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Zuim AF, Edwards A, Ausiello D, Bhatta D, Edwards DA. Hypertonic Aerosols Hydrate Airways Longer and Reduce Acidification Risk with Nonpermeating Cation and Permeating Anion Salts. J Aerosol Med Pulm Drug Deliv 2024; 37:64-76. [PMID: 38354286 DOI: 10.1089/jamp.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background: Hyperosmolar aerosols appear to promote or suppress upper airway dysfunction caused by dehydration in a composition-dependent manner. We sought to explore this composition dependence experimentally, in an interventional human clinical study, and theoretically, by numerical analysis of upper airway ion and water transport. Methods: In a double-blinded, placebo-controlled clinical study, phonation threshold pressure (PTP) was measured prenasal and postnasal inhalation of hypertonic aerosols of NaCl, KCl, CaCl2, and MgCl2 in seven human subjects. Numerical analysis of water and solute exchanges in the upper airways following deposition of these same aerosols was performed using a mathematical model previously described in the literature. Results: PTP decreased by 9%-22% relative to baseline (p < 0.05) for all salts within the first 30 minutes postadministration, indicating effective laryngeal hydration. Only MgCl2 reduced PTP beyond 90 minutes (21% below baseline at 2 hours postadministration). By numerical analysis, we determined that, while airway water volume up to 15 minutes postdeposition is dictated by osmolarity, after 30 minutes, divalent cation salts, such as MgCl2, better retain airway surface liquid (ASL) volume by slow paracellular clearance of the divalent cation. Fall of CFTR chloride flux with rise in ASL height, a promoter of airway acidification, appears to be a signature of permeating cation (NaCl) and nonpermeating anion (mannitol) aerosol deposition. For hypertonic aerosols that lack permeating cation and include permeating anion (CaCl2 and MgCl2), this acid-trigger signature does not exist. Conclusions: Nonpermeating cation and permeating anion hypertonic aerosols appear to hydrate upper airways longer and, rather than provoke, may reduce laryngeal dysfunction such as cough and bronchoconstriction.
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Affiliation(s)
- Ana Flavia Zuim
- Steinberg School of Music, New York University, New York, New York, USA
| | - Aurélie Edwards
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Dennis Ausiello
- Center for Assessment Technology and Continuous Health (CATCH), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deen Bhatta
- Sensory Cloud, Inc., Boston, Massachusetts, USA
| | - David A Edwards
- Sensory Cloud, Inc., Boston, Massachusetts, USA
- John Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
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2
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Edwards DA, Chung KF. Mucus Transpiration as the Basis for Chronic Cough and Cough Hypersensitivity. Lung 2024; 202:17-24. [PMID: 38135857 DOI: 10.1007/s00408-023-00664-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Chronic cough is characterized by a state of cough hypersensitivity. We analyze the process of transpiration, by which water appears to evaporate from laryngeal and tracheal mucus as from the surface of a leaf, as a potential cause of cough hypersensitivity. In this process, osmotic pressure differences form across mucus, pulling water toward the air, and preventing mucus dehydration. Recent research suggests that these osmotic differences grow on encounter with dry and dirty air, amplifying pressure on upper airway epithelia and initiating a cascade of biophysical events that potentially elevate levels of ATP, promote inflammation and acidity, threaten water condensation, and diminish mucus water permeability. Among consequences of this inflammatory cascade is tendency to cough. Studies of isotonic, hypotonic, and hypertonic aerosols targeted to the upper airways give insights to the nature of mucus transpiration and its relationship to a water layer that forms by condensation in the upper airways on exhalation. They also suggest that, while hypertonic NaCl and mannitol may provoke cough and bronchoconstriction, hypertonic salts with permeating anions and non-permeating cations may relieve these same upper respiratory dysfunctions. Understanding of mucus transpiration and its role in cough hypersensitivity can lead to new treatment modalities for chronic cough and other airway dysfunctions promoted by the breathing of dry and dirty air.
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Affiliation(s)
- David A Edwards
- John Paulson School of Engineering and Applied Sciences, Harvard University, 29 Oxford St, Pierce Hall, Cambridge, MA, 02138, USA.
- Center for Nanomedicine, Johns Hopkins School of Medicine, 400 N Broadway St, 6th Floor, Baltimore, MD, 21231, US.
