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Csoma BALÁ, Sydó N, SZŰcs G, Seres É, Erdélyi T, Horváth G, Csulak E, Merkely B, Müller V. Exhaled and Systemic Biomarkers to Aid the Diagnosis of Bronchial Asthma in Elite Water Sports Athletes. Med Sci Sports Exerc 2024; 56:1256-1264. [PMID: 38650115 DOI: 10.1249/mss.0000000000003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Our aim was to evaluate the accuracy of a combined airway inflammatory biomarker assessment in diagnosing asthma in elite water sports athletes. METHODS Members of the Hungarian Olympic and Junior Swim Team and elite athletes from other aquatic disciplines were assessed for asthma by objective lung function measurements, and blood eosinophil count (BEC), serum total immunoglobulin E (IgE), fractional exhaled nitric oxide (F ENO ) measurements, and skin prick testing were performed. A scoring system from BEC, F ENO , serum IgE, and skin test positivity was constructed by dichotomizing the variables and assigning a score of 1 if the variable is elevated. These scores were summed to produce a final composite score ranging from 0 to 4. RESULTS A total of 48 participants were enrolled (age 21 ± 4 yr, 42% male), of which 22 were diagnosed with asthma. Serum total IgE and F ENO levels were higher in asthmatic individuals (68 [27-176] vs 24 [1-43], P = 0.01; 20 [17-26] vs 15 [11-22], P = 0.02), and positive prick test was also more frequent (55% vs 8%, P < 0.01). Asthmatic participants had higher composite variable scores (2 [1-3] vs 1 [0-1], P = 0.02). Receiver operating characteristic analysis showed that total IgE, F ENO , and composite variable were suitablefor identifying asthmatic participants (area under the curve = 0.72, P = 0.01; 0.70, P = 0.02, and 0.69, P = 0.03). A composite score of >2 reached a specificity of 96.2%, a sensitivity of 36.4%, and a likelihood ratio of 9.5. Logistic regression model revealed a strong association between the composite variable and the asthma diagnosis (OR = 2.71, 95% confidence interval = 1.17-6.23, P = 0.02). CONCLUSIONS Our data highlight the diagnostic value of combined assessment of Th2-type inflammation in elite water sports athletes. The proposed scoring system may be helpful in ruling in asthma in this population upon clinical suspicion.
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Affiliation(s)
- BALÁzs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Nóra Sydó
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Gergő SZŰcs
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Éva Seres
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Tamás Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Gábor Horváth
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Emese Csulak
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
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2
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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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3
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Zhang M, Deng YL, Liu C, Lu WQ, Zeng Q. Impacts of disinfection byproduct exposures on male reproductive health: Current evidence, possible mechanisms and future needs. CHEMOSPHERE 2023; 331:138808. [PMID: 37121289 DOI: 10.1016/j.chemosphere.2023.138808] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
Disinfection byproducts (DBPs) are a class of ubiquitous chemicals in drinking water and inevitably result in widespread human exposures. Potentially adverse health effects of DBP exposures, including reproductive and developmental outcomes, have been increasing public concerns. Several reviews have focused on the adverse pregnancy outcomes of DBPs. This review summarized current evidence on male reproduction health upon exposure to DBPs from toxicological and epidemiological literature. Based on existing experimental studies, there are sufficient evidence showing that haloacetic acids (HAAs) are male reproductive toxicants, including reduced epididymal weight, decreased semen parameters and sperm protein 22, and declined testosterone levels. However, epidemiological evidence remains insufficient to support a link of DBP exposures with adverse male reproductive outcomes, despite that blood and urinary DBP biomarkers are associated with decreased semen quality. Eight potential mechanisms, including germ/somatic cell dysfunction, oxidative stress, genotoxicity, inflammation, endocrine hormones, folate metabolism, epigenetic alterations, and gut microbiota, are likely involved in male reproductive toxicity of DBPs. We also identified knowledge gaps in toxicological and epidemiological studies to enhance future needs.
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Affiliation(s)
- Min Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yan-Ling Deng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chong Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Wen-Qing Lu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
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4
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Zhou Y, Duan Q, Yang D. In vitro human cell-based models to study airway remodeling in asthma. Biomed Pharmacother 2023; 159:114218. [PMID: 36638596 DOI: 10.1016/j.biopha.2023.114218] [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: 07/20/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Airway remodeling, as a predominant characteristic of asthma, refers to the structural changes that occurred both in the large and small airways. These pathological changes not only contribute to airway hyperresponsiveness and airway obstruction, but also predict poor outcomes of patients. In vitro models are the alternatives to animal models that facilitate airway remodeling research. Current approaches to mimic airway remodeling in vitro include mono cultures of cell lines and primary cells that are derived from the respiratory tract, and co-culture systems that consist of different cell subpopulations. Moreover, recent advances in microfluid chips and organoids show promise in simulating the complex architecture and functionality of native organs. According, they enable highly physiological-relevant investigations of human diseases in vitro. Here we aim to detail the current human cell-based models regarding their key pros and cons, and to discuss how they may be used to facilitate our understanding of airway remodeling in asthma.
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Affiliation(s)
- Ying Zhou
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing 100144, China
| | - Qirui Duan
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing 100144, China
| | - Dong Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shijingshan District, Beijing 100144, China.
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5
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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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6
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Goossens J, Decaesteker T, Jonckheere AC, Seys S, Verelst S, Dupont L, Bullens DMA. How to detect young athletes at risk of exercise-induced bronchoconstriction? Paediatr Respir Rev 2022; 44:40-46. [PMID: 34740520 DOI: 10.1016/j.prrv.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is a prevalent condition in elite athletes caused by transient airway narrowing during or after exercise. Young athletes nowadays start early to perform high level exercise, highlighting the need to screen for EIB in a younger population. The purpose of this review is to evaluate current evidence of pre-tests with high probability to predict a positive provocation test in young and adolescent athletes, aged 12-24 years and thus indicate whether a young athlete is at risk of having EIB. Up to now, there is no validated screening test available to increase the pre-test probability of a provocation test of EIB in young and adolescent athletes. We would recommend that a clinical guideline committee might consider the development of a flow chart to screen for EIB in adolescent athletes. It could be composed of a symptom-based questionnaire focusing on wheezing during exercise, atopic state, reversibility test (to exclude EIB with asthma) and completed with markers in blood/serum. However, more research is necessary.
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Affiliation(s)
- Janne Goossens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium.
| | - Tatjana Decaesteker
- KU Leuven, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven 3000, Belgium
| | - Anne-Charlotte Jonckheere
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium
| | - Sven Seys
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium
| | - Sophie Verelst
- UZ Leuven, Clinical Division of Paediatrics, Leuven 3000, Belgium
| | - Lieven Dupont
- KU Leuven, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven 3000, Belgium; UZ Leuven, Clinical Division of Respiratory Medicine, Leuven 3000, Belgium
| | - Dominique M A Bullens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium; UZ Leuven, Clinical Division of Paediatrics, Leuven 3000, Belgium
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7
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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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8
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Støle Melsom H, Randa A, Hisdal J, Stang JS, Stensrud T. Prevalence of Asthma among Norwegian Elite Athletes. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:3887471. [PMID: 38655166 PMCID: PMC11022777 DOI: 10.1155/2022/3887471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/14/2022] [Indexed: 04/26/2024]
Abstract
Objective Asthma is a common problem among elite athletes and represents a health risk interfering with the athlete's performance status. This study aimed to evaluate the asthma prevalence among Norwegian summer and winter elite athletes and asthma prevalence across sport categories. We also aimed to examine whether bronchial hyperresponsiveness (BHR), lung function, fraction of exhaled nitric oxide (FENO), and allergy status differed between asthmatic and non-asthmatic elite athletes. Methods Norwegian athletes qualifying for the Beijing Olympic Summer Games 2008 (n = 80) and the Vancouver Olympic Winter Games 2010 (n = 55) were included. The athletes underwent clinical respiratory examination including lung function measurement, methacholine bronchial challenge for assessment of BHR, FENO, and skin prick testing. Asthma was diagnosed based on respiratory symptoms and clinical examination including objective measurements. Results Asthma was more prevalent among winter athletes (50%) than summer athletes (20%). Thirty-three (52%) endurance athletes, 3 (6%) team sport athletes, and 7 (33%) technical sport athletes had medically diagnosed asthma. Significantly lower lung function (p < 0.001) and higher prevalence of severe BHR (p < 0.001) were found in asthmatic athletes compared with non-asthmatic athletes. Conclusion Asthma is common among Norwegian elite athletes, with winter and endurance athletes showing the highest prevalence. Asthmatic athletes were characterized by lower lung function and more severe BHR compared with non-asthmatic counterparts. The high prevalence among winter and endurance athletes demonstrates a need for increased attention to prevent and reduce the prevalence of asthma among those athletes.
