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Klain A, Giovannini M, Pecoraro L, Barni S, Mori F, Liotti L, Mastrorilli C, Saretta F, Castagnoli R, Arasi S, Caminiti L, Gelsomino M, Indolfi C, Del Giudice MM, Novembre E. Exercise-induced bronchoconstriction, allergy and sports in children. Ital J Pediatr 2024; 50:47. [PMID: 38475842 DOI: 10.1186/s13052-024-01594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy.
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126, Verona, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Lucia Liotti
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, 60123, Ancona, Italy
| | - Carla Mastrorilli
- Pediatric and Emergency Department, Pediatric Hospital Giovanni XXIII, AOU Policlinic of Bari, 70126, Bari, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Riccardo Castagnoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98124, Messina, Italy
| | - Mariannita Gelsomino
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, University Foundation Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Elio Novembre
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
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Pourmanaf H, Nikoukheslat S, Sari-Sarraf V, Amirsasan R, Vakili J, Mills DE. The acute effects of endurance exercise on epithelial integrity of the airways in athletes and non-athletes: A systematic review and meta-analysis. Respir Med 2023; 220:107457. [PMID: 37951313 DOI: 10.1016/j.rmed.2023.107457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/22/2023] [Accepted: 11/03/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Acute endurance exercise may induce airway epithelium injury. However, the response of epithelial integrity markers of the airways including club cell secretory protein (CC16) and surfactant protein D (SP-D) to endurance exercise have not been systematically reviewed. Therefore, the aim of this systematic review and meta-analysis was to assess the acute effects of endurance exercise on markers of epithelial integrity of the airways (CC16, SP-D and the CC16/SP-D ratio) in athletes and non-athletes. METHODS A systematic search was performed utilizing PubMed/Medline, EMBASE, Web of Science, and hand searching bibliographies of retrieved articles through to September 2022. Based on the inclusion criteria, articles with available data about the acute effects of endurance exercise on serum or plasma concentrations of CC16, SP-D and CC16/SP-D ratio in athletes and non-athletes were included. Quality assessment of studies and statistical analysis were conducted via Review Manager 5.4 software. RESULTS The search resulted in 908 publications. Finally, thirteen articles were included in the review. Acute endurance exercise resulted in an increase in CC16 (P = 0.0006, n = 13) and CC16/SP-D ratio (P = 0.005, n = 2) whereas SP-D (P = 0.47, n = 3) did not change significantly. Subgroup analysis revealed that the type (P = 0.003), but not the duration of exercise (P = 0.77) or the environmental temperature (P = 0.06) affected the CC16 response to endurance exercise. CONCLUSIONS Acute endurance exercise increases CC16 and the CC16/SP-D ratio, as markers of epithelial integrity, but not SP-D in athletes and non-athletes.
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Affiliation(s)
- Hadi Pourmanaf
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Saeid Nikoukheslat
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Vahid Sari-Sarraf
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Ramin Amirsasan
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Javad Vakili
- Faculty of Physical Education and Sport Sciences, University of Tabriz, Tabriz, Iran
| | - Dean E Mills
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia; Respiratory and Exercise Physiology Research Group, School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Queensland, Australia; Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia.
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Rojas-Quintero J, Laucho-Contreras ME, Wang X, Fucci QA, Burkett PR, Kim SJ, Zhang D, Tesfaigzi Y, Li Y, Bhashyam AR, Li Z, Khamas H, Celli B, Pilon AL, Polverino F, Owen CA. CC16 augmentation reduces exaggerated COPD-like disease in Cc16-deficient mice. JCI Insight 2023; 8:130771. [PMID: 36787195 PMCID: PMC10070105 DOI: 10.1172/jci.insight.130771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Low Club Cell 16 kDa protein (CC16) plasma levels are linked to accelerated lung function decline in patients with chronic obstructive pulmonary disease (COPD). Cigarette smoke-exposed (CS-exposed) Cc16-/- mice have exaggerated COPD-like disease associated with increased NF-κB activation in their lungs. It is unclear whether CC16 augmentation can reverse exaggerated COPD in CS-exposed Cc16-/- mice and whether increased NF-κB activation contributes to the exaggerated COPD in CS-exposed Cc16-/- lungs. CS-exposed WT and Cc16-/- mice were treated with recombinant human CC16 (rhCC16) or an NF-κB inhibitor versus vehicle beginning at the midpoint of the exposures. COPD-like disease and NF-κB activation were measured in the lungs. RhCC16 limited the progression of emphysema, small airway fibrosis, and chronic bronchitis-like disease in WT and Cc16-/- mice partly by reducing pulmonary inflammation (reducing myeloid leukocytes and/or increasing regulatory T and/or B cells) and alveolar septal cell apoptosis, reducing NF-κB activation in CS-exposed Cc16-/- lungs, and rescuing the reduced Foxj1 expression in CS-exposed Cc16-/- lungs. IMD0354 treatment reduced exaggerated lung inflammation and rescued the reduced Foxj1 expression in CS-exposed Cc16-/- mice. RhCC16 treatment reduced NF-κB activation in luciferase reporter A549 cells. Thus, rhCC16 treatment limits COPD progression in CS-exposed Cc16-/- mice partly by inhibiting NF-κB activation and represents a potentially novel therapeutic approach for COPD.
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Affiliation(s)
- Joselyn Rojas-Quintero
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Eugenia Laucho-Contreras
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Xiaoyun Wang
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Clinical and Experimental Therapeutics program, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Quynh-Anh Fucci
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R Burkett
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Se-Jin Kim
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics program, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, Georgia, USA
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yohannes Tesfaigzi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yuhong Li
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Abhiram R Bhashyam
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zhang Li
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Haider Khamas
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bartolome Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Francesca Polverino
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Caroline A Owen
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Huljev Šipoš I, Šipoš K, Steiner J, Grubić Rotkvić P, Ljubičić Đ, Šola AM, Lozo Vukovac E, Kereš T, Plavec D. Validation of the fractional exhaled breath temperature measurement: reference values. J Breath Res 2023; 17. [PMID: 36762826 DOI: 10.1088/1752-7163/acb598] [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: 08/11/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023]
Abstract
Exhaled breath temperature (EBT) is a known biomarker of inflammation and airways blood flow. As opposed to previous studies, we were able to measure temperature of separate fractions of exhaled breath (fEBT) (those from the peripheral and central airways). The aim was to validate the fEBT measurement method to determine the reference values and the influence of endogenous and exogenous factors on fEBT in healthy subjects. This cross-sectional study included 55 healthy adults in whom fEBT was repeatedly measured, two days in a row, using a FractAir®device. Also, basal metabolic rate, level of physical activity, distance from the main road, outdoor and ambient temperature, air pressure and humidity, haematology and inflammation markers, lung function, cumulative EBT and body temperature at characteristic points on the body were measured. The results showed that fEBT from central airways was lower compared to fEBT from the periphery and that fEBTs were not related to body temperature (p> 0.05 for all). We also showed repeatability of fEBT measurements for two consecutive days. All EBT fractions correlated significantly with ambient temperature (<0.01). No associations of fEBT with other personal and external factors were found using multivariate analysis. At room temperature of 22 °C, the physiological temperature values of the first fraction were 23.481 ± 3.150 °C, the second fraction 26.114 ± 4.024 °C and the third fraction 28.216 ± 3.321 °C. The proposed reference values represent the first part of validation of fEBT as the method for the use in clinical practice.
