg HospitalCopenhagenDenmark
| | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly,National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | | | | | - Kai‐Håkon Carlsen
- Division of Paediatric and Adolescent MedicineOslo University HospitalOsloNorway,Faculty of Medicine, University of OsloInstitute of Clinical MedicineOsloNorway
| | - Mariana Couto
- Allergy CenterCUF Descobertas HospitalLisbonPortugal
| | - Pascale Kippelen
- Division of Sport, Health and Exercise SciencesCollege of Health, Medicine and Life Sciences, Brunel University LondonUK
| | - André Moreira
- Centro Hospitalar Universitário de São JoãoPortoPortugal,Epidemiology Unit (EPIUnit)Laboratory for Integrative and Translational Research in Population Health (ITR)Basic and Clinical Immunology, Department of Pathology, Faculty of MedicineUniversity of PortoPortoPortugal
| | - Helena Pite
- Allergy Center, CUF Descobertas Hospital and CUF Tejo HospitalCEDOC, NOVA University, Universidade NOVA de LisboaLisbonPortugal
| | | | - James H. Hull
- Department of Respiratory MedicineRoyal Brompton HospitalLondonUK,Institute of Sport, Exercise and Health (ISEH)Division of Surgery and Interventional Science, University College London (UCL)LondonUK
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10
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Schwellnus M, Adami PE, Bougault V, Budgett R, Clemm HH, Derman W, Erdener U, Fitch K, Hull JH, McIntosh C, Meyer T, Pedersen L, Pyne DB, Reier-Nilsen T, Schobersberger W, Schumacher YO, Sewry N, Soligard T, Valtonen M, Webborn N, Engebretsen L. International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness. Br J Sports Med 2022; 56:bjsports-2022-105567. [PMID: 35623888 DOI: 10.1136/bjsports-2022-105567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 01/03/2023]
Abstract
Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to 'core' members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.
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Affiliation(s)
- Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- SEMLI, IOC Research Centre, Pretoria, Gauteng, South Africa
| | - Paolo Emilio Adami
- Health & Science Department, World Athletics, Monaco, Monaco Principality
| | - Valerie Bougault
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, Provence-Alpes-Côte d'Azu, France
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Hege Havstad Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine (ISEM), Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- ISEM, IOC Research Center, South Africa, Stellenbosch, South Africa
| | - Uğur Erdener
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Ken Fitch
- School of Human Science; Sports, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London (UCL), London, UK
| | - Cameron McIntosh
- Dr CND McIntosh INC, Edge Day Hospital, Port Elizabeth, South Africa
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - David B Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Tonje Reier-Nilsen
- Oslo Sports Trauma Research Centre, The Norwegian Olympic Sports Centre, Oslo, Norway
- Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Wolfgang Schobersberger
- Insitute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), Kliniken Innsbruck and Private University UMIT Tirol, Hall, Austria
| | | | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- SEMLI, IOC Research Centre, Pretoria, Gauteng, South Africa
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Maarit Valtonen
- KIHU, Research Institute for Olympic Sports, Jyväskylä, Finland
| | - Nick Webborn
- Centre for Sport and Exercise Science and Medicine, University of Brighton, Brighton, UK
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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11
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Kang N, Koh E, Lee JY, Song WJ, Choi DC, Lee BJ. Cut-off value for exercise-induced bronchoconstriction based on the features of the airway obstruction. PLoS One 2022; 17:e0268969. [PMID: 35617173 PMCID: PMC9135203 DOI: 10.1371/journal.pone.0268969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
The current cut-off value for diagnosing exercise-induced bronchoconstriction (EIB) in adults—percent fall in FEV1 (ΔFEV1) ≥ 10% after exercise challenge test (ECT)—has low specificity and weak evidences. Therefore, this study aimed to identify the cut-off value for EIB that provides the highest diagnostic sensitivity and specificity. Participants who underwent the ECT between 2007 and 2018 were categorized according to ΔFEV1: definite EIB (ΔFEV1 ≥ 15%), borderline (10% ≤ ΔFEV1 < 15%), and normal (ΔFEV1 < 10%). Distinct characteristics of the definite EIB group were identified and explored in the borderline EIB group. A receiver operating characteristic curve was plotted to determine the optimal cut-off value. Of 128 patients, 60 were grouped as the definite EIB group, 23 as the borderline group, and 45 as the normal group. All participants were men, with a median age of 20 years (interquartile range [IQR:] 19–23 years). The definite EIB group exhibited wheezing on auscultation (P < 0.001), ΔFEV1/FVC ≥ 10% (P < 0.001), and ΔFEF25–75% ≥ 25% (P < 0.001) compared to other groups. Eight (8/23, 34.8%) patients in the borderline group had at least one of these features, but the trend was more similar to that of the normal group than the definite EIB group. A cut-off value of ΔFEV1 ≥ 13.5% had a sensitivity of 98.5% and specificity of 93.5% for EIB. Wheezing on auscultation, ΔFEV1/FVC ≥ 10%, and ΔFEF25–75% ≥ 25% after ECT may be useful for the diagnosis of EIB, particularly in individuals with a ΔFEV1 of 10–15%. For EIB, a higher cut-off value, possibly ΔFEV1 ≥ 13.5%, should be considered as the diagnostic criterion.
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Affiliation(s)
- Noeul Kang
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunsil Koh
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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12
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Clemm HH, Olin JT, McIntosh C, Schwellnus M, Sewry N, Hull JH, Halvorsen T. Exercise-induced laryngeal obstruction (EILO) in athletes: a narrative review by a subgroup of the IOC Consensus on 'acute respiratory illness in the athlete'. Br J Sports Med 2022; 56:622-629. [PMID: 35193856 PMCID: PMC9120388 DOI: 10.1136/bjsports-2021-104704] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 02/06/2023]
Abstract
Exercise-induced laryngeal obstruction (EILO) is caused by paradoxical inspiratory adduction of laryngeal structures during exercise. EILO is an important cause of upper airway dysfunction in young individuals and athletes, can impair exercise performance and mimic lower airway dysfunction, such as asthma and/or exercise-induced bronchoconstriction. Over the past two decades, there has been considerable progress in the recognition and assessment of EILO in sports medicine. EILO is a highly prevalent cause of unexplained dyspnoea and wheeze in athletes. The preferred diagnostic approach is continuous visualisation of the larynx (via laryngoscopy) during high-intensity exercise. Recent data suggest that EILO consists of different subtypes, possibly caused via different mechanisms. Several therapeutic interventions for EILO are now in widespread use, but to date, no randomised clinical trials have been performed to assess their efficacy or inform robust management strategies. The aim of this review is to provide a state-of-the-art overview of EILO and guidance for clinicians evaluating and treating suspected cases of EILO in athletes. Specifically, this review examines the pathophysiology of EILO, outlines a diagnostic approach and presents current therapeutic algorithms. The key unmet needs and future priorities for research in this area are also covered.
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Affiliation(s)
- Hege Havstad Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland Universityhospital, Bergen, Norway .,Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Tod Olin
- Department of Pediatrics and Medicine, National Jewish Health, Denver, Colorado, USA
| | | | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,IOC Research Centre, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,IOC Research Centre, South Africa
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Thomas Halvorsen
- Department of Pediatric and Adolescent Medicine, Haukeland Universityhospital, Bergen, Norway.,Faculty of Medicine and Dentistry, Department of Clinical Science, University of Bergen, Bergen, Norway.,Norwegian School of Sports Sciences, Oslo, Norway
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13
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Kolnes LJ. Stressed and Distressed: Potential Underpinnings of Exercise-Related Inspiratory Distress in Adolescent Sport Performers. Phys Ther 2022; 102:6398921. [PMID: 34662404 DOI: 10.1093/ptj/pzab242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/23/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022]
Abstract
UNLABELLED Many adolescent sport performers present with exercise-related respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO). The pathogenic underpinnings of EILO are not fully resolved, and existing behavioral management includes therapies targeting laryngeal physiology whereas surgical interventions target laryngeal anatomical anomalies. Recent findings from research and clinical practice indicate that psychological stress and thoracic breathing co-occur with laryngeal tightness in adolescent sport performers with EILO. This Perspective article theorizes on this potential coexistence. It discusses possible underpinnings of respiratory symptoms (including EILO) and thoracic breathing in adolescent sport performers by considering the effects of various stressors to which adolescent sport performers are exposed, and the impact these may have on the breathing, including in terms of laryngeal narrowing. The effect of stress on the breathing is examined in light of the reciprocal communication between the brain and the body and the relationship between psychological stress and stress responses in the respiratory system mediated by the autonomic nervous system. To inform decision-making and clinical awareness in this area, it may be worth expanding the focus from targeting mainly laryngeal structures to also include constrictions of the airways and the effects of thoracic breathing on the larynx during exercise. The importance of considering respiratory distress from a multidimensional perspective, and of incorporating the complexity of sport performers' psychological and physical experiences in the management of their health and well-being, is emphasized. IMPACT This Perspective adds to the understanding of respiratory distress in populations other than adults, which is important and necessary. LAY SUMMARY Adolescent sport performers are exposed to a number of stressors that may affect breathing and laryngeal narrowing, which in turn may have implications for the management of their overall health and well-being.