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Affiliation(s)
- Helene Støle Melsom
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Anders Randa
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Julie Sørbø Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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9
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Peters CM, Peters RC, Lee AD, Lane P, Lam S, Sin DD, McKenzie DC, William Sheel A. software development TO OPTIMIZE THE minimal detectable difference IN huMAN AIRWAY IMAGES CAPTURED USING optical coherence tomography. Clin Physiol Funct Imaging 2022; 42:308-319. [PMID: 35522086 DOI: 10.1111/cpf.12762] [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: 09/09/2021] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
Optical coherence tomography (OCT) is an imaging methodology that can be used to assess human airways. OCT avoids the harmful effects of ionizing radiation and has a high spatial resolution making it well suited for imaging the structure of small airways. Analysis of OCT airway images has typically been performed manually by tracing the airway with a relatively high coefficient of variation. The purpose of this study was to develop an analysis tool to reduce the inter- and intra-observer reproducibility of OCT and improve the ability to detect differences in airways. OCT images from healthy, young human volunteers were used to develop and test the OCT software. Measurement software was developed to allow the conversion of the original image into a grayscale image and was followed by an enhancement operation to brighten the image, and contour measurement. A total of 140 OCT images, 70 small (< 2 mm) and 70 medium (2-4 mm) sized airways, were analyzed. The inter- and intra- observer reproducibility of airway measurements ranged for strong to very strong in the small sized airways. For medium sized airways the reproducibility was considered moderate. Bland-Altman bias was low between observers and observations for all measures. The minimal detectable differences in the airway measurements with our semi-automated software were lower relative to manual tracing in medium-sized airways. Our software improves the ability to perform quantitative OCT analysis and may help to quantify the extent of airway remodelling in respiratory disease or elite athletes in future studies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Carli M Peters
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Robert C Peters
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Anthony D Lee
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Pierre Lane
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Stephen Lam
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital and Department of Medicine (Respirology), University of British Columbia, Vancouver, BC, Canada
| | - Donald C McKenzie
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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10
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Bougault V, Turmel J, Boulet LP. Serum and sputum MMP-9/TIMP-1 in winter sports athletes and swimmers: relationships with airway function. Biomarkers 2021; 27:127-137. [PMID: 34927510 DOI: 10.1080/1354750x.2021.2020902] [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: 11/02/2022]
Abstract
INTRODUCTION Skiers and swimmers present characteristics of airway inflammation and remodeling of the extracellular matrix similar to what is observed in mild asthma. We aimed to compare serum and sputum MMP-9/TIMP-1 levels, to assess the balance between airway fibrogenesis and inflammation process in both categories of athletes, and to observe its seasonal variations in winter sports athletes. METHODS We conducted a retrospective study. Winter sports athletes (n = 41), swimmers (n = 25) and healthy nonathletes (n = 10) had blood sampling, lung function measurement, skin prick tests, eucapnic voluntary hyperpnea challenge, methacholine inhalation test, and induced sputum analysis. Twelve winter sport athletes performed the tests during both summer and winter. Serum and sputum biomarkers were measured by ELISA. RESULTS No significant difference in serum or sputum MMP-9/TIMP-1 ratio was observed between groups, nor relationship with airway function or responsiveness. Serum MMP-9/TIMP-1 ratio was higher during the summer in winter sport athletes compared with winter season (median [Interquartile range]: 3.65 [2.47-4.03] ng.ml-1 and 1.27 [0.97-1.62] ng.ml-1, respectively, p = 0.005). Sputum MMP-9 correlated with methacholine PC20 (r = 0.45, p = 0.019) and serum cc16/SP-D ratio (r=-0.47, p = 0.013). CONCLUSION MMP-9/TIMP-1 ratio in sputum or serum may fluctuate with training or environment but does not correlate with airway function or responsiveness in athletes.
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Affiliation(s)
- Valérie Bougault
- Université Côte d'Azur, LAMHESS, Nice, France.,Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Julie Turmel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Louis-Philippe Boulet
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
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11
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McGovern T, Ano S, Farahnak S, McCuaig S, Martin JG. Cellular Source of Cysteinyl Leukotrienes Following Chlorine Exposure. Am J Respir Cell Mol Biol 2020; 63:681-689. [PMID: 32697598 DOI: 10.1165/rcmb.2019-0385oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Exposure of mice to high concentrations of chlorine leads to the synthesis of cysteinyl leukotrienes (cysLTs). CysLTs contribute to chlorine-induced airway hyperresponsiveness. The aim of the current study was to determine the cellular source of the cysLTs. To achieve this aim, we exposed mice to 100 ppm of chlorine for 5 minutes. Intranasal instillation of clodronate in liposomes and of diphtheria toxin in CD11c-DTR mice was used to deplete macrophages. CCR2-/- mice were used to assess the contribution of recruited macrophages. Eosinophils and neutrophils were depleted with specific antibodies. Platelet-neutrophil aggregation was prevented with an antibody against P-selectin. The potential roles of phagocytosis of neutrophils by macrophages and of transcellular metabolism between epithelial cells and neutrophils were explored in coculture systems. We found that depletion of neutrophils was the only intervention that inhibited the synthesis of cysLTs at 24 hours after chlorine exposure. Although macrophages did synthesize cysLTs in response to phagocytosis of neutrophils, depletion of macrophages did not reduce the increment in cysLTs triggered by chlorine exposure. However, coculture of airway epithelial cells with neutrophils resulted in a significant increase in the synthesis of cysLTs, dependent on the expression of 5-lipoxygenase by neutrophils. We conclude that cysLT synthesis following chlorine exposure may be dependent on transcellular metabolism by neutrophil-epithelial interactions.
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Affiliation(s)
- Toby McGovern
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | - Satoshi Ano
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | - Soroor Farahnak
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | - Sarah McCuaig
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
| | - James G Martin
- Meakins-Christie Laboratories, Research Institute of the McGill University Health Centre and McGill University, Montreal, Quebec, Canada
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12
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Sporn PHS. Chlorine Gas, Airway Inflammation, and Cysteinyl Leukotrienes: The Neutrophil Does Not Work Alone. Am J Respir Cell Mol Biol 2020; 63:553-554. [PMID: 32857592 PMCID: PMC7605154 DOI: 10.1165/rcmb.2020-0347ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter H S Sporn
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois
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13
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Nitter TB, Hirsch Svendsen KV. Covariation amongst pool management, trichloramine exposure and asthma for swimmers in Norway. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 723:138070. [PMID: 32217397 DOI: 10.1016/j.scitotenv.2020.138070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 03/18/2020] [Indexed: 06/10/2023]
Abstract
The association between asthma and exposure to the air in swimming facilities has been acknowledged. However, the variation in, long-term exposure to and management of the respiratory irritant trichloramine (NCl3) is not well understood. In this study, 313 swimmers above 18 years of age licensed by the Norwegian Swimming Association answered a questionnaire about health and swimming. The prevalence of asthma amongst the most-exposed swimmers was 36%. Two facilities, those with the highest and lowest reported prevalence of asthma, were chosen for further investigation. For each facility, a one-week-long monitoring campaign was performed, during which pool management, air and water quality were investigated. The results of this study showed that time of day, occupancy and pool management affect the concentration of NCl3, which ranged from 58 μg/m3 to 461 μg/m3. Furthermore, in one of the facilities, the concentration of CO2 was measured to evaluate whether this contaminant could be used to predict the number of pool occupants as well as the concentration of NCl3 in the air. The concentration of CO2 was significantly correlated with occupancy level (ρ = 0.82, p = 0.01) and NCl3 concentration (r = 0.80, p = 0.01). Furthermore, according to the random intercept model the concentration of CO2 explained 52% of the variation observed in the air concentration of NCl3. CO2 sensors to control the air supply can help reduce the air concentrations of NCl3 and balance the air supply based on occupancy level.