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London, 227B Guy Scadding Building, Royal Brompton Hospital, London, SW7 2AZ, UK
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Jong M, Hanstock HG, Stenfors N, Ainegren M. Elite skiers' experiences of heat- and moisture-exchanging devices and training and competition in the cold: A qualitative survey. Health Sci Rep 2023; 6:e1511. [PMID: 37662540 PMCID: PMC10469044 DOI: 10.1002/hsr2.1511] [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: 03/06/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background and Aims Winter endurance athletes have a high prevalence of exercise-induced bronchoconstriction (EIB) and asthma, probably due to repeated and prolonged inhalation of cold and dry air. Heat- and moisture-exchanging devices (HME) warm and humidify inhaled air and prevent EIB. The aim of this study was to share cross-country skiers and biathletes' experiences of training and competition in low temperatures, views on temperature limits, usage of HME, and consequences of cold exposure on their health. Methods Eleven Swedish World Championship or Olympic medalists in cross-country skiing and biathlon were interviewed and transcripts were analyzed using qualitative content analysis. Results Participants described how cold temperatures predominantly affected the airways, face, and extremities. During training, extreme cold was managed by choosing warmer clothing, modification of planned sessions, use of HME, delaying training, or changing location. In competition, participants described limited possibility for such choices and would prefer adjustment of existing rules (i.e., more conservative temperature limits), especially since they understood elite skiing in low temperatures to present an occupational hazard to their health. Participants had at times used HMEs during training in cold environments but described mixed motives for their use-that HMEs warm and humidify cold inhaled air but introduce additional resistance to breathing and can cause problems due to mucus and ice build-up. Skiers also perceived that they had become more sensitive to cold during the latter part of their careers. Conclusions The present study gives a unique insight into the "cold" reality of being an elite athlete in skiing and biathlon. Cold exposure results in negative health consequences that are preventable, which means that rules must be followed, and organizers should acknowledge responsibility in protecting athletes from occupational hazards. Development of evidence-based guidelines for protection of athletes' respiratory health should be a focus for future translational research.
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Affiliation(s)
- Mats Jong
- Department of Health Sciences/Public Health, Swedish Winter Sports Research CentreMid Sweden UniversityÖstersundSweden
| | - Helen G. Hanstock
- Department of Health Sciences/Public Health, Swedish Winter Sports Research CentreMid Sweden UniversityÖstersundSweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Division of MedicineUmeå UniversityUmeåSweden
| | - Mats Ainegren
- Department of Engineering, Mathematics, and Science Education, SportsTech Research CentreMid Sweden UniversityÖstersundSweden
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4
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Mäki-Heikkilä R, Koskela H, Karjalainen J, Parkkari J, Huhtala H, Valtonen M, Lehtimäki L. Cross-country skiers often experience respiratory symptoms during and after exercise but have a low prevalence of prolonged cough. BMJ Open Sport Exerc Med 2023; 9:e001502. [PMID: 37342789 PMCID: PMC10277524 DOI: 10.1136/bmjsem-2022-001502] [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: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
Background Cross-country skiers train and compete during the winter for long periods of time in subfreezing conditions, which strains the airways and provokes respiratory symptoms. This study aimed to compare the prevalence of exercise-related symptoms and prolonged cough in competitive cross-country skiers versus the general population and to investigate the association between these symptoms and asthma. Methods A questionnaire was sent to Finnish cross-country skiers (n=1282) and a random sample of the general population (n=1754), with response rates of 26.9% and 19.0%, respectively. Results Both groups were mostly asymptomatic at rest, but symptoms were increased in both groups during and after exercise. Cough was more prevalent after exercise in skiers and phlegm production was more common during and after exercise in skiers. Asthma did not provoke specific symptoms, but symptom prevalence was higher in asthmatic individuals. Skiers had a higher prevalence of cough after exercise (60.6% vs 22.8%, p<0.001) compared with controls, but controls had a higher prevalence of prolonged cough (4.1% vs 9.6%, p=0.004). In participants without asthma, cold air triggered symptoms more often in skiers than controls, while strong odours triggered symptoms more often in asthmatic controls than skiers. Chronic cough lasting more than 8 weeks was rare, reported by 4.8% of controls and 2.0% of skiers. Conclusion Cross-country skiers, especially those with asthma, experience a higher burden of exercise-related respiratory symptoms compared with controls. However, repeated exposure to cold air does not appear to result in long-term hypersensitivity of the cough reflex arc.