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Affiliation(s)
| | - Kristijan Šipoš
- Department of Cardiology, Clinic for Cardiovascular Diseases Magdalena, Krapinske toplice, Croatia
| | | | | | - Đivo Ljubičić
- Department of Pulmonology, University Hospital Dubrava, Zagreb, Croatia
| | - Ana Marija Šola
- Department of Pulmonology, Special Hospital for Pulmonary Diseases, Zagreb, Croatia
| | | | - Tatjana Kereš
- Department of Intensive Care, University Hospital Dubrava, Zagreb, Croatia
| | - Davor Plavec
- Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
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Pax7 + Satellite Cells in Human Skeletal Muscle After Exercise: A Systematic Review and Meta-analysis. Sports Med 2023; 53:457-480. [PMID: 36266373 DOI: 10.1007/s40279-022-01767-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Skeletal muscle has extraordinary regenerative capabilities against challenge, mainly owing to its resident muscle stem cells, commonly identified by Pax7+, which expediently donate nuclei to the regenerating multinucleated myofibers. This local reserve of stem cells in damaged muscle tissues is replenished by undifferentiated bone marrow stem cells (CD34+) permeating into the surrounding vascular system. OBJECTIVE The purpose of the study was to provide a quantitative estimate for the changes in Pax7+ muscle stem cells (satellite cells) in humans following an acute bout of exercise until 96 h, in temporal relation to circulating CD34+ bone marrow stem cells. A subgroup analysis of age was also performed. METHODS Four databases (Web of Science, PubMed, Scopus, and BASE) were used for the literature search until February 2022. Pax7+ cells in human skeletal muscle were the primary outcome. Circulating CD34+ cells were the secondary outcome. The standardized mean difference (SMD) was calculated using a random-effects meta-analysis. Subgroup analyses were conducted to examine the influence of age, training status, type of exercise, and follow-up time after exercise. RESULTS The final search identified 20 studies for Pax7+ cells comprising a total of 370 participants between the average age of 21 and 74 years and 26 studies for circulating CD34+ bone marrow stem cells comprising 494 participants between the average age of 21 and 67 years. Only one study assessed Pax7+ cells immediately after aerobic exercise and showed a 32% reduction in exercising muscle followed by a fast repletion to pre-exercise level within 3 h. A large effect on increasing Pax7+ cell content in skeletal muscles was observed 24 h after resistance exercise (SMD = 0.89, p < 0.001). Pax7+ cells increased to ~ 50% above pre-exercise level 24-72 h after resistance exercise. For a subgroup analysis of age, a large effect (SMD = 0.81, p < 0.001) was observed on increasing Pax7+ cells in exercised muscle among adults aged > 50 years, whereas adults at younger age presented a medium effect (SMD = 0.64, p < 0.001). Both resistance exercise and aerobic exercise showed a medium overall effect in increasing circulating CD34+ cells (SMD = 0.53, p < 0.001), which declined quickly to the pre-exercise baseline level after exercise within 6 h. CONCLUSIONS An immediate depletion of Pax7+ cells in exercising skeletal muscle concurrent with a transient release of CD34+ cells suggest a replenishment of the local stem cell reserve from bone marrow. A protracted Pax7+ cell expansion in the muscle can be observed during 24-72 h after resistance exercise. This result provides a scientific basis for exercise recommendations on weekly cycles allowing for adequate recovery time. Exercise-induced Pax7+ cell expansion in muscle remains significant at higher age, despite a lower stem cell reserve after age 50 years. More studies are required to confirm whether Pax7+ cell increment can occur after aerobic exercise. CLINICAL TRIAL REGISTRATION Registered at the International Prospective Register of Systematic Reviews (PROSPERO) [identification code CRD42021265457].
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Nauwelaerts SJD, Van Goethem N, De Cremer K, Sierra NB, Vercauteren J, Stroobants C, Bernard A, Nawrot T, Roosens NHC, De Keersmaecker SCJ. Noninvasive integrative approach applied to children in the context of recent air pollution exposure demonstrates association between fractional exhaled nitric oxide (FeNO) and urinary CC16. ENVIRONMENTAL RESEARCH 2023; 216:114441. [PMID: 36191620 DOI: 10.1016/j.envres.2022.114441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Exposure to the air pollutant particulate matter (PM) is associated with increased risks of respiratory diseases and enhancement of airway inflammation in children. In the context of large scale air pollution studies, it can be challenging to measure fractional exhaled nitric oxide (FeNO) as indicator of lung inflammation. Urinary CC16 (U-CC16) is a potential biomarker of increased lung permeability and toxicity, increasing following short-term PM2.5 exposure. The single nucleotide polymorphism (SNP) CC16 G38A (rs3741240) affects CC16 levels and respiratory health. Our study aimed at assessing the use of U-CC16 (incl. CC16 G38A from saliva) as potential alternative for FeNO by investigating their mutual correlation in children exposed to PM. Samples from a small-scale study conducted in 42 children from urban (n = 19) and rural (n = 23) schools examined at two time points, were analysed. When considering recent (lag1) low level exposure to PM2.5 as air pollution measurement, we found that U-CC16 was positively associated with FeNO (β = 0.23; 95% CI [-0.01; 0.47]; p = 0.06) in an adjusted analysis using a linear mixed effects model. Further, we observed a positive association between PM2.5 and FeNO (β = 0.56; 95% CI [0.02; 1.09]; p = 0.04) and higher FeNO in urban school children as compared to rural school children (β = 0.72; 95% CI [0.12; 1.31]; p = 0.02). Although more investigations are needed, our results suggest that inflammatory responses evidenced by increased FeNO are accompanied by potential increased lung epithelium permeability and injury, evidenced by increased U-CC16. In future large scale studies, where FeNO measurement is less feasible, the integrated analysis of U-CC16 and CC16 G38A, using noninvasive samples, might be a suitable alternative to assess the impact of air pollution exposure on the respiratory health of children, which is critical for policy development at population level.
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Affiliation(s)
- Sarah J D Nauwelaerts
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium; Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Brussels, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Koen De Cremer
- Platform Chromatography and Mass Spectrometry, Sciensano, Brussels, Belgium
| | | | | | - Christophe Stroobants
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Alfred Bernard
- Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Brussels, Belgium
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nancy H C Roosens
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium
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Cold air exposure at - 15 °C induces more airway symptoms and epithelial stress during heavy exercise than rest without aggravated airway constriction. Eur J Appl Physiol 2022; 122:2533-2544. [PMID: 36053365 PMCID: PMC9613713 DOI: 10.1007/s00421-022-05004-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/26/2022] [Indexed: 11/19/2022]
Abstract
Purpose Exposure to cold air may harm the airways. It is unclear to what extent heavy exercise adds to the cold-induced effects on peripheral airways, airway epithelium, and systemic immunity among healthy individuals. We investigated acute effects of heavy exercise in sub-zero temperatures on the healthy airways. Methods Twenty-nine healthy individuals underwent whole body exposures to cold air in an environmental chamber at − 15 °C for 50 min on two occasions; a 35-min exercise protocol consisting of a 5-min warm-up followed by 2 × 15 min of running at 85% of VO2max vs. 50 min at rest. Lung function was measured by impulse oscillometry (IOS) and spirometry before and immediately after exposures. CC16 in plasma and urine, and cytokines in plasma were measured before and 60 min after exposures. Symptoms were surveyed pre-, during and post-trials. Results FEV1 decreased after rest (− 0.10 ± 0.03 L, p < 0.001) and after exercise (− 0.06 ± 0.02 L, p = 0.012), with no difference between trials. Exercise in − 15 °C induced greater increases in lung reactance (X5; p = 0.023), plasma CC16 (p < 0.001) as well as plasma IL-8 (p < 0.001), compared to rest. Exercise induced more intense symptoms from the lower airways, whereas rest gave rise to more general symptoms. Conclusion Heavy exercise during cold air exposure at − 15 °C induced signs of an airway constriction to a similar extent as rest in the same environment. However, biochemical signs of airway epithelial stress, cytokine responses, and symptoms from the lower airways were more pronounced after the exercise trial. Supplementary Information The online version contains supplementary material available at 10.1007/s00421-022-05004-3.