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Affiliation(s)
- Therese Bergh Nitter
- Department of Civil and Environmental Engineering, Norwegian University of Science and Technology (NTNU), Norway; Department of Industrial Economics and Technology Management, NTNU, Norway.
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14
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Leahy MG, Peters CM, Geary CM, Koehle MS, McKenzie DC, Brotherhood J, Sheel AW. Diagnosis of Exercise-induced Bronchoconstriction in Swimmers: Context Matters. Med Sci Sports Exerc 2020; 52:1855-1861. [PMID: 32175977 DOI: 10.1249/mss.0000000000002335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Swimmers have a high prevalence of exercise-induced bronchoconstriction (EIB), which may be associated with repeated exposure to chlorinated pool water. The eucapnic voluntary hyperpnea (EVH) test is used to diagnose EIB; however, it fails to replicate the environmental conditions experienced by swimmers. The relationship between the composition of the EVH inspired gas and the development of EIB from swim exercise remains unclear. PURPOSE This study aimed to compare the bronchoconstrictive effect of a chlorinated inspirate EVH test and swim test to a laboratory-based EVH test in swimmers. METHODS Fifteen collegiate swimmers (n = 5 male, n = 10 female; 21 ± 2 yr) completed 3 d of testing in pseudorandom order; a standard EVH test (EVHL), a pool air EVH test (EVHCl), and a swimming test (Swim). Spirometry was measured at baseline, and 3, 5, 10, 15, and 20 min after each test. RESULTS EVHL elicited a forced expired volume in 1 s (FEV1) fall index of -9.7% ± 6.4% compared with -6.6% ± 9.2% and -3.0% ± 7.5% after EVHCl and Swim, respectively (P < 0.05). Using Bland-Altman analysis, we found good agreement between EVHL and EVHCl (bias = -2.8, r = 0.79; P < 0.05) with poor agreement between EVHL and Swim (bias = -6.7, r = 0.20) and between EVHCl and Swim (bias = -3.9, r = 0.50; both P < 0.05). Forced expired flow between 25% and 75% lung volume and peak expired flow were significantly reduced by the EVHL compared with the EVHCl and Swim tests (P < 0.05). CONCLUSIONS EVHL elicits a greater forced expired volume in 1-s fall index compared with EVHCl and Swim. The unique aquatic environment of swimmers potentially protects against bronchoconstriction and should be considered in the determination of EIB.
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Affiliation(s)
- Michael George Leahy
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, CANADA
| | - Carli M Peters
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, CANADA
| | - Caitlin M Geary
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, CANADA
| | | | | | | | - A William Sheel
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, CANADA
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15
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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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16
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Kotsiou OS, Peletidou S, Vavougios G, Karetsi E, Stavrou V, Zakynthinos G, Gourgoulianis KI, Daniil Z. Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers. Ann Allergy Asthma Immunol 2019; 123:249-255. [PMID: 31247303 DOI: 10.1016/j.anai.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Swimming is recommended for people with asthma. However, the inevitable exposure to chlorine and its disinfectant byproducts in indoor swimming pools could be responsible for bronchial inflammation and asthma development. Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation that predicts asthma exacerbations. OBJECTIVES To evaluate pretraining and posttraining FeNO levels in young swimmers with asthma attending an indoor chlorinated pool compared with a set of healthy swimmers and to examine the potential risk of exposure to chlorine as a factor associated with bronchial inflammation. METHODS A total of 146 children (8-18 years old) constantly attending an indoor chlorinated swimming pool were enrolled. Spirometry and FeNO measurements were performed 30 minutes after their arrival at the pool and immediately after exercise. Pre-exercise and postexercise spirometric and FeNO levels were assessed in a random subgroup of 14 swimmers (10 with asthma and 4 without) who performed cardiopulmonary exercise testing. RESULTS Asthma was detected in 23 swimmers. In swimmers with asthma, preswimming FeNO values were significantly elevated compared with swimmers without asthma and their FeNO values measured before cardiopulmonary exercise testing. Postexercise FeNO values were significantly decreased by approximately one-third in healthy children and children with asthma in all sporting backgrounds. However, postswimming FeNO values remained significantly higher in swimmers with asthma compared with those without asthma. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio values showed no significant difference before and after 2 types of activity. CONCLUSION Elevated FeNO levels before and after swimming were recorded in swimmers with asthma not observed in a different exercise field. The presence of chlorine in the indoor swimming pool seems to explain this finding.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Sotiria Peletidou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Vavougios
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Karetsi
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Stavrou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Zakynthinos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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17
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Kippelen P, Anderson SD, Hallstrand TS. Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction. Immunol Allergy Clin North Am 2019; 38:165-182. [PMID: 29631728 DOI: 10.1016/j.iac.2018.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Exercise is a common trigger of bronchoconstriction. In recent years, there has been increased understanding of the pathophysiology of exercise-induced bronchoconstriction. Although evaporative water loss and thermal changes have been recognized stimuli for exercise-induced bronchoconstriction, accumulating evidence points toward a pivotal role for the airway epithelium in orchestrating the inflammatory response linked to exercise-induced bronchoconstriction. Overproduction of inflammatory mediators, underproduction of protective lipid mediators, and infiltration of the airways with eosinophils and mast cells are all established contributors to exercise-induced bronchoconstriction. Sensory nerve activation and release of neuropeptides maybe important in exercise-induced bronchoconstriction, but further research is warranted.
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Affiliation(s)
- Pascale Kippelen
- Department of Life Sciences, Division of Sport, Health and Exercise Sciences, Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK
| | - Sandra D Anderson
- Central Clinical School, Sydney Medical School, University of Sydney, Parramatta Road, Sydney New South Wales 2006, Australia.
| | - Teal S Hallstrand
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Center for Lung Biology, University of Washington, Box 358052, 850 Republican Street, Seattle, WA 98109-4714, USA
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18
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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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Abstract
An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.
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20
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Bougault V, Odashiro P, Turmel J, Orain M, Laviolette M, Joubert P, Boulet L. Changes in airway inflammation and remodelling in swimmers after quitting sport competition. Clin Exp Allergy 2018; 48:1748-1751. [DOI: 10.1111/cea.13257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/19/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Valérie Bougault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
- URePSSS Unité de Recherche Pluridisciplinaire Sport Santé Société Université de Lille Lille France
| | - Patricia Odashiro
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
| | - Julie Turmel
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
| | - Michèle Orain
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
| | - Michel Laviolette
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
| | - Philippe Joubert
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
| | - Louis‐Philippe Boulet
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ) Université Laval Québec Québec Canada
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21
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Airway remodeling in asthma: update on mechanisms and therapeutic approaches. Curr Opin Pulm Med 2018; 24:56-62. [PMID: 29076828 DOI: 10.1097/mcp.0000000000000441] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The term 'airway remodeling' reflects changes in the type, quantity, and nature of airway wall components and their organization. The purpose of this review is to look at recent publications on airway remodeling in asthma. RECENT FINDINGS Animal models and in-vitro studies have confirmed the involvement of airway epithelium, airway smooth muscle (ASM), and extracellular matrix components in asthma-related airway remodeling. They report influences on proliferation of ASM cells, and how their orientation or morphology, in addition to the heterogeneity of ASM mass at different levels of airways could influence their effects. Clinical benefits have been observed following reduction of ASM following bronchial thermoplasty. Asthmatic epithelial cell transcriptome alterations were found to involve metabolism and epigenetics, beyond epithelial mesenchymal trophic unit driven by injury and repair in chronic inflammation. New ways to explore airway remodeling such as imaging or endoscopic techniques have been evaluated. Finally, new data support the role of eosinophils and mast cells in remodeling and show the influence of new asthma drugs on this process. SUMMARY As recently stated by an American Thoracic Society task force, we need more research on airway remodeling, its determinants and clinical relevance, and on the effects of asthma drugs on its various components.