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Affiliation(s)
- Liv-Jorunn Kolnes
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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14
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Medical Problems of the Athlete. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Price OJ, Sewry N, Schwellnus M, Backer V, Reier-Nilsen T, Bougault V, Pedersen L, Chenuel B, Larsson K, Hull JH. Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on 'acute respiratory illness in the athlete'. Br J Sports Med 2021; 56:213-222. [PMID: 34872908 DOI: 10.1136/bjsports-2021-104601] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020). ELIGIBILITY CRITERIA Original full-text studies, including male or female athletes/physically active individuals/military personnel (aged 15-65 years) who had a prior asthma diagnosis and/or underwent screening for lower airway dysfunction via self-report (ie, patient recall or questionnaires) or objective testing (ie, direct or indirect bronchial provocation challenge). RESULTS In total, 1284 studies were identified. Of these, 64 studies (n=37 643 athletes) from over 21 countries (81.3% European and North America) were included. The prevalence of lower airway dysfunction was 21.8% (95% CI 18.8% to 25.0%) and has remained stable over the past 30 years. The highest prevalence was observed in elite endurance athletes at 25.1% (95% CI 20.0% to 30.5%) (Q=293, I2=91%), those participating in aquatic (39.9%) (95% CI 23.4% to 57.1%) and winter-based sports (29.5%) (95% CI 22.5% to 36.8%). In studies that employed objective testing, the highest prevalence was observed in studies using direct bronchial provocation (32.8%) (95% CI 19.3% to 47.2%). A high degree of heterogeneity was observed between studies (I2=98%). CONCLUSION Lower airway dysfunction affects approximately one in five athletes, with the highest prevalence observed in those participating in elite endurance, aquatic and winter-based sporting disciplines. Further longitudinal, multicentre studies addressing causality (ie, training status/dose-response relationship) and evaluating preventative strategies to mitigate against the development of lower airway dysfunction remain an important priority for future research.
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Affiliation(s)
- Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,IOC Research Centre, Pretoria, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,IOC Research Centre, Pretoria, South Africa
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshopitalet, Copenhagen University, Denmark, Copenhagen, Denmark
| | | | - Valerie Bougault
- Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, Nice, France
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Bruno Chenuel
- Centre Hospitalier Régional Universitaire de Nancy, Centre Universitaire de Médecine du Sport et Activité Physique Adaptée, Service des Explorations de la Fonction Respiratoire, Université de Lorraine, Nancy, France.,Medical Physiology, Université de Lorraine, Nancy, France
| | - Kjell Larsson
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK .,Division of Surgery and Interventional Science, Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
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16
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Hull JH, Jackson AR, Ranson C, Brown F, Wootten M, Loosemore M. The benefits of a systematic assessment of respiratory health in illness-susceptible athletes. Eur Respir J 2021; 57:13993003.03722-2020. [PMID: 33334943 DOI: 10.1183/13993003.03722-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/26/2020] [Indexed: 12/15/2022]
Abstract
Respiratory tract illness is a leading cause of training and in-competition time loss in elite athletes. Asthma is known to be prevalent in athletes, but the coexistence of other respiratory problems in those deemed to be susceptible to respiratory tract illness is unknown. The aim of this study was to apply a comprehensive prospective approach to identify respiratory problems and explore relationships in athletes with heightened respiratory illness susceptibility.UK World Class Performance Programme athletes prospectively completed a systematic review of respiratory health with validated questionnaires and respiratory-focused investigations, including studies of nasal flow, exhaled nitric oxide, spirometry, bronchoprovocation testing and allergy testing.Systematic respiratory health assessment was completed by 122 athletes (55 females, mean±sd age 24±4 years). At least one respiratory health issue, requiring intervention, was identified in 97 (80%) athletes and at least two abnormalities were found in 73 (60%). Sinonasal problems were the most commonly identified problem (49%) and 22% of athletes had a positive indirect bronchoprovocation test. Analysis revealed two respiratory health clusters: 1) asthma, sinus problems and allergy; and 2) laryngeal and breathing pattern dysfunction. Respiratory illness susceptible athletes had 3.6±2.5 episodes in the year prior to assessment and were more likely to have allergy (OR 2.6, 95% CI 1.0-6.5), sinonasal problems (2.6, 1.1-6.0) and symptoms of laryngeal (5.4, 1.8-16.8) and breathing pattern dysfunction (3.9, 1.1-14.0) than nonsusceptible athletes (all p<0.05).A systematic approach to respiratory assessment identifies a high prevalence and coexistence of multiple respiratory problems in illness-susceptible athletes.
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Affiliation(s)
- James H Hull
- Dept of Respiratory Medicine, Royal Brompton Hospital, London, UK .,National Heart and Lung Institute, Imperial College, London, UK.,The Institute of Sport, Exercise and Health, University College London, London, UK
| | - Anna R Jackson
- Athlete Health, English Institute of Sport, Manchester, UK
| | - Craig Ranson
- Athlete Health, English Institute of Sport, Manchester, UK
| | | | | | - Mike Loosemore
- The Institute of Sport, Exercise and Health, University College London, London, UK.,Athlete Health, English Institute of Sport, Manchester, UK
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17
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Goddard T, Sonnappa S. The role of cardiopulmonary exercise testing in evaluating children with exercise induced dyspnoea. Paediatr Respir Rev 2021; 38:24-32. [PMID: 32980274 DOI: 10.1016/j.prrv.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Abstract
Exercise induced dyspnoea (EID) is a common manifestation in children and adolescents. Although EID is commonly attributed to exercise induced bronchoconstriction, several conditions other than asthma can cause EID in otherwise healthy children and adolescents. Cardiopulmonary exercise testing (CPET) offers a non-invasive comprehensive assessment of the cardiovascular, ventilatory and metabolic responses to exercise and is a powerful diagnostic and prognostic tool. CPET is a reproducible, non-invasive form of testing that allows for comparison against age- and gender-specific norms. CPET can assess the child's exercise capacity, determine the limiting factors associated with this, and be used to prescribe individualised interventions. EID can occur due to asthma, exercise induced laryngeal obstruction, breathing pattern disorders, chest wall restriction and cardiovascular pathology among other causes. Differentiating between these varied causes is important if effective therapy is to be initiated and quality of life improved in subjects with EID.
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Affiliation(s)
- T Goddard
- Royal Brompton Hospital, Paediatric Respiratory Medicine, London, UK; The University of Adelaide, Adelaide, Australia
| | - S Sonnappa
- Royal Brompton Hospital, Paediatric Respiratory Medicine, London, UK; National Heart and Lung Institute, Imperial College, UK.