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Nauwelaerts SJD, Van Goethem N, Ureña BT, De Cremer K, Bernard A, Saenen ND, Nawrot TS, Roosens NHC, De Keersmaecker SCJ. Urinary CC16, a potential indicator of lung integrity and inflammation, increases in children after short-term exposure to PM 2.5/PM 10 and is driven by the CC16 38GG genotype. ENVIRONMENTAL RESEARCH 2022; 212:113272. [PMID: 35439460 DOI: 10.1016/j.envres.2022.113272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
Particular matter (PM) exposure is a big hazard for public health, especially for children. Serum CC16 is a well-known biomarker of respiratory health. Urinary CC16 (U-CC16) can be a noninvasive alternative, albeit requiring adequate adjustment for renal handling. Moreover, the SNP CC16 G38A influences CC16 levels. This study aimed to monitor the effect of short-term PM exposure on CC16 levels, measured noninvasively in schoolchildren, using an integrative approach. We used a selection of urine and buccal DNA samples from 86 children stored in an existing biobank. Using a multiple reaction monitoring method, we measured U-CC16, as well as RBP4 (retinol binding protein 4) and β2M (beta-2-microglobulin), required for adjustment. Buccal DNA samples were used for CC16 G38A genotyping. Linear mixed-effects models were used to find relevant associations between U-CC16 and previously obtained data from recent daily PM ≤ 2.5 or 10 μm exposure (PM2.5, PM10) modeled at the child's residence. Our study showed that exposure to low PM at the child's residence (median levels 18.9 μg/m³ (PM2.5) and 23.6 μg/m³ (PM10)) one day before sampling had an effect on the covariates-adjusted U-CC16 levels. This effect was dependent on the CC16 G38A genotype, due to its strong interaction with the association between PM levels and covariates-adjusted U-CC16 (P = 0.024 (PM2.5); P = 0.061 (PM10)). Only children carrying the 38GG genotype showed an increase of covariates-adjusted U-CC16, measured 24h after exposure, with increasing PM2.5 and PM10 (β = 0.332; 95% CI: 0.110 to 0.554 and β = 0.372; 95% CI: 0.101 to 0.643, respectively). To the best of our knowledge, this is the first study using an integrative approach to investigate short-term PM exposure of children, using urine to detect early signs of pulmonary damage, and taking into account important determinants such as the genetic background and adequate adjustment of the measured biomarker in urine.
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Affiliation(s)
- Sarah J D Nauwelaerts
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium; Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Woluwe, Brussels, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Epidemiology and Biostatistics, Institut de Recherche Expérimentale et Clinique, Faculty of Public Health, Université catholique de Louvain, Belgium
| | - Berta Tenas Ureña
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium
| | - Koen De Cremer
- Platform Chromatography and Mass Spectrometry, Sciensano, Brussels, Belgium
| | - Alfred Bernard
- Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Woluwe, Brussels, Belgium
| | - Nelly D Saenen
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nancy H C Roosens
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium
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Gavrielatos A, Ratkevica I, Stenfors N, Hanstock HG. Influence of exercise duration on respiratory function and systemic immunity among healthy, endurance-trained participants exercising in sub-zero conditions. Respir Res 2022; 23:121. [PMID: 35550109 PMCID: PMC9103459 DOI: 10.1186/s12931-022-02029-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background Strenuous endurance exercise in sub-zero temperatures can cause airway damage that may lead to EIB. Prolonged exercise can also elicit greater immune perturbations than short-duration exercise. However, the influence of exercise duration on lung function and systemic immunity in sub-zero temperatures has not been established. Additionally, it is currently unknown whether atopic disposition, which is risk factor for EIB, influences respiratory responses in a sub-zero climate. The aim of this study was to compare respiratory and systemic immune responses to two cold air running trials of short and long duration, as well as to examine whether the responses differed between atopic and non-atopic subjects. Methods Eighteen healthy, endurance-trained subjects (males/females: 14/4; age: 29.4 ± 5.9 years old; BMI: 23.1 ± 1.7; atopic/non-atopic: 10/8) completed two moderate-intensity climate chamber running trials at − 15 °C, lasting 30 and 90 min, in a randomized, cross-over design. Lung function (spirometry and impulse oscillometry), serum CC16, respiratory symptoms, and blood leukocyte counts were examined before and after the trials. Results Lung function was not significantly affected by exercise or exercise duration. CC16 concentration increased after both trials (p = 0.027), but the response did not differ between trials. Respiratory symptom intensity was similar after each trial. There was a greater increase in neutrophils (p < 0.001), and a decrease in eosinophils (p < 0.001) after the 90-min bout. The 90-min protocol increased X5 compared to the 30-min protocol only in atopic subjects (p = 0.015) while atopy increased lower airway symptoms immediately after the 90-min session (p = 0.004). Conclusions Our results suggest that a 90-min bout of moderate-intensity exercise at − 15 °C does not cause substantial lung function decrements, airway epithelial damage or respiratory symptoms compared to 30 min running in the same environment, despite a heightened redistribution of white blood cells. However, exercise at − 15 °C may cause airway injury and evoke respiratory symptoms, even at moderate intensity. Atopic status may lead to greater peripheral bronchodilation and higher frequency of respiratory symptoms after long-duration exercise in cold. Trial registration: 01/02/2022 ISRCTN13977758. This trial was retrospectively registered upon submission to satisfy journal guidelines. The authors had not initially registered the study, as the intervention was considered to be a controlled simulation of exercise in a naturally occurring environment (i.e. sub-zero air) for healthy volunteers. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02029-2.
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Affiliation(s)
- Angelos Gavrielatos
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Iluta Ratkevica
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland
| | - Nikolai Stenfors
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helen G Hanstock
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
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10
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A breathing mask attenuates acute airway responses to exercise in sub-zero environment in healthy subjects. Eur J Appl Physiol 2022; 122:1473-1484. [PMID: 35391634 PMCID: PMC9132816 DOI: 10.1007/s00421-022-04939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Cold air exposure is associated with increased respiratory morbidity and mortality. Repeated inhalation of cold and dry air is considered the cause of the high prevalence of asthma among winter endurance athletes. This study assessed whether a heat- and moisture-exchanging breathing device (HME) attenuates airway responses to high-intensity exercise in sub-zero temperatures among healthy subjects. METHODS Using a randomized cross-over design, 23 healthy trained participants performed a 30-min warm-up followed by a 4-min maximal, self-paced running time trial in - 15 °C, with and without HME. Lung function was assessed pre- and immediately post-trials. Club cell protein (CC-16), 8-isoprostane, and cytokine concentrations were measured in plasma and urine pre- and 60 min post trials. Symptoms were assessed prior to, during, and immediately after each trial in the chamber. RESULTS HME use attenuated the decrease in forced expiratory volume in 1 s (FEV1) post trials (∆FEV1: mean (SD) HME - 0.5 (1.9) % vs. no-HME - 2.7 (2.7) %, p = 0.002). HME also substantially attenuated the median relative increase in plasma-CC16 concentrations (with HME + 27% (interquartile range 9-38) vs no-HME + 121% (55-162), p < 0.001) and reduced airway and general symptom intensity, compared to the trial without HME. No significant changes between trials were detected in urine CC16, 8-isoprostane, or cytokine concentrations. CONCLUSION The HME attenuated acute airway responses induced by moderate-to-maximal-intensity exercise in - 15 °C in healthy subjects. Further studies are needed to examine whether this HMEs could constitute primary prevention against asthma in winter endurance athletes.
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11
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Karamaoun C, Haut B, Blain GM, Bernard A, Daussin FN, Dekerle J, Bougault V, Mauroy B. Is airway damage during physical exercise related to airway dehydration? Inputs from a computational model. J Appl Physiol (1985) 2022; 132:1031-1040. [PMID: 35201932 DOI: 10.1152/japplphysiol.00520.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In healthy subjects, at low minute ventilation (V̇E) during physical exercise, the water content and the temperature of the airways are well regulated. However, with the increase in V̇E, the bronchial mucosa becomes dehydrated and epithelial damage occurs. Our goal was to demonstrate the correspondence between the ventilatory threshold inducing epithelial damage, measured experimentally, and the dehydration threshold, estimated numerically. In 16 healthy adults, we assessed epithelial damage before and following a 30-min continuous cycling exercise at 70% of maximal work rate, by measuring the variation pre- to post-exercise of serum club cell protein (cc16/cr). Blood samples were collected at rest, just at the end of the standardized 10-min warm-up, and immediately, 30 min and 60 min post-exercise. V̇E was measured continuously during exercise. Airway water and heat losses were estimated using a computational model adapted to the experimental conditions and were compared to a literature-based threshold of dehydration. Eleven participants exceeded the threshold for bronchial dehydration during exercise (group A) and 5 did not (group B). Compared to post warm-up, the increase in cc16/cr post-exercise was significant (mean increase ± SEM: 0.48 ± 0.08 ng.l-1, i.e. 101 ± 32%, p < 0.001) only in group A but not in group B (mean difference ± SEM: 0.10 ± 0.04 ng.l-1, i.e. 13 ± 7 %, p = 0.79). Our findings suggest that the use of a computational model may be helpful to estimate an individual dehydration threshold of the airways that is associated with epithelial damage during physical exercise.