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22
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Systemic and airway oxidative stress in competitive swimmers. Respir Med 2018; 137:129-133. [DOI: 10.1016/j.rmed.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/02/2018] [Indexed: 11/20/2022]
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23
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Couto M, Kurowski M, Moreira A, Bullens DMA, Carlsen K, Delgado L, Kowalski ML, Seys SF. Mechanisms of exercise-induced bronchoconstriction in athletes: Current perspectives and future challenges. Allergy 2018; 73:8-16. [PMID: 28599081 DOI: 10.1111/all.13224] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 01/08/2023]
Abstract
The evidence of exercise-induced bronchoconstriction (EIB) without asthma (EIBwA ) occurring in athletes led to speculate about different endotypes inducing respiratory symptoms within athletes. Classical postulated mechanisms for bronchial obstruction in this population include the osmotic and the thermal hypotheses. More recently, the presence of epithelial injury and inflammation in the airways of athletes was demonstrated. In addition, neuronal activation has been suggested as a potential modulator of bronchoconstriction. Investigation of these emerging mechanisms is of major importance as EIB is a significant problem for both recreational and competitive athletes and is the most common chronic condition among Olympic athletes, with obvious implications for their competing performance, health and quality of life. Hereby, we summarize the latest achievements in this area and identify the current gaps of knowledge so that future research heads toward better defining the etiologic factors and mechanisms involved in development of EIB in elite athletes as well as essential aspects to ultimately propose preventive and therapeutic measures.
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Affiliation(s)
- M. Couto
- Allergy Unit Hospital & Instituto CUF Porto Porto Portugal
| | - M. Kurowski
- Department of Immunology, Rheumatology and Allergy Healthy Ageing Research Centre Medical University of Łódź Łódź Poland
| | - A. Moreira
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar São João E.P.E. Porto Portugal
| | - D. M. A. Bullens
- Laboratory of Pediatric Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
- Division of Pediatrics UZ Leuven Leuven Belgium
| | - K.‐H. Carlsen
- Institute for Clinical Medicine University of Oslo Oslo Norway
| | - L. Delgado
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar São João E.P.E. Porto Portugal
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy Healthy Ageing Research Centre Medical University of Łódź Łódź Poland
| | - S. F. Seys
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
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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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Abstract
OBJECTIVE To investigate the effect of a swimming break on airway hyperresponsiveness (AHR) and to evaluate perception of bronchoconstriction-related symptoms after methacholine challenge testing (MCT). DESIGN Observational, controlled study. SETTING University department. PARTICIPANTS Overall, 25 healthy, elite, competitive swimmers aged ≥14 years from the local Olympic training center and 25 healthy control subjects. INDEPENDENT VARIABLE Duration of water abstinence. MAIN OUTCOME MEASURES Primary outcome measures were a positive MCT with a provocation dose (PD) and the perception score of bronchoconstriction-related symptoms at visit 1 (V1, training period) and visit 2 (V2, after swimming break). RESULTS In the study, 13 swimmers (52%) and 10 control subjects (40%) showed AHR. The PD did not differ significantly between V1 and V2 in the swimmers (P = 0.81) or in the control subjects (P = 0.74). No correlation of fraction of exhaled nitric oxide with the PD could be established in both the groups (swimmers: P = 0.97; controls: P = 0.99). The majority of swimmers with AHR were asymptomatic, and only minimal differences in perception of bronchoconstriction-related symptoms between swimmers and control subjects were observed (P = 0.23). CONCLUSIONS A swimming break of 25 ± 8 days does not seem sufficient to significantly reduce AHR in elite swimmers. Thus, relevant and systematic effects of short-term water abstinence on AHR seem unlikely. Because the majority of swimmers remain asymptomatic, AHR may escape routine screening examinations. The impact of AHR on athletic performance and the long-term clinical consequences remain to be clarified.
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26
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Boulet LP. Airway remodeling in asthma: Mechanisms, clinical relevance, treatment, and prevention. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2017. [DOI: 10.1080/24745332.2017.1295776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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27
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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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Gomà A, de Lluis R, Roca-Ferrer J, Lafuente J, Picado C. Respiratory, ocular and skin health in recreational and competitive swimmers: Beneficial effect of a new method to reduce chlorine oxidant derivatives. ENVIRONMENTAL RESEARCH 2017; 152:315-321. [PMID: 27835856 DOI: 10.1016/j.envres.2016.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Chlorine by-products may irritate the eyes, nose, skin and airways of swimmers and may cause chronic airway inflammation. OBJECTIVE To assess the salutary effects on swimmers health of a new method of water disinfection. METHODS Recreational (n=320) and competitive swimmers (n=53) participated in the study. The first part of the study (Phase A) was carried out while using the current standard method. The second part (Phase B) began 8 weeks after the new method had been introduced. Total oxidants in air and chlorine species in water were assessed by standard methods. All swimmers completed a questionnaire on health complaints. Exhaled breath condensate (EBC) was used to monitor the levels of leukotriene B4 (LTB4) and cysteinyl leukotrienes (CysLTs) in airway from competitive swimmers. RESULTS The new system resulted in a 75% and 39% reduction in the concentration of total oxidants and of nitrogen trichloride respectively in the air of the swimming pool. With the new system recreational swimmers experienced fewer symptoms of cough and irritation of the eyes, nose and skin. A decrease in eye irritation symptoms was also noted by competitive swimmers. The baseline concentration of CysLTs in EBC decreased significantly in Phase B with respect to Phase A. CONCLUSIONS The new method markedly reduced the levels of irritant oxidant substances in the pool atmosphere that resulted in a reduction of eye, nose, skin and cough complaints in recreational swimmers, and eye irritation in competitive swimmers. It was also associated with reduced CysLT levels in the airways of competitive swimmers.
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Affiliation(s)
- Anton Gomà
- Grup GENOCOV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Rosó de Lluis
- Servei de Pneumologia i Al·lèrgia Respiratoria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Jordi Roca-Ferrer
- Servei de Pneumologia i Al·lèrgia Respiratoria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Javier Lafuente
- Grup GENOCOV, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - César Picado
- Servei de Pneumologia i Al·lèrgia Respiratoria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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29
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Selge C, Thomas S, Nowak D, Radon K, Wolfarth B. Asthma prevalence in German Olympic athletes: A comparison of winter and summer sport disciplines. Respir Med 2016; 118:15-21. [PMID: 27578466 DOI: 10.1016/j.rmed.2016.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/21/2016] [Accepted: 07/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prevalence of asthma in elite athletes shows very wide ranges. It remains unclear to what extent this is influenced by the competition season (winter vs. summer) or the ventilation rate achieved during competition. The aim of this study was to evaluate prevalence of asthma in German elite winter and summer athletes from a wide range of sport disciplines and to identify high risk groups. METHODS In total, 265 German elite winter athletes (response 77%) and 283 German elite summer athletes (response 64%) answered validated respiratory questionnaires. Using logistic regression, the asthma risks associated with competition season and ventilation rate during competition, respectively, were investigated. A subset of winter athletes was also examined for their FENO-levels and lung function. RESULTS With respect to all asthma outcomes, no association was found with the competition season. Regarding the ventilation rate, athletes in high ventilation sports were at increased risk of asthma, as compared to athletes in low ventilation sports (doctors' diagnosed asthma: OR 2.32, 95% CI 1.19-4.53; use of asthma medication: OR 4.46, 95% CI 1.52-13.10; current wheeze or use of asthma medication: OR 2.78, 95% CI 1.34-5.76). Athletes with doctors' diagnosed asthma were at an approximate four-fold risk of elevated FENO-values. CONCLUSIONS The clinically relevant finding of this study is that athletes' asthma seems to be more common in sports with high ventilation during competition, whereas the summer or winter season had no impact on the frequency of the disease. Among winter athletes, elevated FENO suggested suboptimal control of asthma.