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Affiliation(s)
| | - Heikki Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Pohjois-Savo, Finland
- Institute of Clinical Sciences, Faculty of Health Sciences, University of Eastern Finland School of Medicine, Kuopio, Pohjois-Savo, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Pirkanmaa, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Pirkanmaa, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Pirkanmaa, Finland
| | - Maarit Valtonen
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Pirkanmaa, Finland
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5
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Edwards DA, Chung KF. Mouth breathing, dry air, and low water permeation promote inflammation, and activate neural pathways, by osmotic stresses acting on airway lining mucus. QRB DISCOVERY 2023; 4:e3. [PMID: 37529032 PMCID: PMC10392678 DOI: 10.1017/qrd.2023.1] [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] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Respiratory disease and breathing abnormalities worsen with dehydration of the upper airways. We find that humidification of inhaled air occurs by evaporation of water over mucus lining the upper airways in such a way as to deliver an osmotic force on mucus, displacing it towards the epithelium. This displacement thins the periciliary layer of water beneath mucus while thickening topical water that is partially condensed from humid air on exhalation. With the rapid mouth breathing of dry air, this condensation layer, not previously reported while common to transpiring hydrogels in nature, can deliver an osmotic compressive force of up to around 100 cm H2O on underlying cilia, promoting adenosine triphosphate secretion and activating neural pathways. We derive expressions for the evolution of the thickness of the condensation layer, and its impact on cough frequency, inflammatory marker secretion, cilia beat frequency and respiratory droplet generation. We compare our predictions with human clinical data from multiple published sources and highlight the damaging impact of mouth breathing, dry, dirty air and high minute volume on upper airway function. We predict the hypertonic (or hypotonic) saline mass required to reduce (or amplify) dysfunction by restoration (or deterioration) of the structure of ciliated and condensation water layers in the upper airways and compare these predictions with published human clinical data. Preserving water balance in the upper airways appears critical in light of contemporary respiratory health challenges posed by the breathing of dirty and dry air.
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Affiliation(s)
- David A. Edwards
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kian Fan Chung
- Experimental Studies Unit, National Heart and Lung Institute, Imperial College London, London, UK
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6
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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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7
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Basin S, Valentin S, Demoulin-Alexikova S, Demoulin B, Foucaud L, Gérard D, Pouget C, Allado E, Chenuel B, Poussel M. Impact of Inhaled Corticosteroids on the Modulation of Respiratory Defensive Reflexes During Artificial Limb Exercise in Ovalbumin-Sensitized Rabbits. Front Physiol 2022; 12:804577. [PMID: 35145425 PMCID: PMC8821955 DOI: 10.3389/fphys.2021.804577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Cough is a major lower airway defense mechanism that can be triggered by exercise in asthma patients. Studies on cough reflex in experimental animal models revealed a decrease of cough reflex sensitivity during exercise in healthy animals, but a lack of desensitization in ovalbumin-sensitized rabbits. The aim of our study is to evaluate the impact of inhaled corticosteroids on cough reflex during artificial limb exercise in an animal model of eosinophilic airway inflammation. Materials and Methods Sixteen adult ovalbumin-sensitized rabbits were randomly divided into two groups. The “OVA-Corticoid” group (n = 8) received inhaled corticosteroids (budesonide; 1 mg/day during 2 consecutive days) while the “OVA-Control” (n = 8) group was exposed to saline nebulization. The sensitivity of defensive reflexes induced by direct mechanical stimulation of the trachea was studied in anesthetized animals, at rest and during artificial limb exercise. Cell count was performed on bronchoalveolar lavage fluid and middle lobe tissue sections to assess the level of eosinophilic inflammation. Results All rabbits were significantly sensitized but there was no difference in eosinophilic inflammation on bronchoalveolar lavage or tissue sections between the two groups. Artificial limb exercise resulted in a significant (p = 0.002) increase in minute ventilation by 30% (+ 209 mL.min–1, ± 102 mL/min–1), with no difference between the two groups. 322 mechanical tracheal stimulations were performed, 131 during exercise (40.7%) and 191 at rest (59.3%). Cough reflex was the main response encountered (46.9%), with a significant increase in cough reflex threshold during artificial limb exercise in the “OVA-Corticoid” group (p = 0.039). Cough reflex threshold remained unchanged in the “OVA-Control” group (p = 0.109). Conclusion Inhaled corticosteroids are able to restore desensitization of the cough reflex during artificial limb exercise in an animal model of airway eosinophilic inflammation. Airway inflammation thus appears to be involved in the physiopathology of exercise-induced cough in this ovalbumin sensitized rabbit model. Inhaled anti-inflammatory treatments could have potential benefit for the management of exercise-induced cough in asthma patients.