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Affiliation(s)
- Cyril Karamaoun
- Laboratoire J. A. Dieudonné, UMR CNRS 7351, Université Côte d'Azur, Nice, France.,Centre VADER, Université Côte d'Azur, Nice, France.,Institut de Physique de Nice (INPHYNI), UMR CNRS 7010, University Côte d'Azur, Nice, France
| | - Benoît Haut
- Transfers, Interfaces & Processes (TIPs), Université libre de Bruxelles, Brussels, Belgium
| | - Grégory M Blain
- Centre VADER, Université Côte d'Azur, Nice, France.,Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS), Université Côte d'Azur, Nice, France
| | - Alfred Bernard
- Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Université catholique de Louvain, Brussels, Belgium
| | - Frédéric Nicolas Daussin
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS-Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Jeanne Dekerle
- Fatigue and Exercise Tolerance Laboratory (FET), Centre for Sport Exercise Science and Medicine, University of Brighton, United Kingdom
| | - Valerie Bougault
- Centre VADER, Université Côte d'Azur, Nice, France.,Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS), Université Côte d'Azur, Nice, France
| | - Benjamin Mauroy
- Laboratoire J. A. Dieudonné, UMR CNRS 7351, Université Côte d'Azur, Nice, France.,Centre VADER, Université Côte d'Azur, Nice, France
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12
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Elkhatib SK, Alley J, Jepsen M, Smeins L, Barnes A, Naik S, Ackermann MR, Verhoeven D, Kohut ML. Exercise duration modulates upper and lower respiratory fluid cellularity, antiviral activity, and lung gene expression. Physiol Rep 2021; 9:e15075. [PMID: 34676696 PMCID: PMC8531599 DOI: 10.14814/phy2.15075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/18/2021] [Indexed: 12/02/2022] Open
Abstract
Exercise has substantial health benefits, but the effects of exercise on immune status and susceptibility to respiratory infections are less clear. Furthermore, there is limited research examining the effects of prolonged exercise on local respiratory immunity and antiviral activity. To assess the upper respiratory tract in response to exercise, we collected nasal lavage fluid (NALF) from human subjects (1) at rest, (2) after 45 min of moderate-intensity exercise, and (3) after 180 min of moderate-intensity exercise. To assess immune responses of the lower respiratory tract, we utilized a murine model to examine the effect of exercise duration on bronchoalveolar lavage (BAL) fluid immune cell content and lung gene expression. NALF cell counts did not change after 45 min of exercise, whereas 180 min significantly increased total cells and leukocytes in NALF. Importantly, fold change in NALF leukocytes correlated with the post-exercise fatigue rating in the 180-min exercise condition. The acellular portion of NALF contained strong antiviral activity against Influenza A in both resting and exercise paradigms. In mice undergoing moderate-intensity exercise, BAL total cells and neutrophils decreased in response to 45 or 90 min of exercise. In lung lobes, increased expression of heat shock proteins suggested that cellular stress occurred in response to exercise. However, a broad upregulation of inflammatory genes was not observed, even at 180 min of exercise. This work demonstrates that exercise duration differentially alters the cellularity of respiratory tract fluids, antiviral activity, and gene expression. These changes in local mucosal immunity may influence resistance to respiratory viruses, including influenza or possibly other pathogens in which nasal mucosa plays a protective role, such as rhinovirus or SARS-CoV-2.
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Affiliation(s)
- Safwan K. Elkhatib
- Department of KinesiologyIowa State UniversityAmesIowaUSA
- Present address:
Cellular & Integrative PhysiologyCollege of MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jessica Alley
- Department of KinesiologyIowa State UniversityAmesIowaUSA
- Program of ImmunobiologyIowa State UniversityAmesIowaUSA
- Present address:
Lineberger Comprehensive Cancer Center, School of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Michael Jepsen
- Department of KinesiologyIowa State UniversityAmesIowaUSA
- Present address:
College of Osteopathic MedicineCampbell UniversityLillingtonNorth CarolinaUSA
| | - Laurel Smeins
- Department of KinesiologyIowa State UniversityAmesIowaUSA
| | - Andrew Barnes
- Department of KinesiologyIowa State UniversityAmesIowaUSA
- Present address:
Kirksville College of Osteopathic MedicineA.T. Still UniversityKirksvilleMissouriUSA
| | - Shibani Naik
- Program of ImmunobiologyIowa State UniversityAmesIowaUSA
- Present address:
Arisan Therapeutics11189 Sorrento Valley Rd, Suite 104, San DiegoCaliforniaUSA
| | - Mark R. Ackermann
- Department of Veterinary PathologyCollege of Veterinary MedicineIowa State UniversityAmesIowaUSA
- Present address:
Director, Anatomic Veterinary Pathology DiagnosticsZoetisClear LakeIowa50428USA
| | - David Verhoeven
- Department of Veterinary Microbiology and Preventive MedicineCollege of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Marian L. Kohut
- Department of KinesiologyIowa State UniversityAmesIowaUSA
- Program of ImmunobiologyIowa State UniversityAmesIowaUSA
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13
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Nikniaz L, Ghojazadeh M, Nateghian H, Nikniaz Z, Farhangi MA, Pourmanaf H. The interaction effect of aerobic exercise and vitamin D supplementation on inflammatory factors, anti-inflammatory proteins, and lung function in male smokers: a randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:102. [PMID: 34461991 PMCID: PMC8406718 DOI: 10.1186/s13102-021-00333-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/20/2021] [Indexed: 01/26/2023]
Abstract
Background This study aimed to investigate the interaction effect of aerobic exercise and vitamin D supplementation on inflammation (TNF-α, IL-6, CC16, SP-D, and CC16/SP-D ratio) and lung function (FEV1, FVC, and FEV1/FVC ratio) in male smokers.
Methods After applying inclusion criteria, a total of 40 healthy male smokers were recruited in this study. The participants were randomly divided into four groups as follows: Aerobic Exercise + vitamin D Supplementation (AE + VitD, n = 10), Aerobic Exercise (AE, n = 10), vitamin D Supplementation (VitD, n = 10), and Control (C, n = 10). The participants in the AE + VitD and AE groups performed aerobic exercise training (running) up to 50% of the maximum heart rate, three times a week for four weeks. Participants in AE + VitD and VitD groups received 6000 IU/w vitamin D3 for four weeks. The participants in control group did not receive any intervention. Serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, Clara cell protein (CC16), surfactant protein (SP)-D, CC16/SP-D ratio, and lung function (FEV1, FVC, and FEV1/FVC ratio) were measured before and after four weeks of intervention. Results Serum levels of TNF-α, IL-6, and CC16 decreased significantly in AE + VitD, VitD, and AE groups after four weeks (P < 0.05). Serum SP-D level decreased significantly only in the AE + VitD group (P = 0.011). In addition, FEV1 and FVC increased significantly (P < 0.05) in AE + VitD and AE groups after four weeks of intervention. However, the interventions did not have a significant effect on CC16/SP-D ratio and FEV1/FVC ratio (P > 0.05). Furthermore, serum levels of 1,25-dihydroxyvitamin D increased significantly in AE + VitD and VitD groups (P < 0.05) after four weeks of intervention. However, except for TNF-α, between-group comparisons showed no significant differences in levels of IL-6, CC16, SP-D, CC16/SP-D ratio, FEV1, FVC, FEV1/FVC, and 1,25-dihydroxyvitamin D (P > 0.05). Conclusions The results of present study were that aerobic exercise combined with vitamin D supplementation can reduce serum inflammatory factors and anti-inflammatory proteins and improve lung function after four weeks of intervention. Further trials with larger sample size and longer duration are suggested to confirm these results. Trial registration Retrospectively registered. IRCT20180513039637N4. Registration date: 2020/10/20. URL: https://www.irct.ir/search/result?query=IRCT20180513039637N4
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Affiliation(s)
- Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hooman Nateghian
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hadi Pourmanaf
- Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
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14
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Eklund L, Schagatay F, Tufvesson E, Sjöström R, Söderström L, Hanstock HG, Sandström T, Stenfors N. An experimental exposure study revealing composite airway effects of physical exercise in a subzero environment. Int J Circumpolar Health 2021; 80:1897213. [PMID: 33685367 PMCID: PMC7946023 DOI: 10.1080/22423982.2021.1897213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Exposure to a cold climate is associated with an increased morbidity and mortality, but the specific mechanisms are largely unknown. People with cardiopulmonary disease and winter endurance athletes are particularly vulnerable. This study aimed to map multiple domains of airway responses to exercise in subzero temperature in healthy individuals. Thirty-one healthy subjects underwent whole-body exposures for 50 minutes on two occasions in an environmental chamber with intermittent moderate-intensity exercise in +10 °C and -10 °C. Lung function, plasma/urine CC16 , and symptoms were investigated before and after exposures. Compared to baseline, exercise in -10 °C decreased FEV1 (p=0.002), FEV1/FVC (p<0.001), and increased R20Hz (p=0.016), with no differences between exposures. Reactance increased after +10 °C (p=0.005), which differed (p=0.042) from a blunted response after exercise in -10 °C. Plasma CC16 increased significantly within exposures, without differences between exposures. Exercise in -10 °C elicited more intense symptoms from the upper airways, compared to +10 °C. Symptoms from the lower airways were few and mild. Short-duration moderate-intensity exercise in -10 °C induces mild symptoms from the lower airways, no lung function decrements or enhanced leakage of biomarkers of airway epithelial injury, and no peripheral bronchodilatation, compared to exercise in +10 °C.