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18
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Management of Exercise-Induced Bronchoconstriction in Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2183-2192. [PMID: 32620432 DOI: 10.1016/j.jaip.2020.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/25/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is a phenomenon observed in asthma but is also seen in healthy individuals and frequently in athletes. High prevalence rates are observed in athletes engaged in endurance sports, winter sports, and swimming. The pathophysiology of EIB is thought to be related to hyperventilation, cold air, and epithelial damage caused by chlorine and fine particles in inspired air. Several diagnostic procedures can be used; however, the diagnosis of EIB based on self-reported symptoms is not reliable and requires an objective examination. The hyperosmolar inhalation test and eucapnic voluntary hyperpnea test, which involve indirect stimulation of the airway, are useful for the diagnosis of EIB. A short-acting β-agonist is the first choice for prevention of EIB, and an inhaled corticosteroid is essential for patients with asthma. Furthermore, treatment should accommodate antidoping requirements in elite athletes. Tailoring of the therapeutic strategy to the individual case and the prognosis after cessation of athletic activity are issues that should be clarified in the future.
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19
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Del Giacco S, Couto M, Firinu D, Garcia-Larsen V. Management of Intermittent and Persistent Asthma in Adolescent and High School Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2166-2181. [PMID: 32620431 DOI: 10.1016/j.jaip.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/06/2023]
Abstract
Asthma is the most common chronic condition during childhood and adolescence, affecting an estimated 8% of children and youngsters below 18 years in the United States and the United Kingdom. In adolescent athletes, asthma-like symptoms may represent a common consequence of regular sport practice. Asthma in young athletes poses several challenges, including the ambiguity of definitions and diagnosis of asthma resulting from exercise-induced symptoms, the best pharmacological treatments, and the nonpharmacological options for the management of disease and the challenges inherent to this age group. At a time when the regular practice of sports is increasingly being recommended for a healthy living, the support network around the young athletes is crucial to reduce the impact of asthma on their physical and emotional well-being. In this review, we examine the main issues around the definitions and clinical differentiations of asthma in young sport athletes. We discuss best practice approaches to improve the adherence to the clinical management, including nonpharmacological strategies directed at the family and trainers of athlete adolescents.
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Affiliation(s)
- Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Mariana Couto
- Immunoallergology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vanessa Garcia-Larsen
- Program in Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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20
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Brannan JD, Kippelen P. Bronchial Provocation Testing for the Identification of Exercise-Induced Bronchoconstriction. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2156-2164. [PMID: 32620430 DOI: 10.1016/j.jaip.2020.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 01/26/2023]
Abstract
Exercise-induced bronchoconstriction (EIB) occurs in patients with asthma, children, and otherwise healthy athletes. Poor diagnostic accuracy of respiratory symptoms during exercise requires objective assessment of EIB. The standardized tests currently available are based on the assumption that the provoking stimulus to EIB is dehydration of the airway surface fluid due to conditioning large volumes of inhaled air. "Indirect" bronchial provocation tests that use stimuli to cause endogenous release of bronchoconstricting mediators from airway inflammatory cells include dry air hyperpnea (eg, exercise and eucapnic voluntary hyperpnea) and osmotic aerosols (eg, inhaled mannitol). The airway response to different indirect tests is generally similar in patients with asthma and healthy athletes with EIB. Furthermore, the airway sensitivity to these tests is modified by the same pharmacotherapy used to treat asthma. In contrast, pharmacological agents such as methacholine, given by inhalation, act directly on smooth muscle to cause contraction. These "direct" tests have been used traditionally to identify airway hyperresponsiveness in clinical asthma but are less useful to diagnose EIB. The mechanistic differences between indirect and direct tests have helped to elucidate the events leading to airway narrowing in patients with asthma and elite athletes, while improving the clinical utility of these tests to diagnose and manage EIB.
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Affiliation(s)
- John D Brannan
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia.
| | - Pascale Kippelen
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom; Division of Sport, Health and Exercise Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
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21
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Kennedy MD, Lenz E, Niedermeier M, Faulhaber M. Are Respiratory Responses to Cold Air Exercise Different in Females Compared to Males? Implications for Exercise in Cold Air Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186662. [PMID: 32933124 PMCID: PMC7559764 DOI: 10.3390/ijerph17186662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
Research has shown that cold air exercise causes significant respiratory dysfunction, especially in female athletes. However, how female and male athletes respond to cold air exercise is not known. Thus, we aimed to compare acute respiratory responses (function, recovery and symptoms) in males and females after high-intensity cold air exercise. Eighteen (nine female) athletes completed two environmental chamber running trials at 0 °C and −20 °C (humidity 34 ± 5%) on different days in a randomized starting order. Spirometry was performed pre, 3, 6, 10, 15 and 20 min post. Respiratory symptoms were measured posttrial and heart rate and rating of perceived exertion were assessed during each trial. No significant differences in delta change (pre to post) were found at either temperature between sexes for FEV1, FVC, FEF50% and FEF25–75%. At −20 °C, FEV1 decreased similarly in both sexes (males: 7.5%, females: 6.3%) but not at 0 °C, p = 0.003. Postexertion respiratory function recovery and reported symptoms were not different between sexes at either temperature. These results indicate no sex-based differences in acute respiratory responses (function, recovery and symptoms) to cold air exercise. However, intense exercise at −20 °C is challenging to the respiratory system in both sexes and may lead to altered respiratory responses compared to mild winter conditions like 0 °C.
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Affiliation(s)
- Michael D. Kennedy
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada;
| | - Elisabeth Lenz
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (E.L.); (M.F.)
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (E.L.); (M.F.)
- Correspondence:
| | - Martin Faulhaber
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (E.L.); (M.F.)
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22
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Riiser A, Stensrud T, Stang J, Andersen LB. Aerobic performance among healthy (non-asthmatic) adults using beta2-agonists: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2020; 55:975-983. [PMID: 32816795 DOI: 10.1136/bjsports-2019-100984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the effect of beta2-agonists on aerobic performance in healthy, non-asthmatic study participants. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA We searched four databases (PubMed, Embase, SPORTDiscus and Web of Science) for randomised controlled trials published until December 2019. Studies examining the effect of beta2-agonists on maximal physical performance lasting longer than 1 min were included in the meta-analysis. Data are presented as standardised difference in mean (SDM) with 95% CI. RESULTS The present meta-analysis includes 47 studies. The studies comprise 607 participants in cross-over trials, including 99 participants in three-way cross-over trials and 27 participants in a four-way cross-over trial. Seventy-three participants were included in parallel trials. Beta2-agonists did not affect aerobic performance compared with placebo (SDM 0.051, 95% CI -0.020 to 0.122). The SDM for the included studies was not heterogeneous (I2=0%, p=0.893), and the effect was not related to type of beta2-agonist, dose, administration route, duration of treatment or performance level of participants. Beta2-agonists had no effect on time trial performance, time to exhaustion or maximal oxygen consumption (p<0.218). CONCLUSION/IMPLICATION The present study shows that beta2-agonists do not affect aerobic performance in non-asthmatic subjects regardless of type, dose, administration route, duration of treatment or performance level of participants. The results of the present study should be of interest to WADA and to anyone who is interested in equal opportunities in competitive sports. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018109223.
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Affiliation(s)
- Amund Riiser
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Vestland, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Julie Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Bo Andersen
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Vestland, Norway
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23
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Riiser A, Stensrud T, Stang J, Andersen LB. Can β2-agonists have an ergogenic effect on strength, sprint or power performance? Systematic review and meta-analysis of RCTs. Br J Sports Med 2020; 54:1351-1359. [PMID: 32747344 DOI: 10.1136/bjsports-2019-100708] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We aimed to examine the effect of β2-agonists on anaerobic performance in healthy non-asthmatic subjects. DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA We searched four databases (PubMed, Embase, SPORTDiscus and Web of Science) for randomised controlled trials, published until December 2019, examining the effect of β2-agonists on maximal physical performance lasting 1 min or shorter. Data are presented as standardised difference in mean (SDM) with 95% confidence intervals (95% CI). RESULTS 34 studies were included in the present meta-analysis. The studies include 44 different randomised and placebo-controlled comparisons with β2-agonists comprising 323 participants in crossover trials, and 149 participants in parallel trials. In the overall analyses, β2-agonists improved anaerobic performance by 5% (SDM 0.29, 95% CI 0.16 to 0.42), but the effect was related to dose and administration route. In a stratified analysis, the SDM was 0.14 (95% CI 0.00 to 0.28) for approved β2-agonists and 0.46 (95% CI 0.24 to 0.68) for prohibited β2-agonists, respectively. Furthermore, SDM was 0.16 (95% CI 0.02 to 0.30) for inhaled administration and 0.51 (95% CI 0.25 to 0.77) for oral administration, respectively, and 0.20 (95% CI 0.07 to 0.33) for acute treatment and 0.50 (95% CI 0.20 to 0.80) for treatment for multiple weeks. Analyses stratified for the type of performance showed that strength (0.35, 95% CI 0.15 to 0.55) and sprint (0.17, 95% CI 0.06 to 0.29) performance were improved by β2-agonists. CONCLUSION/IMPLICATION Our study shows that non-asthmatic subjects can improve sprint and strength performance by using β2-agonists. It is uncertain, however, whether World Anti-Doping Agency (WADA)-approved doses of β2-agonists improve performance. Our results support that the use of β2-agonists should be controlled and restricted to athletes with documented asthma. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018109223.