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Affiliation(s)
- Charlotte Selge
- Department of Neurology, University Hospital Munich (LMU), Munich, Germany.
| | - Silke Thomas
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany.
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.
| | - Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.
| | - Bernd Wolfarth
- Department of Sport Medicine Humboldt University and Charité University School of Medicine, Berlin, Germany.
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Morici G, Gruttad'Auria CI, Baiamonte P, Mazzuca E, Castrogiovanni A, Bonsignore MR. Endurance training: is it bad for you? Breathe (Sheff) 2016; 12:140-7. [PMID: 27408632 PMCID: PMC4933620 DOI: 10.1183/20734735.007016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Educational aims Endurance exercise training exerts many positive effects on health, including improved metabolism, reduction of cardiovascular risk, and reduced all-cause and cardiovascular mortality. Intense endurance exercise causes mild epithelial injury and inflammation in the airways, but does not appear to exert detrimental effects on respiratory health or bronchial reactivity in recreational/non-elite athletes. Conversely, elite athletes of both summer and winter sports show increased susceptibility to development of asthma, possibly related to environmental exposures to allergens or poor conditioning of inspired air, so that a distinct phenotype of “sports asthma” has been proposed to characterise such athletes, who more often practise aquatic and winter sports. Overall, endurance training is good for health but may become deleterious when performed at high intensity or volume. Endurance training is good for health but may become deleterious when performed at high intensity or volumehttp://ow.ly/4n9jR4
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Affiliation(s)
- Giuseppe Morici
- BioNeC Dept, University of Palermo, Palermo, Italy; Institute of Biomedicine and Molecular Immunology (IBIM), CNR, Palermo, Italy
| | | | | | | | | | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology (IBIM), CNR, Palermo, Italy; DiBiMIS, University of Palermo, Palermo, Italy
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Abstract
The prevalence of airway dysfunction in elite swimmers is among the highest in elite athletes. The traditional view that swimmers naturally gravitate toward swimming because of preexisting respiratory disorders has been challenged. There is now sufficient evidence that the higher prevalence of bronchial tone disorders in elite swimmers is not the result of a natural selection bias. Rather, the combined effects of repeated chlorine by-product exposure and chronic endurance training can lead to airway dysfunction and atopy. This review will detail the underpinning causes of airway dysfunction observed in elite swimmers. It will also show that airway dysfunction does not prevent success in elite level swimming. Neither does it inhibit lung growth and might be partially reversible when elite swimmers retire from competition.
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Affiliation(s)
- Mitch Lomax
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
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Simpson AJ, Bood JR, Anderson SD, Romer LM, Dahlén B, Dahlén SE, Kippelen P. A standard, single dose of inhaled terbutaline attenuates hyperpnea-induced bronchoconstriction and mast cell activation in athletes. J Appl Physiol (1985) 2016; 120:1011-7. [PMID: 26846550 PMCID: PMC4894945 DOI: 10.1152/japplphysiol.00700.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/28/2016] [Indexed: 12/30/2022] Open
Abstract
This study provides the first in vivo evidence for a mast cell stabilizing effect of the short-acting inhaled β2-adrenoceptor agonist terbutaline, when administered prophylactically at a clinically recommended dose (0.5 mg) before bronchial provocation with dry air. Our data therefore support the proposal that β2-adrenoceptor agonist-mediated mast cell stabilization is a major contributor to bronchoprotection in individuals with exercise-induced bronchoconstriction. Release of bronchoactive mediators from mast cells during exercise hyperpnea is a key factor in the pathophysiology of exercise-induced bronchoconstriction (EIB). Our aim was to investigate the effect of a standard, single dose of an inhaled β2-adrenoceptor agonist on mast cell activation in response to dry air hyperpnea in athletes with EIB. Twenty-seven athletes with EIB completed a randomized, double-blind, placebo-controlled, crossover study. Terbutaline (0.5 mg) or placebo was inhaled 15 min prior to 8 min of eucapnic voluntary hyperpnea (EVH) with dry air. Pre- and postbronchial challenge, urine samples were analyzed by enzyme immunoassay for 11β-prostaglandin F2α (11β-PGF2α). The maximum fall in forced expiratory volume in 1 s of 14 (12–20)% (median and interquartile range) following placebo was attenuated to 7 (5–9)% with the administration of terbutaline (P < 0.001). EVH caused a significant increase in 11β-PGF2α from 41 (27–57) ng/mmol creatinine at baseline to 58 (43–72) ng/mmol creatinine at its peak post-EVH following placebo (P = 0.002). The rise in 11β-PGF2α was inhibited with administration of terbutaline: 39 (28–44) ng/mmol creatinine at baseline vs. 40 (33–58) ng/mmol creatinine at its peak post-EVH (P = 0.118). These data provide novel in vivo evidence of mast cell stabilization following inhalation of a standard dose of terbutaline prior to bronchial provocation with EVH in athletes with EIB.
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Affiliation(s)
- A J Simpson
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, United Kingdom
| | - J R Bood
- Unit for Experimental Asthma Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Unit for Clinical Asthma Research, Department of Internal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; and
| | - S D Anderson
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - L M Romer
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, United Kingdom
| | - B Dahlén
- Unit for Clinical Asthma Research, Department of Internal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; and
| | - S-E Dahlén
- Unit for Experimental Asthma Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; and
| | - P Kippelen
- Centre for Human Performance, Exercise and Rehabilitation, College of Health and Life Sciences, Brunel University London, United Kingdom;
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Rundell KW, Anderson SD, Sue-Chu M, Bougault V, Boulet LP. Air quality and temperature effects on exercise-induced bronchoconstriction. Compr Physiol 2016; 5:579-610. [PMID: 25880506 DOI: 10.1002/cphy.c130013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is exaggerated constriction of the airways usually soon after cessation of exercise. This is most often a response to airway dehydration in the presence of airway inflammation in a person with a responsive bronchial smooth muscle. Severity is related to water content of inspired air and level of ventilation achieved and sustained. Repetitive hyperpnea of dry air during training is associated with airway inflammatory changes and remodeling. A response during exercise that is related to pollution or allergen is considered EIB. Ozone and particulate matter are the most widespread pollutants of concern for the exercising population; chronic exposure can lead to new-onset asthma and EIB. Freshly generated emissions particulate matter less than 100 nm is most harmful. Evidence for acute and long-term effects from exercise while inhaling high levels of ozone and/or particulate matter exists. Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool. Swimmers typically do not respond in the pool; however, a large percentage responds to a dry air exercise challenge. Studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic. Winter sport athletes and swimmers have a higher prevalence of EIB, asthma and airway remodeling than other athletes and the general population. Because of fossil fuel powered ice resurfacers in ice rinks, ice rink athletes have shown high rates of EIB and asthma. For the athlete training in the urban environment, training during low traffic hours and in low traffic areas is suggested.