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Affiliation(s)
- Linda Eklund
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Filip Schagatay
- Department of Community Medicine and Rehabilitation, Unit of Research, Education and Development, Umeå University, Östersund, Sweden
| | | | - Rita Sjöström
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | - Helen G Hanstock
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Thomas Sandström
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nikolai Stenfors
- Division of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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15
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Pourmanaf H, Hamzehzadeh A, Nikniaz L. The effect of physical preparedness levels on serum levels of CC16, SP-D and lung function in endurance runners. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Tufvesson E, Stenberg H, Ankerst J, Bjermer L. Type 2 Inflammatory Biomarker Response After Exercise Challenge Testing. J Asthma Allergy 2020; 13:269-274. [PMID: 32904520 PMCID: PMC7455603 DOI: 10.2147/jaa.s258561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Exercise-induced bronchoconstriction is due to osmotic stimulus of the airway epithelium and leads to a cascade of biomarker release from several inflammatory cells. Several type 2 (T2) mediators have been linked to exercise-induced bronchoconstriction, but the T2 response per se has not been described during exercise. The aim of this study was therefore to investigate T2 biomarkers in plasma and urine from subjects with asthma and healthy controls before and after an exercise challenge. Methods Twenty-two subjects with mild asthma and 18 healthy controls performed an exercise challenge test on a treadmill, and fractional exhaled NO (FeNO) was measured at baseline. Blood and urine samples were collected repeatedly during 60 min after the test and Interleukin-13 (IL-13), thymus and activation-related chemokine (TARC), periostin and leukotrienes were measured. Results Asthmatics and controls showed similar levels of IL-13, TARC, periostin and Cys-LT in plasma at baseline, and there were no differences in baseline levels between subjects with a negative and positive exercise challenge. After exercise, there was an overall increase in interleukin-13 (IL-13) in plasma in all subjects (p<0.001), with a peak at 10 min after the exercise challenge in both the asthmatic and control group. An increase in TARC in plasma was also seen (p<0.001), but only in the control subjects. In contrast, Cys-LT in plasma showed an overall decrease in all subjects (p<0.001), while periostin in plasma did not change. In conjunction with plasma, the level of IL-13 was increased in urine 30 min after the exercise challenge (p=0.002) and decreased again at 60 min (p=0.004). Similarly, leukotriene E4 (LTE4) was increased in urine samples, with a peak at 60 min and most pronounced in asthmatic subjects (p<0.001) but was seen also in controls (p=0.008). Discussion In conclusion, circulating levels of IL-13 are increased after exercise to the same extent in asthmatics and healthy control subjects, which indicates a physiological rather than a pathophysiological response. Also, the levels of TARC and leukotrienes were affected after exercise.
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Affiliation(s)
- Ellen Tufvesson
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Henning Stenberg
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jaro Ankerst
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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17
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Li W, Xiao L, Zhou Y, Wang D, Ma J, Xie L, Yang M, Zhu C, Wang B, Chen W. Plasma CC16 mediates the associations between urinary metals and fractional exhaled nitric oxide: A cross-sectional study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 258:113713. [PMID: 31818622 DOI: 10.1016/j.envpol.2019.113713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/14/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
Exposure to environmental metals has been reported to be associated with airway inflammation. Fractional exhaled nitric oxide (FeNO) is an important inflammatory biomarker of the airway. However, the associations between metal exposures and FeNO change and the underlying mechanisms remain unclear. To investigate the associations between urinary metals and FeNO, and the potential role of Club cell secretory protein (CC16), a lung epithelial biomarker, in these associations. We conducted a cross-sectional study from the Wuhan-Zhuhai cohort and measured eight urinary metals, plasma CC16 and FeNO among 3067 subjects by using inductively coupled plasma-mass spectrometry, enzyme-linked immunosorbent assay kit and Nano Coulomb Nitric Oxide Analyzer, respectively. Mixed linear models were used to quantify dose-relationships between urinary metals and FeNO, as well as urinary metals and plasma CC16. The potential role of plasma CC16 in the associations between urinary metals and FeNO was estimated using mediationanalyses. After adjusting for covariates, one percent increase in urinary vanadium, nickel or antimony was associated with a respective 6.60% (95% CI: 3.52%, 9.68%), 2.18% (0.45%, 3.91%), 4.87% (1.47%, 8.27%) increase in FeNO level. The adverse associations were much stronger among participants with low concentration of plasma CC16 than those with high CC16 level. Moreover, plasma CC16 decreased monotonically with increasing quartiles of urinary vanadium, nickel or antimony. Mediation analyses found that CC16 mediated the associations between urinary metals and FeNO by 5.64%, 39.06% and 25.18% for vanadium, nickel and antimony respectively. CC16 plays an important role in airway inflammation. General population with lower plasma CC16 concentration is more likely to suffer from airway inflammation when exposed to high levels of vanadium, nickel or antimony.
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Affiliation(s)
- Wei Li
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Lili Xiao
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Yun Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Jixuan Ma
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Li Xie
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Meng Yang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Chunmei Zhu
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Bin Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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18
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Dimov P, Labor M, Plavec D. Fraction of air coming from conductive airways has the negative balance in heat dissipation after maximal effort exercise-a physiological basis for exercise-induced bronchoconstriction. J Breath Res 2019; 13:046011. [PMID: 31307029 DOI: 10.1088/1752-7163/ab3254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Exhaled breath temperature (EBT) has recently been used as a tool to assess the level of inflammation in airways. The newest technology can also assess EBT coming from different fractions of exhaled air (fEBT). We aimed to assess the changes in fEBT after a maximal cardio-pulmonary exercise test in healthy athletes. Forty-four healthy professional athletes (two females) were included. Their mean (±SD) age was 22.9 ± 4.8 years. An innovative device (FractAir®) was used for fEBT measurement, dividing the exhaled air into three fractions (V1, V2 and V3) coming from different parts of the lungs; the large airways (anatomic dead space), conductive airways (functional dead space) and the peripheral part. For V3 an EBT point measured at 1200 ml of exhaled volume was used to obtain the information about the distant parts of the lungs while eliminating the difference in the volume of total exhaled air before and after the exercise. The difference (temperature gain) between the starting and peak EBT for each fraction was also calculated. The peak fEBT values before and after exercise did not differ significantly (p > 0.05 for all three fractions). Temperature gain analysis for each fEBT showed a significant fall after exercise for V2 (1.71 °C ± 0.43 versus 1.38 °C ± 0.50, p < 0.001), but not for the other two fractions (p > 0.05 for both). The lower heat emission from this part of the airway (conductive airway) after exercise could mean that during hyperventilation heat emission is increased in this specific fraction. We can conclude that the changes of fEBT after physical exercise are not linear. They affect different fractions of the lungs in different ways, and the relationship between flow and volume on one side and the temperature of exhaled air on the other can vary significantly.