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Affiliation(s)
- Amund Riiser
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Vestlandet, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Julie Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Lars Bo Andersen
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Vestlandet, Norway
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Greiwe J, Cooke A, Nanda A, Epstein SZ, Wasan AN, Shepard KV, Capão-Filipe M, Nish A, Rubin M, Gregory KL, Dass K, Blessing-Moore J, Randolph C. Work Group Report: Perspectives in Diagnosis and Management of Exercise-Induced Bronchoconstriction in Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2542-2555. [PMID: 32636147 DOI: 10.1016/j.jaip.2020.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
Exercise-induced bronchoconstriction, otherwise known as exercise-induced bronchoconstriction with asthma or without asthma, is an acute airway narrowing that occurs as a result of exercise and can occur in patients with asthma. A panel of members from the American Academy of Allergy, Asthma & Immunology Sports, Exercise, & Fitness Committee reviewed the diagnosis and management of exercise-induced bronchoconstriction in athletes of all skill levels including recreational athletes, high school and college athletes, and professional athletes. A special emphasis was placed on the recommendations and regulations set forth by professional athletic organizations after a detailed review of their collective bargaining agreements, substance abuse policies, antidoping program manuals, and the World Anti-Doping Agency antidoping code. The recommendations in this review are based on currently available evidence in addition to providing guidance for athletes of all skill levels as well as their treating physicians to better understand which pharmaceutical and nonpharmaceutical management options are appropriate as well as which medications are permitted or prohibited, and the proper documentation required to remain compliant.
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Affiliation(s)
- Justin Greiwe
- Bernstein Allergy Group Inc, Cincinnati, Ohio; Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew Cooke
- Lake Allergy, Asthma & Immunology PA, Tavares, Fla
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Kirk V Shepard
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Hospital, Tampa, Fla
| | | | - Andy Nish
- Northeast Georgia Physician's Group Allergy and Asthma, Gainesville, Ga
| | - Mark Rubin
- Asthma and COPD Emmi Solutions, Chicago, Ill; CME Education Program Steering Committee, The France Foundation, Old Lyme, Conn
| | - Karen L Gregory
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Okla; School of Nursing and Health Studies, Georgetown University, Washington, DC
| | - Kathleen Dass
- Michigan Allergy, Asthma & Immunology Center PLLC, Oak Park, Mich; Division of Immunology/Allergy Section, Department of Internal Medicine, Oakland University William Beaumont Hospital, Rochester, Mich
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Vernec A, Healy D. Prevalence of therapeutic use exemptions at the Olympic Games and association with medals: an analysis of data from 2010 to 2018. Br J Sports Med 2020; 54:920-924. [PMID: 32376674 PMCID: PMC7392493 DOI: 10.1136/bjsports-2020-102028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 01/13/2023]
Abstract
Objectives The percentage of athletes with Therapeutic Use Exemptions (TUEs) competing in elite sport and the association with winning medals has been a matter of speculation in the absence of validated competitor numbers. We used International Olympic Committee (IOC) and World Anti-Doping Agency (WADA) data to identify athletes competing with TUEs at five Olympic Games (Games) and a possible association between having a TUE and winning an Olympic medal. Methods We used the IOC’s competition results and WADA’s TUE database to identify the number of TUEs for athlete competitions (ACs, defined as one athlete competing in one event) and any associations with medals among athletes competing in individual competitions. We calculated risk ratios (RR) for the probability of winning a medal among athletes with a TUE compared with that of athletes without a TUE. We also reported adjusted RR (RRadj) controlling for country resources, which is a potential confounder. Results During the Games from 2010 to 2018, there were 20 139 ACs and 2062 medals awarded. Athletes competed with a TUE in 0.9% (181/20 139) of ACs. There were 21/2062 medals won by athletes with a TUE. The RR for winning a medal with a TUE was 1.13 (95% CI: 0.73 to 1.65; p=0.54), and the RRadj was 1.07 (95% CI: 0.69 to 1.56; p=0.73). Conclusion The number of athletes competing with valid TUEs at Games is <1%. Our results suggested that there is no meaningful association between being granted a TUE and the likelihood of winning a medal.
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Affiliation(s)
- Alan Vernec
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
| | - David Healy
- Science and Medicine, World Anti-Doping Agency, Montreal, Quebec, Canada
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Allen H, Backhouse SH, Hull JH, Price OJ. Anti-doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations. Sports Med 2020; 49:659-668. [PMID: 30887312 PMCID: PMC6459780 DOI: 10.1007/s40279-019-01075-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. Pharmacological inhaler therapy currently forms the mainstay of treatment; however, for elite athletes competing under the constraints of the World Anti-Doping Code (Code), a number of established therapies are prohibited both in and/or out of competition and/or have a maximum permitted dose. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma.
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Affiliation(s)
- Hayden Allen
- Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK
| | - Susan H Backhouse
- Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Oliver J Price
- Carnegie School of Sport, Leeds Beckett University, Leeds, LS6 3QT, UK.
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Zeiger JS, Weiler JM. Special Considerations and Perspectives for Exercise-Induced Bronchoconstriction (EIB) in Olympic and Other Elite Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2194-2201. [PMID: 32006727 DOI: 10.1016/j.jaip.2020.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
Diagnosing and treating elite and Olympic athletes with exercise-induced bronchoconstriction has been well established. However, a subset of elite and Olympic athletes with exercise-induced bronchoconstriction experience symptoms of breathlessness due to lack of adherence, improper medications, and/or generalized breathing dysfunction. A short review of traditional treatment plans for elite and Olympic athletes is presented along with the challenges of adherence, managing dysfunctional breathing, and measuring and treating mental skills deficits that may impact breathing. Elite and Olympic athletes may not respond to traditional treatment for exercise-induced bronchospasm, and we present some of the reasons why the athletes fail to respond. Furthermore, we present information on how to detect and treat elite and Olympic athletes with difficult-to-treat asthma. As part of this review we developed a flow diagram for medical providers to identify the reasons for lack of response to traditional treatment plans for exercise-induced bronchoconstriction with options for other treatment modalities.