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Affiliation(s)
- Kenneth W Rundell
- Department of The Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
| | - Sandra D Anderson
- Clinical Professor Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Malcolm Sue-Chu
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Morissette MC, Murray N, Turmel J, Milot J, Boulet LP, Bougault V. Increased exhaled breath condensate 8-isoprostane after a swimming session in competitive swimmers. Eur J Sport Sci 2015; 16:569-76. [DOI: 10.1080/17461391.2015.1063702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bonini M, Palange P. Exercise-induced bronchoconstriction: new evidence in pathogenesis, diagnosis and treatment. Asthma Res Pract 2015; 1:2. [PMID: 27965757 PMCID: PMC4970375 DOI: 10.1186/s40733-015-0004-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 05/07/2015] [Indexed: 11/10/2022] Open
Abstract
The acute airway narrowing that occurs as a result of exercise is defined exercise-induced bronchoconstriction (EIB). Most recent guidelines recommend distinguishing EIB with underlying clinical asthma (EIBA) from the occurrence of bronchial obstruction in subjects without other symptoms and signs of asthma (EIBwA). EIB has been in fact reported in up to 90 % of asthmatic patients, reflecting the level of disease control, but it may develop even in subjects without clinical asthma, particularly in children, athletes, patients with atopy or rhinitis and following respiratory infections. Both EIBA and EIBwA have peculiar pathogenic mechanisms, diagnostic criteria and responses to treatment and prevention. The use of biomarkers, proteomic approaches and innovative technological procedures will hopefully contribute to better define peculiar phenotypes and to clarify the role of EIB as risk factor for the development of asthma, as well as an occupational disease.
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Affiliation(s)
- Matteo Bonini
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Viale dell'Universita', 37, 00185 Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Viale dell'Universita', 37, 00185 Rome, Italy
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Burns J, Mason C, Mueller N, Ohlander J, Zock JP, Drobnic F, Wolfarth B, Heinrich J, Omenaas E, Stensrud T, Nowak D, Radon K. Asthma prevalence in Olympic summer athletes and the general population: An analysis of three European countries. Respir Med 2015; 109:813-20. [PMID: 26013359 DOI: 10.1016/j.rmed.2015.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/30/2015] [Accepted: 05/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some studies have shown a higher prevalence of asthma in elite athletes as compared to the general population. It is inconclusive to what extent certain sport categories are especially affected. The present study offered a unique opportunity to assess these differences in asthma prevalence in the general population and elite summer athletes from a wide range of sport disciplines across various geographical areas. METHODS Cross-sectional data for 1568 general population participants from the European Community Respiratory Health Survey II and 546 elite athletes from the Global Allergy and Asthma European Network Olympic study from three European countries were analyzed. Using logistic regression, the asthma risks associated with athlete sport practice, endurance level and aquatic sport practice, respectively, were investigated. RESULTS Athletes in the highest endurance category had increased risk of doctor-diagnosed asthma (OR 3.5; 95% CI 1.7-7.5), asthma symptoms (OR 3.0; CI 1.5-6.0) and asthma symptoms or medication use (OR 3.5; CI 1.8-6.7) compared to the general population. Aquatic athletes were at increased risk of doctor-diagnosed asthma (OR 2.0; CI 1.1-3.9), asthma symptoms (OR 2.6; CI 1.3-5.0) and asthma symptoms or medication use (OR 2.3; CI 1.2-4.4) when compared to individuals not involved in aquatic sports. Regarding the entire athlete population, no increase in asthma was found when compared to the general population. CONCLUSIONS Practice of very high endurance and aquatic sports may be associated with increased asthma risks. Athlete participation as such showed no association with asthma risk.
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Affiliation(s)
- Jacob Burns
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstrasse 1, Munich, Germany
| | - Catherine Mason
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstrasse 1, Munich, Germany
| | - Natalie Mueller
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstrasse 1, Munich, Germany; Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè 10-12, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid, Spain.
| | - Johan Ohlander
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstrasse 1, Munich, Germany
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), C/ Doctor Aiguader 88, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Plaça de la Mercè 10-12, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid, Spain; Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, Utrecht, The Netherlands
| | - Franchek Drobnic
- Medical Services FC Barcelona and Sport Physiology, GIRSANE CAR, Av. Alcalde Barnils 3-5, Sant Cugat del Vallès, Spain
| | - Bernd Wolfarth
- Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Georg-Brauchle-Ring 56-58, Munich, Germany
| | - Joachim Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Ernst Omenaas
- Centre for Clinical Research, Haukeland University Hospital, Jonas Liesvei 65, Bergen, Norway
| | - Trine Stensrud
- Norwegian School of Sport Sciences (NIH), Mailbox 4014, Ulleval Stadion, Oslo, Norway
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstrasse 1, Munich, Germany
| | - Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Ziemssenstrasse 1, Munich, Germany
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Prevalence and characteristics of asthma in the aquatic disciplines. J Allergy Clin Immunol 2015; 136:588-94. [PMID: 25819982 DOI: 10.1016/j.jaci.2015.01.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the health benefits of swimming as a form of exercise, evidence exists that both the swimming pool environment and endurance exercise are etiologic factors in the development of asthma. The prevalence of asthma in swimmers is high compared with that in participants in other Olympic sport disciplines. There are no publications comparing the prevalence of asthma in the 5 aquatic disciplines. OBJECTIVE The purpose of this study is to examine and compare the prevalence of asthma in the aquatic disciplines and in contrast with other Olympic sports. METHODS Therapeutic Use Exemptions containing objective evidence of athlete asthma/airway hyperresponsiveness (AHR) were collected for all aquatic athletes participating in swimming, diving, synchronized swimming, water polo, and open water swimming for major events during the time period from 2004-2009. The prevalence of asthma/AHR in the aquatic disciplines was analyzed for statistical significance (with 95% CIs) and also compared with that in other Olympic sports. RESULTS Swimming had the highest prevalence of asthma/AHR in comparison with the other aquatic disciplines. The endurance aquatic disciplines have a higher prevalence of asthma/AHR than the aquatic nonendurance disciplines. Asthma/AHR is more common in Oceania, Europe, and North America than in Asia, Africa, and South America. In comparison with other Olympic sports, swimming, synchronized swimming, and open water swimming were among the top 5 sports for asthma/AHR prevalence. CONCLUSION Asthma/AHR in the endurance aquatic disciplines is common at the elite level and has a varied geographic distribution. Findings from this study demonstrate the need for development of aquatic discipline-specific prevention, screening, and treatment regimens.
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Health effects from swimming training in chlorinated pools and the corresponding metabolic stress pathways. PLoS One 2015; 10:e0119241. [PMID: 25742134 PMCID: PMC4351252 DOI: 10.1371/journal.pone.0119241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/27/2015] [Indexed: 11/19/2022] Open
Abstract
Chlorination is the most popular method for disinfecting swimming pool water; however, although pathogens are being killed, many toxic compounds, called disinfection by-products (DBPs), are formed. Numerous epidemiological publications have associated the chlorination of pools with dysfunctions of the respiratory system and with some other diseases. However, the findings concerning these associations are not always consistent and have not been confirmed by toxicological studies. Therefore, the health effects from swimming in chlorinated pools and the corresponding stress reactions in organisms are unclear. In this study, we show that although the growth and behaviors of experimental rats were not affected, their health, training effects and metabolic profiles were significantly affected by a 12-week swimming training program in chlorinated water identical to that of public pools. Interestingly, the eyes and skin are the organs that are more directly affected than the lungs by the irritants in chlorinated water; instead of chlorination, training intensity, training frequency and choking on water may be the primary factors for lung damage induced by swimming. Among the five major organs (the heart, liver, spleen, lungs and kidneys), the liver is the most likely target of DBPs. Through metabolomics analysis, the corresponding metabolic stress pathways and a defensive system focusing on taurine were presented, based on which the corresponding countermeasures can be developed for swimming athletes and for others who spend a lot of time in chlorinated swimming pools.