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Affiliation(s)
- Petar Dimov
- Pathophysiology Department, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Marina Labor
- Department of Pulmonology, University Hospital Centre Osijek, Osijek, Croatia,Medical Faculty Osijek, J.J. Strossmayer University, Osijek, Croatia
| | - Davor Plavec
- Medical Faculty Osijek, J.J. Strossmayer University, Osijek, Croatia,Research Department, Srebrnjak Children’s Hospital, Zagreb, Croatia,Author to whom any correspondence should be addressed
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19
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Karvonen T, Lehtimäki L. Flow-independent nitric oxide parameters in asthma: a systematic review and meta-analysis. J Breath Res 2019; 13:044001. [PMID: 31239409 DOI: 10.1088/1752-7163/ab2c99] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Fractional exhaled nitric oxide (FENO) has been proposed as a non-invasive marker of inflammation in the lungs. Measuring FENO at several flow rates enables the calculation of flow independent NO-parameters that describe the NO-exchange dynamics of the lungs more precisely. The purpose of this study was to compare the NO-parameters between asthmatics and healthy subjects in a systematic review and meta-analysis. METHODS A systematic search was performed in Ovid Medline, Web of Science, Scopus and Cochrane Library databases. All studies with asthmatic and healthy control groups with at least one NO-parameter calculated were included. RESULTS From 1137 identified studies, 33 were included in the meta-analysis. All NO-parameters (alveolar NO concentration (CANO), bronchial flux of NO (JawNO), bronchial mucosal NO concentration (CawNO) and bronchial wall NO diffusion capacity (DawNO)) were found increased in glucocorticoid-treated and glucocorticoid-naïve asthma. JawNO and CANO were most notably increased in both study groups. Elevation of DawNO and CawNO seemed less prominent in both asthma groups. DISCUSSION We found that all the NO-parameters are elevated in asthma as compared to healthy subjects. However, results were highly heterogenous and the evidence on CawNO and DawNO is still quite feeble due to only few studies reporting them. To gain more knowledge on the NO-parameters in asthma, nonlinear methods and standardized study protocols should be used in future studies.
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Affiliation(s)
- Tuomas Karvonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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20
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Combes A, Dekerle J, Dumont X, Twomey R, Bernard A, Daussin F, Bougault V. Continuous exercise induces airway epithelium damage while a matched-intensity and volume intermittent exercise does not. Respir Res 2019; 20:12. [PMID: 30654798 PMCID: PMC6337858 DOI: 10.1186/s12931-019-0978-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While continuous exercise (CE) induces greater ventilation ([Formula: see text]E) when compared to intermittent exercise (IE), little is known of the consequences on airway damage. Our aim was to investigate markers of epithelial cell damage - i.e. serum levels of CC16 and of the CC16/SP-D ratio - during and following a bout of CE and IE of matched work. METHODS Sixteen healthy young adults performed a 30-min continuous (CE) and a 60-min intermittent exercise (IE; 1-min work: 1-min rest) on separate occasions in a random order. Intensity was set at 70% of their maximum work rate (WRmax). Heart rate (HR) and [Formula: see text]E were measured throughout both tests. Blood samples were taken at rest, after the 10th min of the warm-up, at the end of both exercises, half way through IE (matched time but 50% work done for IE) as well as 30- and 60-min post-exercise. Lactate and CC16 and SP-D were determined. RESULTS Mean [Formula: see text]E was higher for CE compared to IE (85 ± 17 l.min- 1 vs 50 ± 8 l.min- 1, respectively; P < 0.001). Serum-based markers of epithelial cell damage remained unchanged during IE. Interaction of test × time was observed for SP-D (P = 0.02), CC16 (μg.l- 1) (P = 0.006) and CC16/SP-D ratio (P = 0.03). Maximum delta CC16/SP-D was significantly correlated with mean [Formula: see text]E sustained (r = 0.83, P < 0.001) during CE but not during IE. CONCLUSION The 30-min CE performed at 70% WRmax induced mild airway damage, while a time- or work-matched IE did not. The extent of the damage during CE was associated with the higher ventilation rate.
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Affiliation(s)
- Adrien Combes
- URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Lille, France
| | - Jeanne Dekerle
- Fatigue and Exercise Laboratory, Centre for Sport Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne, UK
| | - Xavier Dumont
- Louvain Center of Toxicology and Applied Pharmacology, Catholic University of Louvain, Brussels, Belgium
| | - Rosie Twomey
- Fatigue and Exercise Laboratory, Centre for Sport Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne, UK
| | - Alfred Bernard
- Louvain Center of Toxicology and Applied Pharmacology, Catholic University of Louvain, Brussels, Belgium
| | - Frédéric Daussin
- URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Lille, France
| | - Valérie Bougault
- URePSSS, Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Lille, France. .,LAMHESS, Université Côte d'Azur, Nice, France. .,Eurasport, 413 Avenue Eugène Avinée, 59120, Loos, France.
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Leite MR, Zanetta DMT, Antonangelo L, Marçal LJ, Ramos D, Almeida Burdmann E, Paula Santos U. Burnt sugarcane harvesting work: effects on pulmonary and systemic inflammatory markers. Inhal Toxicol 2018; 30:205-212. [PMID: 30328727 DOI: 10.1080/08958378.2018.1494765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: To evaluate the effects of burnt sugarcane harvesting on the plasmatic and urinary concentrations of the club cell secretory protein (CC16) and inflammatory systemic biomarkers in a group of sugarcane cutters. Methods: Seventy-eight sugar cane workers were evaluated. The plasmatic and urinary concentrations of CC16, a pulmonary damage marker and inflammatory systemic biomarkers were collected at three time points: before, three months after and six months after the onset of the burnt sugarcane harvesting period. All evaluations were performed at ∼7 am, before the daily work shift. In the three-month evaluation, a post-work shift assessment (acute effect) was also performed. Results: The age of the workers was 37.9 ± 11.0 years. The PM2.5 concentrations were 27.0 (23.0-33.0) and 101.0 (31.0-139.5) µg/m3 in the pre harvest and harvest periods, respectively (p < .001). Burnt sugarcane harvesting was associated with a reduction, throughout the work during burnt sugarcane harvesting (subchronic effect), in plasmatic and urinary CC16 concentrations. Acutely, there was a decrease in plasmatic concentrations. There were acute and subchronic increases in inflammatory markers (neutrophils, monocytes) and muscle damage markers (CK and LDH) and a decrease in red blood cells. Conclusions: Harvesting of burnt sugarcane was associated with acute and subchronic reductions in the plasmatic and urinary concentrations of CC16 protein and changes in systemic inflammatory markers.
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Affiliation(s)
- Marceli Rocha Leite
- a Divisao de Pneumologia , Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | | | - Leila Antonangelo
- c Laboratório de Investigação Médica 03 (LIM-03) - Departamento de Patologia, da Faculdade de Medicina FMUSP , Universidade de São Paulo , São Paulo , Brazil
| | - Lia Junqueira Marçal
- c Laboratório de Investigação Médica 03 (LIM-03) - Departamento de Patologia, da Faculdade de Medicina FMUSP , Universidade de São Paulo , São Paulo , Brazil
| | - Dionei Ramos
- d Department of Physiotherapy , Universidade Estadual Paulista "Júlio de Mesquita Filho" Campus de Presidente Prudente , São Paulo , Brazil
| | - Emmanuel Almeida Burdmann
- e Laboratório de Investigação Médica 12 (LIM-12), Divisão de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de São Paulo , São Paulo , Brazil
| | - Ubiratan Paula Santos
- f Divisão de Pneumologia , Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
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22
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Ferraro V, Carraro S, Bozzetto S, Zanconato S, Baraldi E. Exhaled biomarkers in childhood asthma: old and new approaches. Asthma Res Pract 2018; 4:9. [PMID: 30094051 PMCID: PMC6081883 DOI: 10.1186/s40733-018-0045-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Asthma is a chronic condition usually characterized by underlying inflammation. The study of asthmatic inflammation is of the utmost importance for both diagnostic and monitoring purposes. The gold standard for investigating airway inflammation is bronchoscopy, with bronchoalveolar lavage and bronchial biopsy, but the invasiveness of such procedures limits their use in children. For this reason, in the last decades there has been a growing interest for the development of noninvasive methods. Main body In the present review, we describe the most important non-invasive methods for the study of airway inflammation in children, focusing on the measure of the fractional exhaled nitric oxide (feNO), on the measure of the exhaled breath temperature (EBT) and on the analysis of both exhaled breath condensate (EBC) and exhaled air (Volatile Organic Compounds, VOCs), using targeted and untargeted approaches. We summarize what is currently known on the topic of exhaled biomarkers in childhood asthma, with a special emphasis on emerging approaches, underlining the role of exhaled biomarkers in the diagnosis, management and treatment of asthma, and their potential for the development of personalized treatments. Conclusion Among non-invasive methods to study asthma, exhaled breath analysis remains one of the most interesting approaches, feNO and “-omic” sciences seem promising for the purpose of characterizing biomarkers of this disease.