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Simpson AJ, Horne S, Sharp P, Sharps R, Kippelen P. Effect of Creatine Supplementation on the Airways of Youth Elite Soccer Players. Med Sci Sports Exerc 2020; 51:1582-1590. [PMID: 30913162 PMCID: PMC6693921 DOI: 10.1249/mss.0000000000001979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Owing to its well-established ergogenic potential, creatine is a highly popular food supplement in sports. As an oral supplement, creatine is considered safe and ethical. However, no data exist on the safety of creatine on lung function in athletes. The aim of this project was to evaluate the effects of a standard course of creatine on the airways of youth elite athletes. Methods Nineteen elite soccer players, 16–21 yr old, completed a stratified, randomized, double-blind, placebo-controlled, parallel-group trial. The creatine group (n = 9) ingested 0.3 g·kg−1⋅d−1 of creatine monohydrate (CM) for 1 wk (loading phase) and 5 g·d−1 for 7 wk (maintenance phase), and the placebo group (n = 10) received the same dosages of maltodextrin. Airway inflammation (assessed by exhaled nitric oxide, FENO) and airway responsiveness (to dry air hyperpnoea) were measured pre- and postsupplementation. Results Mild, unfavorable changes in FENO were noticed by trend over the supplementation period in the CM group only (P = 0.056 for interaction, η2 = 0.199), with a mean group change of 9 ± 13 ppb in the CM group versus −5 ± 16 ppb in the placebo group (P = 0.056, d = 0.695). Further, the maximum fall in forced expiratory volume in 1 s after dry air hyperpnoea was larger by trend postsupplementation in the CM group compared with the placebo group: 9.7% ± 7.5% vs 4.4% ± 1.4%, respectively (P = 0.070, d = 0.975). These adverse effects were more pronounced when atopic players only (n = 15) were considered. Conclusion On the basis of the observed trends and medium to large effect sizes, we cannot exclude that creatine supplementation has an adverse effect on the airways of elite athletes, particularly in those with allergic sensitization. Further safety profiling of the ergogenic food supplement is warranted.
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Affiliation(s)
- Andrew J Simpson
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, Uxbridge, UNITED KINGDOM
| | - Sara Horne
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, Uxbridge, UNITED KINGDOM.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UNITED KINGDOM
| | - Peter Sharp
- Watford Football Club, Watford, UNITED KINGDOM
| | | | - Pascale Kippelen
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, Uxbridge, UNITED KINGDOM.,Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, Uxbridge, UNITED KINGDOM
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Medical Problems of the Athlete. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_58-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Kennedy MD, Steele AR, Parent EC, Steinback CD. Cold air exercise screening for exercise induced bronchoconstriction in cold weather athletes. Respir Physiol Neurobiol 2019; 269:103262. [PMID: 31369875 DOI: 10.1016/j.resp.2019.103262] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/10/2019] [Accepted: 07/28/2019] [Indexed: 12/27/2022]
Abstract
Exercise Induced Bronchoconstriction (EIB) prevalence in cold weather athletes is high. Currently, no standardized cold air exercise provocation test exists. Thus we aimed to determine EIB prevalence using a Cold Air Test (CAT; 5 km outdoor running; -15 °C) compared to the most common EIB screen the Eucapnic Voluntary Hyperpnea (EVH) test in cold weather athletes. Sixteen (9 male; 20-35 years old) cold weather athletes completed EVH 72 h before CAT. Spirometry, Fractional Expired Nitric Oxide (FENO), respiratory symptoms were measured and atopy status was determined. Five and 7 participants were EIB + on the EVH and CAT, respectively. Level of agreement was 50% between tests. FEV1 recovery was significantly prolonged and Peak Expiratory Flow was decreased after CAT compared to EVH. Predictive characteristics of EIB + included FENO >12 ppb, FEV1/FVC ratio (<0.75) and BMI < 20. EVH does not always reflect EIB triggered by cold weather exercise. More research is required to understand the best EIB screens for cold weather athletes.
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Affiliation(s)
- Michael D Kennedy
- Athlete Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Andrew R Steele
- Neurovascular Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Eric C Parent
- Clinical Spinal Research Lab, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D Steinback
- Neurovascular Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Rowe A, Mahony N, Fleming N, Donne B. The effect of diurnal variation in exercise-induced bronchoconstriction. J Asthma 2019; 57:1063-1070. [PMID: 31274345 DOI: 10.1080/02770903.2019.1640731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Exercise-induced bronchoconstriction (EIB) is an acute, transient narrowing of the airway as a result of exercise. Diurnal variation in asthma is well-established, however, few studies have investigated diurnal variability in EIB; no study has used eucapnic voluntary hyperpnea (EVH). The aim of this study was to examine circadian variability in EIB using EVH.Methods: Fourteen recreationally-active males with mild to moderate asthma and nine healthy controls were randomized to first complete either an AM (07:00-08:00) or PM (17:00-18:00) EVH challenge, followed by the alternate test 34 h to 7 days later. The EVH protocol comprised of six-minutes of hyperventilation of a 5% CO2 gas at a minimum ventilation rate of 21 × FEV1 min-1. The primary outcome measure was FEV1 pre- and post-EVH.Results: We observed no diurnal effect on EIB in the asthma group. The minimum observed post-EVH FEV1 in the asthma cohort was 3.58 ± 0.95 L in AM and 3.62 ± 0.87 L in PM tests, corresponding to a 15.0 ± 15.3% vs. 14.9 ± 14.7% reduction from baseline, respectively. The asthma group showed similar baseline FEV1 before AM (4.21 ± 0.79 L) and PM (4.25 ± 0.65 L) tests. No difference was observed in minute ventilation between AM (26.1 ± 3.4 × FEV1 min-1) and PM (25.6 ± 3.8 × FEV1 min-1) tests for the asthma cohort. Controls displayed no significant changes in FEV1 or minute ventilation between tests.Conclusions: When baseline pulmonary function is similar, this study suggests that time-of-day has no effect on EIB in mild to moderate asthma.
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Affiliation(s)
- Andrew Rowe
- Human Performance Laboratory, Discipline of Anatomy, Watt's Building, Trinity College Dublin, Dublin, Ireland
| | - Nicholas Mahony
- Human Performance Laboratory, Discipline of Anatomy, Watt's Building, Trinity College Dublin, Dublin, Ireland
| | - Neil Fleming
- Human Performance Laboratory, Discipline of Anatomy, Watt's Building, Trinity College Dublin, Dublin, Ireland
| | - Bernard Donne
- Human Performance Laboratory, Discipline of Anatomy, Watt's Building, Trinity College Dublin, Dublin, Ireland
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Robinson K, Kremen T, Olin JT, Wilber R. Pulmonary Function Evaluation in Elite Swimmers: A Case Series of Environmental Considerations. Curr Sports Med Rep 2019; 18:109-111. [PMID: 30969233 DOI: 10.1249/jsr.0000000000000578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Iftikhar IH, Greer M, Jaiteh A. A Meta-analysis of Diagnostic Test Agreement Between Eucapnic Voluntary Hyperventilation and Cardiopulmonary Exercise Tests for Exercise-Induced Bronchoconstriction. Lung 2019; 197:483-492. [PMID: 31076858 DOI: 10.1007/s00408-019-00233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Exercise-induced bronchoconstriction (EIB) is very common in athletes. Cardiopulmonary exercise tests (CPET) have traditionally been used for the diagnosis of EIB. However, alternative indirect bronchoprovocation tests have recently been used as surrogate tests. One of these is the eucapnic voluntary hyperventilation (EVH). This meta-analysis studied the agreement between the two tests. METHODS An extensive search in PubMed and Medline was conducted for studies where participants underwent both CPET and EVH with measurement of forced expiratory volume in 1-second (FEV1). After extracting data using two-by-two contingency tables, pooled positive and negative agreements were first calculated between the two tests, with EVH benchmarked against CPET, and then, pooled positive and negative agreements were calculated with CPET benchmarked against EVH. RESULTS The pooled positive and negative agreements between EVH and CPET (with CPET as the reference) were 0.62 [(95% confidence interval 0.54-0.70), I2 77%] and 0.61 [(0.56-0.65)), I2 81%]. The pooled positive and negative agreements between CPET and EVH (with EVH as the reference) were 0.36 [(0.30-0.42), I2 93%] and 0.82 [(0.77-0.86), I2 78%]. The average of positive test results with EVH across all studies was greater than that of CPETs (58.84% vs. 39.51%). CONCLUSIONS Results of this meta-analysis show poor positive agreement between the two tests but high negative agreement (specifically using EVH as reference), suggesting that either test can be used for correctly identifying those without EIB. Results also suggest that the chances of a test resulting positive are higher with EVH than with CPET.