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Affiliation(s)
- Sarah Basin
- Department of Pneumology, CHRU Nancy, Nancy, France
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- *Correspondence: Sarah Basin,
| | - Simon Valentin
- Department of Pneumology, CHRU Nancy, Nancy, France
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Department of Pediatric Respiratory Function Testing, CHRU Nancy, Nancy, France
| | - Bruno Demoulin
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Laurent Foucaud
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | | | - Celso Pouget
- Department of Pathology CHRU Nancy, Nancy, France
| | - Edem Allado
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
| | - Bruno Chenuel
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
| | - Mathias Poussel
- EA 3450 DevAH—Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
- Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
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9
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Valentin S, Chenuel B, Demoulin-Alexikova S, Demoulin B, Gérard D, Foucaud L, Poussel M. Desensitization of the Cough Reflex Induced by Corticosteroids in Ovalbumin-Sensitized Rabbits During Artificial Limb Exercise. Front Physiol 2020; 11:466. [PMID: 32528305 PMCID: PMC7247830 DOI: 10.3389/fphys.2020.00466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Cough is a major symptom frequently experienced during exercise, mainly in asthmatic patients. Inhaled glucocorticoids represent the keystone treatment in the management of asthma, but little is known about interactions between cough and exercise, especially in controlled patients. During exercise, cough reflex (CR) appears downregulated in healthy animal models whereas a lack of desensitization of CR has been shown in ovalbumin-sensitized animal models, mimicking asthmatic disease. Aims and Objectives The goal of our study was to clarify the potential modulation of the CR induced by inhaled corticosteroids (CS) in ovalbumin (OVA) sensitized rabbits during artificial limb exercise. Materials and Methods Seventeen OVA sensitized rabbits were studied. Among them, 9 were treated with CS delivered intravenously (OVA-Corticoids). The ventilatory response to direct tracheal stimulation, performed at rest and during exercise, was determined to assess the incidence and the sensitivity of the CR. Broncho-alveolar lavage (BAL) and cell counts were performed to determine the level of airway inflammation. Exercise was mimicked by electrically induced hindlimb muscular contractions (EMC). Results Compared to rest values, EMC increased minute ventilation by 28% without any decrease in respiratory resistance (Rsr). Among 322 tracheal stimulations, 172 (53%) were performed at rest and 150 (47%) during exercise. The sensitivity of CR decreased during artificial limb exercise compared to baseline in OVA-Corticoids rabbits (p = 0.0313) while it remained unchanged in OVA rabbits (p = NS). Conclusion Corticosteroids appear to restore the desensitization of the CR in OVA sensitized rabbits during artificial limb exercise, suggesting the potential role of airway inflammation in the pathophysiology of cough during exercise in asthmatics.
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Affiliation(s)
- Simon Valentin
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France.,Department of Pneumology, CHRU Nancy, Nancy, France
| | - Bruno Chenuel
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France.,Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
| | - Silvia Demoulin-Alexikova
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Bruno Demoulin
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | | | - Laurent Foucaud
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France
| | - Mathias Poussel
- EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, Université de Lorraine, Nancy, France.,Pulmonary Function Testing and Exercise Physiology, CHRU Nancy, Nancy, France
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10
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Thevis M, Kuuranne T, Geyer H. Annual banned‐substance review – Analytical approaches in human sports drug testing. Drug Test Anal 2020; 12:7-26. [DOI: 10.1002/dta.2735] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research ‐ Institute of Biochemistry German Sport University Cologne Cologne Germany
- European Monitoring Center for Emerging Doping Agents Cologne Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses, University Center of Legal Medicine, Genève and Lausanne Centre Hospitalier Universitaire Vaudois and University of Lausanne Epalinges Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research ‐ Institute of Biochemistry German Sport University Cologne Cologne Germany
- European Monitoring Center for Emerging Doping Agents Cologne Germany
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11
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Abstract
Asthma is a chronic lower respiratory disease that is very common worldwide, and its incidence is increasing year by year. Since the 1970s, asthma has become widespread, with approximately 300 million people affected worldwide and about 250,000 people have lost their lives. Asthma seriously affects people's physical and mental health, resulting in reduced learning efficiency, limited physical activities, and decreased quality of life. Therefore, raising awareness of the risk of asthma and how to effectively treat asthma have become important targets for the prevention and management of asthma in recent years. For patients with asthma, exercise training is a widely accepted adjunct to drug-based and non-pharmacological treatment. It has been recommended abroad that exercise prescriptions are an important part of asthma management.
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Affiliation(s)
- Shengguang Ding
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chongjun Zhong
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
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