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40
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Seys SF, Hox V, Van Gerven L, Dilissen E, Marijsse G, Peeters E, Dekimpe E, Kasran A, Aertgeerts S, Troosters T, Vanbelle V, Peers K, Ceuppens JL, Hellings PW, Dupont LJ, Bullens DM. Damage-associated molecular pattern and innate cytokine release in the airways of competitive swimmers. Allergy 2015; 70:187-94. [PMID: 25358760 DOI: 10.1111/all.12540] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Daily intensive exercise by elite athletes can result in exercise-induced asthma especially in elite swimmers and this may be linked to epithelial damage. OBJECTIVE To study airway epithelial damage and release of damage-associated molecular patterns (DAMPs) after intensive exercise in elite athletes and controls. METHODS We recruited competitive swimmers (n = 26), competitive indoor athletes (n = 13) and controls (n = 15) without any history of asthma. Lung function was measured before, immediately after and 24 h after a 90-min intensive exercise protocol. Sputum induction was performed at baseline and 24 h after exercise. Exercise-induced bronchoconstriction (EIB) was assessed by the eucapnic voluntary hyperventilation test. RESULTS Baseline sputum uric acid, high mobility group box-1, CXCL8 mRNA, sputum neutrophils and serum Clara cell protein-16 (CC-16) were significantly higher in competitive swimmers compared with controls. Intensive swimming for 90 min resulted in an increase of sputum IL-1β, IL-6 and TNF mRNA in competitive swimmers, and of sputum IL-6 mRNA and sputum neutrophils in controls. Although all participants were asymptomatic, seven competitive swimmers, one indoor athlete and one control met the criteria for EIB. CONCLUSION Our findings show that the intensive training combined with exposure to by-products of chlorination induces airway epithelial damage in competitive swimmers. This is associated with increased damage-associated molecular patterns, innate cytokine release and neutrophilic airway inflammation.
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Affiliation(s)
- S. F. Seys
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
- Laboratory of Pneumology; Catholic University of Leuven; Leuven Belgium
| | - V. Hox
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - L. Van Gerven
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - E. Dilissen
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - G. Marijsse
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - E. Peeters
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - E. Dekimpe
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - A. Kasran
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - S. Aertgeerts
- Academic Centre for General Practitioners; Catholic University of Leuven; Leuven Belgium
| | - T. Troosters
- Laboratory of Pneumology; Catholic University of Leuven; Leuven Belgium
| | - V. Vanbelle
- Flemish Swimming Federation; Merelbeke Belgium
| | - K. Peers
- Sport Medical Advice Centre; University Hospitals of Leuven; Leuven Belgium
| | - J. L. Ceuppens
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - P. W. Hellings
- Laboratory of Clinical Immunology; Catholic University of Leuven; Leuven Belgium
| | - L. J. Dupont
- Laboratory of Pneumology; Catholic University of Leuven; Leuven Belgium
| | - D. M. Bullens
- Laboratory of Pediatric Immunology; Catholic University of Leuven; Leuven Belgium
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Abstract
PURPOSE OF REVIEW To summarize the new knowledge on tissue remodeling in the context of lung diseases. Tissue remodeling includes changes in cells: differentiation; response to growths factors, hormones, or environmental factors; and composition of the extracellular matrix. So, can one trigger cause them all or are they independently regulated? RECENT FINDINGS New evidence from clinical and experimental studies strengthened the view that a susceptibility to remodeling can be initiated in early life and be re-activated by environmental triggers later in life. Many studies further support the idea that TGF-β plays the central role in the pathogenesis of remodeling and fibrosis. However, the activation pathways and the end-effect of TGF-β activation seems to be distinctive of disease and effecter cell specific patterns. The existing animal models do not properly reflect the human disease and thus have to be further improved. SUMMARY The central role of TGF-β on pathological mechanisms leading to remodeling and fibrosis has been further confirmed. However, the questions of why TGF-β is activated as well as its disease and cell type specific mode of action remain to be answered. Based on clinical data redefining the term 'tissue remodeling' in a disease and cell type specific way should be considered.
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Bussotti M, Di Marco S, Marchese G. Respiratory disorders in endurance athletes - how much do they really have to endure? Open Access J Sports Med 2014; 5:47-63. [PMID: 24744614 PMCID: PMC3979802 DOI: 10.2147/oajsm.s57828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Respiratory disorders are often a cause of morbidity in top level endurance athletes, more often compromising their performance and rarely being a cause of death. Pathophysiological events occurring during exercise, such as bronchospasm, are sometimes followed by clear pathological symptoms represented by asthma related to physical exertion or rarely by pulmonary edema induced by a strenuous effort. Both bronchospasm and the onset of interstitial edema induced by exercise cannot be considered pathological per se, but are more likely findings that occur in several healthy subjects once physical exhaustion during exertion has been reached. Consequently, we get a vision of the respiratory system perfectly tailored to meet the body's metabolic demands under normal conditions but which is limited when challenged by strenuous exercise, in particular when it happens in an unfavorable environment. As extreme physical effort may elicit a pathological response in healthy subjects, due to the exceeding demand in a perfectly functional system, an overview of the main tools both enabling the diagnosis of respiratory impairment in endurance athletes in a clinical and preclinical phase has also been described.
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Affiliation(s)
- Maurizio Bussotti
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Milan, Italy
| | - Silvia Di Marco
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Milan, Italy
| | - Giovanni Marchese
- Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Milan, Italy
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43
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Price OJ, Ansley L, Menzies-Gow A, Cullinan P, Hull JH. Airway dysfunction in elite athletes--an occupational lung disease? Allergy 2013; 68:1343-52. [PMID: 24117544 DOI: 10.1111/all.12265] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Abstract
Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete's respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.
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Affiliation(s)
- O. J. Price
- Faculty of Health and Life Sciences; Northumbria University; Newcastle UK
| | - L. Ansley
- Faculty of Health and Life Sciences; Northumbria University; Newcastle UK
| | - A. Menzies-Gow
- Department of Respiratory Medicine; Royal Brompton Hospital; London UK
- National Heart and Lung Institute; Imperial College London; London UK
| | - P. Cullinan
- Department of Respiratory Medicine; Royal Brompton Hospital; London UK
- National Heart and Lung Institute; Imperial College London; London UK
| | - J. H. Hull
- Faculty of Health and Life Sciences; Northumbria University; Newcastle UK
- Department of Respiratory Medicine; Royal Brompton Hospital; London UK
- National Heart and Lung Institute; Imperial College London; London UK
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44
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Kippelen P, Tufvesson E, Ali L, Bjermer L, Anderson SD. Urinary CC16 after challenge with dry air hyperpnoea and mannitol in recreational summer athletes. Respir Med 2013; 107:1837-44. [PMID: 24120076 DOI: 10.1016/j.rmed.2013.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/20/2013] [Accepted: 09/21/2013] [Indexed: 10/26/2022]
Abstract
Airway epithelial injury is regarded as a key contributing factor to the pathogenesis of exercise-induced bronchoconstriction (EIB) in athletes. The concentration of the pneumoprotein club cell (Clara cell) CC16 in urine has been found to be a non-invasive marker for hyperpnoea-induced airway epithelial perturbation. Exercise-hyperpnoea induces mechanical, thermal and osmotic stress to the airways. We investigated whether osmotic stress alone causes airway epithelial perturbation in athletes with suspected EIB. Twenty-four recreational summer sports athletes who reported respiratory symptoms on exertion performed a standard eucapnic voluntary hyperpnoea test with dry air and a mannitol test (osmotic challenge) on separate days. Median urinary CC16 increased from 120 to 310 ρg μmol creatinine(-1) after dry air hyperpnoea (P = 0.002) and from 90 to 191 ρg μmol creatinine(-1) after mannitol (P = 0.021). There was no difference in urinary CC16 concentration between athletes who did or did not bronchoconstrict after dry air hyperpnoea or mannitol. We conclude that, in recreational summer sports athletes with respiratory symptoms, osmotic stress per se to the airway epithelium induces a rise in urinary excretion of CC16. This suggests that hyperosmolarity of the airway surface lining perturbs the airway epithelium in symptomatic athletes.