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Affiliation(s)
- Imran H Iftikhar
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA.
| | - Meredith Greer
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA
| | - Ahmadu Jaiteh
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA
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Boulet LP, Turmel J. Cough in exercise and athletes. Pulm Pharmacol Ther 2019; 55:67-74. [PMID: 30771475 DOI: 10.1016/j.pupt.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 02/06/2023]
Abstract
In the general population, particularly in individuals with asthma, cough is a common symptom, often reported after exertion, although regular exercise may be associated with a reduction in the prevalence of cough. In athletes, exercise-induced cough is also a particularly frequent symptom. The main etiologies of cough in athletes are somewhat similar to non-athletes, including asthma/airway hyperresponsiveness, upper airways disorders such as allergic or non-allergic rhinitis, and exercise-induced laryngeal obstruction, although these conditions are more frequently observed in athletes. In these last, this symptom can also be related to the high ventilation and heat exchange experienced during exercise, particularly during exposure to cold/dry air or pollutants. However, gastroesophageal reflux, a common cause of cough in the general population, despite being highly prevalent in athletes, has not been reported as a main cause of cough in athletes. Cough may impair quality of life, sleep and exercise performance in the general population and probably also in athletes, although there are few data on this. The causes of cough should be documented through a systematic evaluation, the treatment adapted according to identified or most probable cough etiology and pattern of presentation, while respecting sports anti-doping regulations. More research is needed on exercise-induced persistent cough in the athlete to determine its pathophysiology, optimal management and consequences.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada.
| | - Julie Turmel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
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Dickinson J, Amirav I, Hostrup M. Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction. Immunol Allergy Clin North Am 2019; 38:245-258. [PMID: 29631733 DOI: 10.1016/j.iac.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pharmacologic management of exercise-induced bronchoconstriction (EIB) is the mainstay of preventative therapy. There are some nonpharmacologic interventions, however, that may assist the management of EIB. This review discusses these nonpharmacologic interventions and how they may be applied to patients and athletes with EIB.
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Affiliation(s)
- John Dickinson
- School of Sport and Exercise Sciences, University of Kent, UK
| | - Israel Amirav
- Department of Paediatrics, University of Alberta, Edmonton, Canada
| | - Morten Hostrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, August Krogh 2nd Floor, Universitetsparken 13, Copenhagen DK-2100, Denmark; Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
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Backer V, Mastronarde J. Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes. Immunol Allergy Clin North Am 2019; 38:231-243. [PMID: 29631732 DOI: 10.1016/j.iac.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is the transient narrowing of the airways during and after exercise that occurs in response to increased ventilation in susceptible individuals. It occurs across the age spectrum in patients with underlying asthma and can occur in athletes without baseline asthma. The inflammatory mechanisms underlying EIB in patients without asthma may be distinct from those underlying EIB in patients with asthma. This review summarizes mechanistic and clinical data that can guide the choice of chronic and acute pharmacologic therapies targeting control of EIB. Relevant regulations from the World Anti-Doping Agency are also discussed.
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Affiliation(s)
- Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen NV 2400, Denmark.
| | - John Mastronarde
- Department of Medical Education, Providence Portland Medical Center, Pulmonary/Critical Care Medicine, Oregon Health & Science University, 5050 Northeast Hoyt Avenue, Suite 540, Portland, OR 97213, USA
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Wiciński M, Leis K, Szyperski P, Węclewicz M, Mazur E, Pawlak-Osińska K. Impact of resveratrol on exercise performance: A review. Sci Sports 2018. [DOI: 10.1016/j.scispo.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diurnal Variation in Physiological and Immune Responses to Endurance Sport in Highly Trained Runners in a Hot and Humid Environment. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3402143. [PMID: 29861827 PMCID: PMC5971328 DOI: 10.1155/2018/3402143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Abstract
Purpose The purpose of this study was to investigate the physiological and immunological response of highly trained runners to an intense bout of exercise performed at two different times of day, in a hot, humid environment. Methods Using a crossover randomized design, 13 highly trained runners (range [Formula: see text] 64-79 ml·kg-1 min-1) performed a 10 km time trial run in hot (28°C) and humid conditions (70%), at 2 different times of day (09:00 hs and 18:00 hs). Venous blood samples were taken to determine WBCs (white blood cells), IL-6 (interleukin-6), CC16 (club cell protein 16), and HSP70 (heat shock protein-70) concentrations. Upper respiratory tract inflammation was additionally assessed using a nasal lavage procedure. Results A significant diurnal difference (p < 0.05) was found for core body temperature, total WBC, and neutrophil and lymphocyte concentrations with higher values at 18:00 hs. A phase response in IL-6, HSP70, WBC, neutrophil, lymphocyte, and CC16 was noted, being more pronounced at 18:00 hs, whilst core body temperature and HR phase responses were more pronounced at 09:00 hs. Conclusion In hot and humid conditions, athletes may wish to consider, when possible, racing and particularly training in the morning where the least homeostatic perturbation occurs.
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Brennan FH, Alent J, Ross MJ. Evaluating the Athlete with Suspected Exercise-Induced Asthma or Bronchospasm. Curr Sports Med Rep 2018. [PMID: 29521704 DOI: 10.1249/jsr.0000000000000463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Exercise-induced asthma (EIA) and exercise-induced bronchospasm (EIB)/bronchoconstriction (EIC) describes two clinical entities by which exercise triggers bronchial hyperresponsiveness. Exercise is a common trigger of bronchospasm in the asthmatic (EIA), as well as athletes without the underlying inflammation associated with asthma (EIC/EIB). Approximately 10% to 20% of the general population have EIA or EIB (). The approach to the diagnosis and subsequent management relies on the clinician's ability to recognize clinical signs and symptoms, then selecting the correct diagnostic test. A baseline spirometry/pulmonary function test is recommended for all athletes to evaluate for underlying asthma. Subsequent direct or indirect bronchial provocation testing is recommended to correctly diagnose EIA or EIB (). Athletes should not be treated empirically with bronchodilators based on symptoms alone without confirmatory spirometry and provocative testing.
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Affiliation(s)
- Fred H Brennan
- University of South Florida/BayCare Sports Medicine Fellowship, Clearwater, FL
| | - Jeffrey Alent
- University of South Florida/BayCare Sports Medicine Fellowship, Clearwater, FL
| | - Michael J Ross
- University of South Florida/BayCare Sports Medicine Fellowship, Clearwater, FL
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Asthma and exercise-induced respiratory symptoms in the athlete: new insights. Curr Opin Pulm Med 2018; 23:71-77. [PMID: 27820744 DOI: 10.1097/mcp.0000000000000339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Asthma and exercise-induced bronchoconstriction (EIB) are common in the athlete and can interfere with sport performances. In this review, we report recent findings on the prevalence, diagnosis and evaluation of these conditions, in addition to specific issues regarding their treatment and antidoping regulations. RECENT FINDINGS Recent studies confirmed the high prevalence of exercise-induced respiratory symptoms, asthma and EIB, in athletes and showed that these conditions are still underdiagnosed and undertreated. Recent studies highlight the suboptimal use of asthma medication in asthmatic and allergic athletes. Regarding the diagnosis and treatment, questions about the role and criteria for positivity of eucapnic voluntary hyperpnea test were raised. It was confirmed that there is a subgroup of athletes with poor response to asthma medication. Finally, regarding antidoping regulations, new methods and changes in criteria for urinary bronchodilator thresholds were suggested. SUMMARY Recent publications confirm that exercise-induced respiratory symptoms, asthma and EIB are common in athletes but often unrecognized and not optimally or successfully treated. It was suggested that current criteria for diagnostic bronchoprovocation test responses could be reassessed, as well as antidoping criteria for β2-agonists urinary levels. There is a need for more research on prevention of airways dysfunction in athletes, identification of different asthma phenotypes and the benefits of standard asthma medication in this population.