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Affiliation(s)
- Valentina Ferraro
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Silvia Carraro
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Sara Bozzetto
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Stefania Zanconato
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padova, Padova, Italy
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Diurnal Variation in Physiological and Immune Responses to Endurance Sport in Highly Trained Runners in a Hot and Humid Environment. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:3402143. [PMID: 29861827 PMCID: PMC5971328 DOI: 10.1155/2018/3402143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Abstract
Purpose The purpose of this study was to investigate the physiological and immunological response of highly trained runners to an intense bout of exercise performed at two different times of day, in a hot, humid environment. Methods Using a crossover randomized design, 13 highly trained runners (range [Formula: see text] 64-79 ml·kg-1 min-1) performed a 10 km time trial run in hot (28°C) and humid conditions (70%), at 2 different times of day (09:00 hs and 18:00 hs). Venous blood samples were taken to determine WBCs (white blood cells), IL-6 (interleukin-6), CC16 (club cell protein 16), and HSP70 (heat shock protein-70) concentrations. Upper respiratory tract inflammation was additionally assessed using a nasal lavage procedure. Results A significant diurnal difference (p < 0.05) was found for core body temperature, total WBC, and neutrophil and lymphocyte concentrations with higher values at 18:00 hs. A phase response in IL-6, HSP70, WBC, neutrophil, lymphocyte, and CC16 was noted, being more pronounced at 18:00 hs, whilst core body temperature and HR phase responses were more pronounced at 09:00 hs. Conclusion In hot and humid conditions, athletes may wish to consider, when possible, racing and particularly training in the morning where the least homeostatic perturbation occurs.
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Bonini M, Usmani OS. Let research leave you breathless, not physical exercise! ERJ Open Res 2018; 4:00010-2018. [PMID: 29577039 PMCID: PMC5859680 DOI: 10.1183/23120541.00010-2018] [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: 01/22/2018] [Accepted: 01/27/2018] [Indexed: 11/26/2022] Open
Abstract
Regular physical activity is strongly recommended by healthcare systems worldwide and evidence-based guidelines and is one of the most effective approaches for preventing chronic inflammatory diseases and maintaining health status [1]. Indeed, extensive evidence exists on the beneficial effect of physical training and rehabilitation programmes in asthma [2]. Physical activity has been shown to improve quality of life, exercise capacity, pulmonary function and symptoms, as well as reduce airway inflammation and bronchial responsiveness in patients with asthma [3–5]. However, intense physical exercise may trigger airway narrowing by imposing a high demand on the respiratory system, requiring subjects to ventilate primarily through the mouth and by-pass the nasal filter, with a subsequent increased pulmonary exposure to inhalant allergens, pollutants, irritants and adverse (i.e. cold, dry) environmental conditions [6]. Such airway narrowing, which transiently occurs as a result of exercise, is defined as exercise-induced bronchoconstriction (EIB) [7]. Interestingly, in a 5-year prospective study, subjects who stopped training experienced an attenuation, or in some circumstances disappearance, of EIB, whereas bronchial responsiveness, exercise-induced respiratory symptoms and eosinophilic airway inflammation increased amongst those who continued strenuous physical exercise, regardless of the pharmacological treatment strategies [8]. Put into context, ongoing intense training appears to be a causative, and not just a concomitant, factor of airway inflammation and narrowing. Proper endotyping of EIB and precision medicine strategies would allow subjects to fully profit from the very beneficial effects of exercise, without incurring health risks or affecting performanceshttp://ow.ly/spjT30irzjX
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Affiliation(s)
- Matteo Bonini
- National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, London, UK
| | - Omar S Usmani
- National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, London, UK
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25
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Ntontsi P, Bakakos P, Papathanasiou E, Tsilogianni Z, Kostikas K, Hillas G, Papatheodorou G, Koulouris N, Papiris S, Loukides S. Exhaled breath temperature in optimally treated asthmatics: severity and underlying mechanisms. J Breath Res 2018; 12:026013. [PMID: 29176061 DOI: 10.1088/1752-7163/aa9d46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Increased vascularity may lead to loss of heat in the airways and may modulate exhaled breath temperature (EBT). Increased EBT has been associated with uncontrolled asthma. AIM We wanted to determine whether the measurement of EBT in optimally treated asthmatic patients is influenced by the increased vascular permeability and whether Vascular endothelial growth factor (VEGF) is implicated in the above process. Furthermore, to assess the impact of asthma severity on EBT values. The diagnostic performance of EBT for the identification of inflammatory profiles in induced sputum was also assessed. METHODS 88 stable asthmatic patients optimally treated for at least 6 months were studied (46 with Severe Refractory Asthma, SRA). EBT was measured with the X-halo device. All patients underwent spirometry, sputum induction for the measurement of % inflammatory cells and for the assessment of both VEGF and albumin in sputum supernatant. The airway vascular permeability index was calculated as the ratio of albumin concentrations in induced sputum and serum. RESULTS EBT (°C) was significantly higher in patients with SRA compared to those with mild to moderate asthma (median IQR 34.2 [32.4-34.6] versus 31.8 [26.3-34.1], p = 0.001). EBT was significantly associated with VEGF levels in sputum supernatant, while SRA was recognized as a significant co-variate. No other significant associations were observed. Finally, in ROC analysis, the diagnostic performance of EBT for the pure eosinophilic or/and neutrophilic profile did not reach statistical significance. CONCLUSION EBT is increasing in severe asthma and is significantly modulated by VEGF levels. Despite the above results its performance for predicting cellular profiles is of limited value.
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Affiliation(s)
- Polyxeni Ntontsi
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Stenberg H, Wadelius E, Moitra S, Åberg I, Ankerst J, Diamant Z, Bjermer L, Tufvesson E. Club cell protein (CC16) in plasma, bronchial brushes, BAL and urine following an inhaled allergen challenge in allergic asthmatics. Biomarkers 2017; 23:51-60. [PMID: 28862880 DOI: 10.1080/1354750x.2017.1375559] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Club cell protein (CC16) is a pneumoprotein secreted by epithelial club cells. CC16 possesses anti-inflammatory properties and is a potential biomarker for airway epithelial damage. We studied the effect of inhaled allergen on pulmonary and systemic CC16 levels. METHODS Thirty-four subjects with allergic asthma underwent an inhaled allergen challenge. Bronchoscopy with bronchoalveolar lavage (BAL) and brushings was performed before and 24 h after the challenge. CC16 was quantified in BAL and CC16 positive cells and CC16 mRNA in bronchial brushings. CC16 was measured in plasma and urine before and repeatedly after the challenge. Thirty subjects performed a mannitol inhalation challenge prior to the allergen challenge. RESULTS Compared to baseline, CC16 in plasma was significantly increased in all subjects 0-1 h after the allergen challenge, while CC16 in BAL was only increased in subjects without a late allergic response. Levels of CC16 in plasma and in the alveolar fraction of BAL correlated significantly after the challenge. There was no increase in urinary levels of CC16 post-challenge. Mannitol responsiveness was greater in subjects with lower baseline levels of CC16 in plasma. CONCLUSIONS The increase in plasma CC16 following inhaled allergen supports the notion of CC16 as a biomarker of epithelial dysfunction.
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Affiliation(s)
- Henning Stenberg
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - Erik Wadelius
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - Subhabrata Moitra
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - Ida Åberg
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - Jaro Ankerst
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - Zuzana Diamant
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden.,b Department of Clinical Pharmacy and Pharmacology, and QPS-NL , University Medical Center Groningen , Groningen , The Netherlands
| | - Leif Bjermer
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - Ellen Tufvesson
- a Department of Clinical Sciences, Respiratory Medicine and Allergology , Lund University , Lund , Sweden
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Popov TA, Kralimarkova TZ, Labor M, Plavec D. The added value of exhaled breath temperature in respiratory medicine. J Breath Res 2017; 11:034001. [PMID: 28592704 DOI: 10.1088/1752-7163/aa7801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recognition of the huge economic burden chronic respiratory diseases pose for society motivated fundamental and clinical research leading to insight into the role of airway inflammation in various disease entities and their phenotypes. However, no easy, cheap and patient-friendly methods to assess it have found a place in routine clinical practice. Measurement of exhaled breath temperature (EBT) has been suggested as a non-invasive method to detect inflammatory processes in the airways as a result of increased blood flow within the airway walls. As EBT values are within a narrow range, the thermometers designed for the purpose of assessing it need to be precise and very sensitive. EBT increases linearly over the pediatric age range and seems to be influenced by gender, but not by height and body weight. In non-smoking individuals with no history of respiratory disease EBT has a natural circadian peak about noon and increases with food intake and physical exercise. When interpreting EBT in subjects with alleged airway pathology, the possibilities of tissue destruction (chronic obstructive pulmonary disease, cystic fibrosis) or excessive bronchial obstruction and air trapping (severe asthma) need to be considered, as these conditions drive (force) EBT down. A prominent advantage of the method is to assess EBT when patients are in a steady state of their disease and to use this 'personal best' to monitor them and guide their treatment. Individual devices outfitted with microprocessors and memory have been created, which can be used for personalized monitoring and disease management by telemedicine.