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Affiliation(s)
- Pascale Kippelen
- Centre for Sports Medicine and Human Performance, Brunel University, UB8 3PH Uxbridge, Middlesex, UK.
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45
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Simpson AJ, Tufvesson E, Anderson SD, Romer LM, Bjermer L, Kippelen P. Effect of terbutaline on hyperpnoea-induced bronchoconstriction and urinary club cell protein 16 in athletes. J Appl Physiol (1985) 2013; 115:1450-6. [PMID: 24030662 DOI: 10.1152/japplphysiol.00716.2013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Repeated injury of the airway epithelium caused by hyperpnoea of poorly conditioned air has been proposed as a key factor in the pathogenesis of exercise-induced bronchoconstriction (EIB) in athletes. In animals, the short-acting β2-agonist terbutaline has been shown to reduce dry airflow-induced bronchoconstriction and the associated shedding of airway epithelial cells. Our aim was to test the efficacy of inhaled terbutaline in attenuating hyperpnoea-induced bronchoconstriction and airway epithelial injury in athletes. Twenty-seven athletes with EIB participated in a randomized, double-blind, placebo-controlled, crossover study. Athletes completed an 8-min eucapnic voluntary hyperpnoea (EVH) test with dry air on two separate days 15 min after inhaling 0.5 mg terbutaline or a matching placebo. Forced expiratory volume in 1 s (FEV1) and urinary concentration of the club cell (Clara cell) protein 16 (CC16, a marker of airway epithelial perturbation) were measured before and up to 60 min after EVH. The maximum fall in FEV1 of 17 ± 8% (SD) on placebo was reduced to 8 ± 5% following terbutaline (P < 0.001). Terbutaline gave bronchoprotection (i.e., post-EVH FEV1 fall <10%) to 22 (81%) athletes. EVH caused an increase in urinary excretion of CC16 in both conditions (P < 0.001), and terbutaline significantly reduced this rise (pre- to postchallenge CC16 increase 416 ± 495 pg/μmol creatinine after placebo vs. 315 ± 523 pg/μmol creatinine after terbutaline, P = 0.016). These results suggest that the inhalation of a single therapeutic dose of terbutaline offers significant protection against hyperpnoea-induced bronchoconstriction and attenuates acute airway epithelial perturbation in athletes.
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Affiliation(s)
- A J Simpson
- Centre for Sports Medicine and Human Performance, Brunel University, Uxbridge, United Kingdom
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46
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Tufvesson E, Svensson H, Ankerst J, Bjermer L. Increase of club cell (Clara) protein (CC16) in plasma and urine after exercise challenge in asthmatics and healthy controls, and correlations to exhaled breath temperature and exhaled nitric oxide. Respir Med 2013; 107:1675-81. [PMID: 24018107 DOI: 10.1016/j.rmed.2013.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/02/2013] [Accepted: 08/06/2013] [Indexed: 01/09/2023]
Abstract
Exercise is known to affect the airway epithelium through dehydration, followed by a release of mediators, such as club cell (Clara) protein (CC16). The aim of this study was to follow the CC16 levels at repeated time points in plasma and urine after exercise in asthmatic subjects and controls, and to relate the findings to exhaled breath temperature (EBT) and exhaled nitric oxide (NO). Twenty-two asthmatics and 18 healthy subjects performed an exercise challenge test on a treadmill. Lung function, CC16 in plasma and urine, EBT and fractional exhaled NO were investigated before and repeatedly for 60 min after the exercise. The increase in CC16 concentration in plasma was seen already one minute after exercise (p < 0.001) and increased further after 20 (p = 0.009) until 60 min (p = 0.001). An increase in urinary levels of CC16 peaked after 30 min (p < 0.001), and declined after 60 min but were still higher than baseline (p = 0.002). There were no differences in plasma or urine CC16 levels between asthmatics and controls, but males had higher plasma levels compared to females (p < 0.001) at all time points. EBT peaked at 15 min (p < 0.001) and thereafter declined, and FENO50 (p < 0.0001), alveolar NO concentration (p = 0.049) and bronchial flux of NO (p = 0.0055) decreased after exercise. In conclusion, this study shows that CC16 in plasma increased during 60 min after exercise, not synchronized with CC16 levels in urine. CC16 levels in plasma correlated to EBT and exhaled NO, reflecting an overall epithelial involvement. There was no difference between asthmatics and healthy controls, showing a physiological rather than pathophysiological response.
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Affiliation(s)
- Ellen Tufvesson
- Respiratory Medicine and Allergology, Dept. of Clinical Sciences, Lund University, 221 84 Lund, Sweden.
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47
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Voisin C, Sardella A, Bernard A. Allergic Sensitization and Airway Inflammation after Early Swimming. Am J Respir Crit Care Med 2013; 187:1392-4. [DOI: 10.1164/rccm.201210-1866le] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bougault V, Boulet LP. Is there a potential link between indoor chlorinated pool environment and airway remodeling/inflammation in swimmers? Expert Rev Respir Med 2013; 6:469-71. [PMID: 23134238 DOI: 10.1586/ers.12.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Abstract
Concerns have been expressed about the possible detrimental effects of chlorine derivatives in indoor swimming pool environments. Indeed, a controversy has arisen regarding the possibility that chlorine commonly used worldwide as a disinfectant favors the development of asthma and allergic diseases. The effects of swimming in indoor chlorinated pools on the airways in recreational and elite swimmers are presented. Recent studies on the influence of swimming on airway inflammation and remodeling in competitive swimmers, and the phenotypic characteristics of asthma in this population are reviewed. Preventative measures that could potentially reduce the untoward effects of pool environment on airways of swimmers are discussed.
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Affiliation(s)
- Valérie Bougault
- Department of Sport sciences and Physical education, Université Droit et Santé Lille 2, E.A. 4488, Lille F-59000, France.
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50
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Risks of new-onset allergic sensitization and airway inflammation after early age swimming in chlorinated pools. Int J Hyg Environ Health 2013; 217:38-45. [PMID: 23601779 DOI: 10.1016/j.ijheh.2013.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 02/06/2023]
Abstract
RATIONALE Irritant chlorination products in swimming pools can cause respiratory problems in swimmers but their possible implication in allergies development is still unclear. OBJECTIVES To assess prospectively whether early-life attendance at chlorinated pools increases the risks of IgE sensitization and of airways inflammation later during childhood. METHODS We conducted a two-year prospective study among 196 kindergarten children (mean age of 5.7 years, 54% of boys). We measured exhaled nitric oxide (eNO) and aeroallergen-specific IgE in nasal mucosa. Parents completed a questionnaire about the child's health, chlorinated pool attendance and potential confounders. MAIN RESULTS Ever swimming at indoor or outdoor chlorinated pools before the age of three years was associated with higher odds for new-onset IgE sensitization to house dust mite (adjusted odds ratio [aOR] 2.93, 95% confidence interval [CI] 1.14-7.55) and for new-onset increased eNO (>15 ppb; aOR, 4.54, 95% CI 1.48-13.9). For both outcomes, aORs increased dose-dependently with time spent in chlorinated pools with values reaching, respectively, 3.60 (95% CI 1.21-10.7) and 5.92 (95% CI 1.72-20.5) when the cumulative pool attendance exceeded 60 h These risks appeared independently of each other, of parental history of allergies and of pre-existing diseases, including eczema, which at baseline was more prevalent in early swimmers (aOR, 2.91; 95% CI 1.23-6.89). Such associations were not seen with IgE sensitization to pollen or cat allergens. CONCLUSION Attendance at chlorinated swimming pools in early life is associated with higher risks of new-onset airways inflammation and IgE sensitization to house dust mite, independently of other risk factors.
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