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Boulet LP, Moreau SP, Villeneuve HÉ, Turmel J. Athletes Do Not Condition Inspired Air More Effectively than Nonathletes during Hyperpnea. Med Sci Sports Exerc 2017; 49:200-205. [PMID: 27471787 DOI: 10.1249/mss.0000000000001064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endurance athletes have a high prevalence of airway diseases, some possibly representing adaptive mechanisms to the need of conditioning large volumes of inspired air during high ventilation in specific environments. The aim of this study is to assess the ability to condition (warm and humidify) inspired air in athletes by measuring the difference between inhaled and exhaled air temperature (ΔT) during and after eucapnic voluntary hyperpnea (EVH) test. METHODS Twenty-three endurance athletes from various sports, 12 with airway hyperresponsiveness (AHR) and/or exercise-induced bronchoconstriction (EIB) (A+), 11 without AHR and/or EIB (A-), 12 nonathletes with AHR and/or EIB (C+), and 11 nonathletes without AHR and/or EIB (C-) were recruited. All subjects attended the laboratory on three occasions, twice for baseline characterization, including questionnaires, pulmonary function, methacholine bronchoprovocation, allergy skin prick tests, exhaled nitric oxide measurement, and a standard EVH, and once to perform a modified EVH to assess ΔT. Inspired and expired air temperatures were measured with a high-precision probe during EVH and at regular intervals until 30 min after the end of the test. RESULTS The global ΔT during the EVH was +5.8°C ± 1.5°C and +4.7°C ± 1.5°C during the 30 min after the EVH. No difference was found between groups for either the ΔT or the slope of ΔT, during and after the EVH. CONCLUSION This study shows no evidence of improved capacity to condition inspired air in endurance athletes, which could have suggested an increased bronchial blood flow or another adaptive mechanism. The absence of an adaptive mechanism could therefore contribute to airway damage observed in athletes in allowing colder but mainly dryer air to penetrate deeper in the lung.
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Moran B, Bryan S, Farrar T, Salud C, Visser G, Decuba R, Renelus D, Buckley T, Dressing M, Peterkin N, Coris E. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes. Curr Sports Med Rep 2017; 16:84-94. [PMID: 28282354 DOI: 10.1249/jsr.0000000000000342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.
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Affiliation(s)
- Byron Moran
- 1Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 2Department of Orthopedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; 3The University of South Carolina School of Medicine, Greenville, SC; 4Primary Care Sports Medicine Fellowship, University of South Florida-Morton Plant Mease, Clearwater, FL; 5Baycare Medical Group Primary Care, St. Petersburg, FL; 6Premiere Med Family and Sports Medicine, Ocoee, FL; 7Family Medicine Residency Program, University of South Florida-Morton Plant Mease, Clearwater, FL; 8Bayfront Primary Care Sports Medicine Fellowship, St. Petersburg, FL; 9Morsani College of Medicine, University of South Florida, Tampa, FL; 10Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL; and 11Baptist Primary Care, Jacksonville, FL; and 12Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
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Allergies and Exercise-Induced Bronchoconstriction in a Youth Academy and Reserve Professional Soccer Team. Clin J Sport Med 2017; 27:450-456. [PMID: 28829345 DOI: 10.1097/jsm.0000000000000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES A high prevalence of respiratory allergies and exercise-induced bronchoconstriction (EIB) has been reported among endurance athletes. This study was designed to analyze the frequency of sensitization to respiratory allergens and EIB in young soccer players. DESIGN Prospective cohort design. SETTING Youth academy and reserve professional soccer team during the seasons 2012 to 2013 and 2013 to 2014. PARTICIPANTS Eighty-five soccer players (mean age: 20 ± 4 years) participated. INTERVENTION Players underwent skin prick tests (SPTs) during the seasons 2012 to 2013 and 2013 to 2014. Spirometry and a eucapnic voluntary hyperpnea test were performed on soccer players during the first season 2012 to 2013 (n = 51) to detect EIB. Two self-administered questionnaires on respiratory history and allergic symptoms (European Community Respiratory Health Survey and Allergy Questionnaire for Athletes) were also distributed during both seasons (n = 59). MAIN OUTCOME MEASURES The number of positive SPTs, exercise-induced respiratory symptoms, presence of asthma, airway obstruction, and EIB. RESULTS Forty-nine percent of players were sensitized to at least one respiratory allergen, 33% reported an allergic disease, 1 player presented airway obstruction at rest, and 16% presented EIB. Factors predictive of EIB were self-reported exercise-induced symptoms and sensitization to at least 5 allergens. CONCLUSIONS Questioning players about exercise-induced respiratory symptoms and allergies as well as spirometry at the time of the inclusion medical checkup would improve management of respiratory health of soccer players and would constitute inexpensive preliminary screening to select players requiring indirect bronchial provocation test or SPTs. CLINICAL RELEVANCE This study showed that despite low frequencies, EIB and allergies are underdiagnosed and undertreated in young soccer players.
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Carter RAA, Joll CA. Occurrence and formation of disinfection by-products in the swimming pool environment: A critical review. J Environ Sci (China) 2017; 58:19-50. [PMID: 28774608 DOI: 10.1016/j.jes.2017.06.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/11/2017] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
Disinfection of water for human use is essential to protect against microbial disease; however, disinfection also leads to formation of disinfection by-products (DBPs), some of which are of health concern. From a chemical perspective, swimming pools are a complex matrix, with continual addition of a wide range of natural and anthropogenic chemicals via filling waters, disinfectant addition, pharmaceuticals and personal care products and human body excretions. Natural organic matter, trace amounts of DBPs and chlorine or chloramines may be introduced by the filling water, which is commonly disinfected distributed drinking water. Chlorine and/or bromine is continually introduced via the addition of chemical disinfectants to the pool. Human body excretions (sweat, urine and saliva) and pharmaceuticals and personal care products (sunscreens, cosmetics, hair products and lotions) are introduced by swimmers. High addition of disinfectant leads to a high formation of DBPs from reaction of some of the chemicals with the disinfectant. Swimming pool air is also of concern as volatile DBPs partition into the air above the pool. The presence of bromine leads to the formation of a wide range of bromo- and bromo/chloro-DBPs, and Br-DBPs are more toxic than their chlorinated analogues. This is particularly important for seawater-filled pools or pools using a bromine-based disinfectant. This review summarises chemical contaminants and DBPs in swimming pool waters, as well as in the air above pools. Factors that have been found to affect DBP formation in pools are discussed. The impact of the swimming pool environment on human health is reviewed.
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Affiliation(s)
- Rhys A A Carter
- Curtin Water Quality Research Centre, Department of Chemistry, Curtin University, Perth, Western Australia 6102, Australia
| | - Cynthia A Joll
- Curtin Water Quality Research Centre, Department of Chemistry, Curtin University, Perth, Western Australia 6102, Australia.
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45
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Eucapnic Voluntary Hyperpnea: Gold Standard for Diagnosing Exercise-Induced Bronchoconstriction in Athletes? Sports Med 2017; 46:1083-93. [PMID: 27007599 PMCID: PMC4963444 DOI: 10.1007/s40279-016-0491-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In athletes, a secure diagnos
is of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Evaluating spirometric indices of airflow before and following an exercise bout is intuitively the optimal means for the diagnosis; however, this approach is recognized as having several key limitations. Accordingly, alternative indirect bronchoprovocation tests have been recommended as surrogate means for obtaining a diagnosis of EIB. Of these tests, it is often argued that the eucapnic voluntary hyperpnea (EVH) challenge represents the ‘gold standard’. This article provides a state-of-the-art review of EVH, including an overview of the test methodology and its interpretation. We also address the performance of EVH against the other functional and clinical approaches commonly adopted for the diagnosis of EIB. The published evidence supports a key role for EVH in the diagnostic algorithm for EIB testing in athletes. However, its wide sensitivity and specificity and poor repeatability preclude EVH from being termed a ‘gold standard’ test for EIB.