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Affiliation(s)
- Todor A Popov
- Clinic of Allergy and Asthma, Medical University Sofia, Bulgaria
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Update on the Mechanisms of Pulmonary Inflammation and Oxidative Imbalance Induced by Exercise. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:4868536. [PMID: 26881028 PMCID: PMC4736402 DOI: 10.1155/2016/4868536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/02/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022]
Abstract
The mechanisms involved in the generation of oxidative damage and lung inflammation induced by physical exercise are described. Changes in lung function induced by exercise involve cooling of the airways, fluid evaporation of the epithelial surface, increased contact with polluting substances, and activation of the local and systemic inflammatory response. The present work includes evidence obtained from the different types of exercise in terms of duration and intensity, the effect of both acute performance and chronic performance, and the influence of special conditions such as cold weather, high altitude, and polluted environments. Levels of prooxidants, antioxidants, oxidative damage to biomolecules, and cellularity, as well as levels of soluble mediators of the inflammatory response and its effects on tissues, are described in samples of lung origin. These samples include tissue homogenates, induced sputum, bronchoalveolar lavage fluid, biopsies, and exhaled breath condensate obtained in experimental protocols conducted on animal and human models. Finally, the need to simultaneously explore the oxidative/inflammatory parameters to establish the interrelation between them is highlighted.
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Couto M, Santos P, Silva D, Delgado L, Moreira A. Exhaled breath temperature in elite swimmers: The effects of a training session in adolescents with or without asthma. Pediatr Allergy Immunol 2015; 26:564-70. [PMID: 26111200 DOI: 10.1111/pai.12426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cooling of the airways and inflammation have been pointed as possible mechanisms for exercise-induced asthma (EIA). We aimed to investigate the effect of training and asthma on exhaled breath temperature (EBT) of elite swimmers. METHODS Elite swimmers annually screened (skin prick tests, spirometry before and after salbutamol inhalation, induced sputum cell counts, and methacholine bronchial challenge) at our department (n = 27) were invited to this prospective study. Swimmers who agreed to participate in the present study (n = 22, 10 with asthma) had axillary temperature and EBT measured (X-halo(®) ) before and after a swimming training session (aerobic/non-aerobic). Linear regression models were used to assess the effect of asthma and other possible explanatory variables (demographics, PD20 , baseline EBT, training intensity, axillary temperature, and the number of hours trained in that week) on EBT change. RESULTS EBT significantly increased after training independently of lung function, airway responsiveness, and inflammation in all swimmers (mean ± SD: 0.32 ± 0.57; p = 0.016). No differences were observed between asthmatic swimmers and others. A significant correlation was observed between baseline and post-exercise EBTs (r = 0.827, p < 0.001). Asthma was not a predictor of ΔEBT after adjusting for confounders; baseline EBT was the variable most strongly associated with ΔEBT, explaining by itself alone 46% of the outcome (r(2) = 0.464). CONCLUSION Although these are preliminary data, a relationship between airway's inflammation and respiratory heat loss during exercise could not be confirmed, suggesting that the increase in exhaled breath temperature is a physiologic rather than a pathological response to exercise.
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Affiliation(s)
- Mariana Couto
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Allergy Unit, Hospital & Instituto CUF Porto, Porto, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
| | - Paulo Santos
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diana Silva
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
| | - Luís Delgado
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal
| | - André Moreira
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.,Centro Hospitalar São João, Porto, Portugal.,Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
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Mirowsky J, Gordon T. Noninvasive effects measurements for air pollution human studies: methods, analysis, and implications. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:354-80. [PMID: 25605444 PMCID: PMC6659729 DOI: 10.1038/jes.2014.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/26/2014] [Accepted: 11/05/2014] [Indexed: 05/09/2023]
Abstract
Human exposure studies, compared with cell and animal models, are heavily relied upon to study the associations between health effects in humans and air pollutant inhalation. Human studies vary in exposure methodology, with some work conducted in controlled settings, whereas other studies are conducted in ambient environments. Human studies can also vary in the health metrics explored, as there exists a myriad of health effect end points commonly measured. In this review, we compiled mini reviews of the most commonly used noninvasive health effect end points that are suitable for panel studies of air pollution, broken into cardiovascular end points, respiratory end points, and biomarkers of effect from biological specimens. Pertinent information regarding each health end point and the suggested methods for mobile collection in the field are assessed. In addition, the clinical implications for each health end point are summarized, along with the factors identified that can modify each measurement. Finally, the important research findings regarding each health end point and air pollutant exposures were reviewed. It appeared that most of the adverse health effects end points explored were found to positively correlate with pollutant levels, although differences in study design, pollutants measured, and study population were found to influence the magnitude of these effects. Thus, this review is intended to act as a guide for researchers interested in conducting human exposure studies of air pollutants while in the field, although there can be a wider application for using these end points in many epidemiological study designs.
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Affiliation(s)
- Jaime Mirowsky
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
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Scott HA, Latham JR, Callister R, Pretto JJ, Baines K, Saltos N, Upham JW, Wood LG. Acute exercise is associated with reduced exhaled nitric oxide in physically inactive adults with asthma. Ann Allergy Asthma Immunol 2015; 114:470-9. [PMID: 25935433 DOI: 10.1016/j.anai.2015.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/27/2015] [Accepted: 04/03/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although exercise has multiple health benefits, relatively little attention has been paid to its potential therapeutic effects in those with asthma. OBJECTIVE To examine the effects of acute exercise on inflammation in physically inactive and active adults with asthma. METHODS Fourteen adults with asthma (n = 6 physically inactive, n = 8 physically active) completed (1) 30 minutes of moderate-intensity exercise on a treadmill and (2) 30 minutes of rest in random order, with 4 weeks between sessions. Exhaled nitric oxide (eNO) was measured before and after the intervention (0, 0.5, 1, 2, 4, and 24 hours). Blood inflammatory mediators were measured before and after the intervention (0, 2, and 24 hours). RESULTS Physically inactive participants had a significant decrease in eNO 4 hours after exercise (-4.8 ppb, -6.4 to -0.5 ppb, P = .028), which was not observed in physically active participants (P = .362). Interluekin-1 receptor antagonist increased in the physically inactive group 2 hours after exercise, with this increase strongly correlated with the decrease in eNO at 4 hours (R = -0.685, P = .007) and 24 hours (R = -0.659, P = .014) after exercise. Interleukin-6 was increased significantly 2 hours after exercise in physically inactive participants. Blood neutrophils and nuclear factor erythroid 2-like 2 gene expression were increased 2 hours after exercise in the overall cohort. CONCLUSION This study demonstrates that acute moderate-intensity exercise is associated with decreased eNO in physically inactive adults with asthma and suggests that interluekin-1 receptor antagonist could have a role in mediating this effect. The attenuated response in physically active participants might be due to the sustained anti-inflammatory effects of exercise training. Future studies should investigate the impact of exercise intensity and exercise training on airway inflammation in those with asthma. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au), registration number ACTRN12613001014741.
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Affiliation(s)
- Hayley A Scott
- Centre for Asthma and Respiratory Diseases, The University of Newcastle, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia; Lung and Allergy Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Jennifer R Latham
- Centre for Asthma and Respiratory Diseases, The University of Newcastle, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jeffrey J Pretto
- Centre for Asthma and Respiratory Diseases, The University of Newcastle, New Lambton Heights, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Katherine Baines
- Centre for Asthma and Respiratory Diseases, The University of Newcastle, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nick Saltos
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - John W Upham
- Lung and Allergy Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa G Wood
- Centre for Asthma and Respiratory Diseases, The University of Newcastle, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, New South Wales, Australia
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