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46
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Fitch KD. The enigma of inhaled salbutamol and sport: unresolved after 45 years. Drug Test Anal 2017; 9:977-982. [DOI: 10.1002/dta.2184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ken D. Fitch
- School of Sports Science, Exercise and Health; University of Western Australia; Crawley WA 6009 Australia
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47
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Kennedy MD, Gill JM, Hodges AN. Field versus race pace conditions to provoke exercise-induced bronchoconstriction in elite swimmers: Influence of training background. J Exerc Sci Fit 2017. [PMID: 29541125 PMCID: PMC5812856 DOI: 10.1016/j.jesf.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Diagnosing Airway hyper-responsiveness (AHR) requires bronchial provocation tests that are performed at rest and after exercise or hyperventilation in either a lab or field setting. Presently, it is unclear whether the proposed AHR field test for swimming induces sufficient provocation due to lack of intensity. Thus we aimed to examine how the 8 minute field swim test compared to all out racing and a lower intensity practice exposure affected AHR. We hypothesized that the race would affect AHR the most thereby highlighting the importance of maximal effort in swim AHR. Methods 10 female and 15 male swimmers completed three conditions (sanctioned race of different distances, 8 min field swim challenge and swim practice). Forced vital capacity (FVC), forced expired volume in 1 second (FEV1) and forced expiratory flow (FEF25-75) were measured at rest and after each exercise condition (at 6 and 10 min) in accordance with standard protocols. AHR was defined as a decrease in FEV1 of ≥10% post exercise. Results A significant increase in FEV1 and FEF25-75 was observed for both post swim field test and post-race. The practice condition reduced FEV1 in 44% of swimmers although the magnitude of change was small. There was a wide variability in the individual responses to the 3 conditions and AHR was diagnosed in one swimmer (race condition). Conclusion All conditions have poor sensitivity to diagnose EIB and total accumulated ventilation (distance swum) did not influence AHR. These results also indicate that elite swimmers, despite many risk factors, are not limited by respiratory function in race conditions. It is proposed that the swim field test not be used for AHR assessment in swimmers due to too high relative humidity.
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Affiliation(s)
- Michael D. Kennedy
- Faculty of Physical Education & Recreation, University of Alberta, Edmonton, Alberta, Canada
- Corresponding author. Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, T6G 2H9, Canada.Faculty of Physical Education and RecreationUniversity of AlbertaEdmontonAlbertaT6G 2H9Canada
| | - Jessie M.S. Gill
- Glen Sather Sport Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Alastair N.H. Hodges
- Department of Kinesiology, Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, BC, Canada
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Nair P, Martin JG, Cockcroft DC, Dolovich M, Lemiere C, Boulet LP, O'Byrne PM. Airway Hyperresponsiveness in Asthma: Measurement and Clinical Relevance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:649-659.e2. [PMID: 28163029 DOI: 10.1016/j.jaip.2016.11.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Airway hyperresponsiveness is a characteristic feature of asthma, and its measurement is an important tool in its diagnosis. With a few caveats, methacholine bronchial provocation by a 2-minute tidal breathing method is highly sensitive; a negative test result (PC20 > 16 mg/mL, PD20 > 400 μg) rules out current asthma with reasonable certainty. A PC20 value of less than 1 mg/mL/PD20 value of less than 25 μg is highly specific (ie, diagnostic) but quite insensitive for asthma. For accurate interpretation of the test results, it is important to control and standardize technical factors that have an impact on nebulizer performance. In addition to its utility to relate symptoms such as cough, wheeze, and shortness of breath to variable airflow obstruction (ie, to diagnose current asthma), the test is useful to make a number of other clinical assessments. These include (1) evaluation of patients with occupational asthma, (2) evaluation of patients with exercise-induced respiratory symptoms, (3) evaluation of novel asthma medications, (4) evaluation of relative potency of inhaled bronchodilators, (5) as a biomarker to adjust anti-inflammatory therapy to improve clinical outcomes, and (6) in the evaluation of patients with severe asthma to rule out masqueraders such as laryngeal dysfunction. The actual mechanism of altered smooth muscle behavior in asthma that is assessed by direct (eg, methacholine) or indirect (eg, allergen) bronchial provocation remains one of the most fundamental questions related to asthma that needs to be determined. The test is underutilized in clinical practice.
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Affiliation(s)
- Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada.
| | - James G Martin
- Meakins Christie Laboratories and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald C Cockcroft
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Myrna Dolovich
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Catherine Lemiere
- Department of Medicine, Sacre Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Boulet
- Division of Respirology, Department of Medicine, University of Laval, Laval, Quebec, Canada
| | - Paul M O'Byrne
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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49
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Kennedy MD, Steinback CD, Skow R, Parent EC. Is Performance of a Modified Eucapnic Voluntary Hyperpnea Test in High Ventilation Athletes Reproducible? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:229-236. [PMID: 28293929 PMCID: PMC5352574 DOI: 10.4168/aair.2017.9.3.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 12/02/2022]
Abstract
Purpose Exercise-induced bronchoconstriction (EIB) is common in “high ventilation” athletes, and the Eucapnic Voluntary Hyperpnea (EVH) airway provocation test is the standard EIB screen. Although the EVH test is widely used, the in-test performance in high ventilation athletes as well as the reproducibility of that performance has not been determined. Reproducibility of pre- and post-test spirometry and self-reported atopy/cough was also examined. Methods High ventilation athletes (competitive swimmers; n=11, 5 males) completed an atopy/cough questionnaire and EVH testing (operator controlled FiCO2) on 2 consecutive days. Results Swimmers achieved 85%±9% and 87%±9% of target FEV1 volume on days 1 and 2, respectively, (P=0.45; ICC 0.57 [0.00-0.86]) resulting in a total ventilation of 687 vs 684 L [P=0.89, ICC 0.89 (0.65-0.97]) equating to 83%±8% and 84%±9% of predicted total volume (ICC 0.54 [0.00-0.85]) between days 1 and 2. FiCO2 required to maintain eucapnic conditions was 2.5%. Pre-test FEV1 was less on day 2 (P=0.04; ICC >0.90). Day 1 to 2 post-test FEV1 was not different, and 4 swimmers were EIB positive (>10% fall in pre-post FEV1) on day 1 (3 on day 2). Conclusions EVH in-test performance is reproducible however required less FiCO2 than standard protocol and the swimmers under-ventilated by 125 and 139 L/min for days 1 and 2, respectively. How this affects EIB diagnosis remains to be determined; however, our results indicate a post-test FEV1 fall of ≥20% may be recommended as the most consistent diagnostic criterion.
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Affiliation(s)
- Michael D Kennedy
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - Craig D Steinback
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Skow
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Eric C Parent
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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50
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White EC, de Klerk N, Hantos Z, Priston M, Hollams EM, James A, Sly PD, Holt PG, Hall GL. Mannitol challenge testing for asthma in a community cohort of young adults. Respirology 2016; 22:678-683. [PMID: 27917572 DOI: 10.1111/resp.12955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Mannitol challenge testing is an established tool for clinical asthma diagnosis, and can be performed outside of specialized respiratory laboratories. Despite applicability in both clinical and non-clinical populations, with different pre-test asthma probabilities, differences in diagnostic properties have not been well explored. This study aimed to quantify the diagnostic utility of mannitol challenge testing for asthma in a community cohort and a symptomatic wheezing subset of this cohort. METHODS During the 22-year follow-up of the Western Australian Pregnancy (Raine) Cohort, 772 participants (384 males) completed mannitol challenge and skin prick testing and respiratory health questionnaires, of whom 148 reporting wheeze in the past 12 months were included in a wheezing subset. RESULTS Responsiveness to mannitol had low sensitivity (19%) and high specificity (97%) to identify current asthma in the complete cohort, with positive and negative predictive values (PPV and NPV) of 45% and 92%, respectively. Within the wheezing subset, sensitivity (19%) and specificity (94%) remained similar, but PPV increased to 79%, and NPV decreased to 52%. CONCLUSION Our findings support previously reported high specificity and good PPV for mannitol challenge testing in symptomatic wheezing populations, and highlight the need for caution when interpreting mannitol test results in non-clinical populations.
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Affiliation(s)
- Elisha C White
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas de Klerk
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Zoltan Hantos
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia.,Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Children's Lung Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia
| | - Monique Priston
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia
| | - Elysia M Hollams
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Alan James
- Department of Pulmonary Physiology/West Australian Sleep Disorders Research Institute, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Peter D Sly
- Children's Lung Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia
| | - Patrick G Holt
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.,Children's Lung Environment and Asthma Research Team, University of Queensland, Brisbane, Queensland, Australia
| | - Graham L Hall
- Telethon Kids Institute, Perth, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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