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Päivinen M, Keskinen K, Putus T, Kujala UM, Kalliokoski P, Tikkanen HO. Asthma, allergies and respiratory symptoms in different activity groups of swimmers exercising in swimming halls. BMC Sports Sci Med Rehabil 2021; 13:119. [PMID: 34607605 PMCID: PMC8491406 DOI: 10.1186/s13102-021-00349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/22/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Respiratory symptoms are common in competitive swimmers. However, among these and in swimmers at other activity levels the swimming distance, the total spent time in swimming halls and their medical background varies. Our objectives were, first, to assess their medical histories and the associations with respiratory symptoms among swimmers in different activity groups and then second, to study the pulmonary function findings and related medications in competitive swimmers who exercise in swimming hall environments the most. METHODS First, 1118 participants consisting of 133 competitive-, 734 fitness- and 251 occasional swimmers answered questionnaires concerning their medical background, their respiratory symptoms in connection to swimming distance and their amount of time spent in swimming halls. Secondly, in 130 competitive swimmers, pulmonary function was tested by spirometry and a specific questionnaire was used to assess respiratory symptoms, medical histories and prescribed medication. RESULTS Respiratory symptoms were reported by 18% of the studied swimmers. Competitive swimmers had significantly more symptoms than fitness- and occasional swimmers. Naturally competitive swimmers swum more than 2000 m and stayed by the pool more than 90 min, longer than the other activity groups of swimmers. Spirometry testing showed airway obstruction in 15 swimmers, which was 12% of the 130 competitive swimmers. 21 of them, had physician-diagnosed asthma and 16 of these individuals had prescribed medication for it. CONCLUSIONS Competitive swimmers had the highest swimming hall exposure and reported significantly more respiratory symptoms. A high prevalence of airway obstruction findings in competitive swimmers with asthma and allergies suggests a need for future recommendations for regular testing and special medical care for competitive swimmers.
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Affiliation(s)
- Marja Päivinen
- Department of Occupational Medicine, Faculty of Medicine, University of Turku, Turku, Finland.
- Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Kari Keskinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuula Putus
- Department of Occupational Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pentti Kalliokoski
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Heikki O Tikkanen
- School of Medicine, Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
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Felgueiras F, Mourão Z, Morais C, Santos H, Gabriel MF, de Oliveira Fernandes E. Comprehensive assessment of the indoor air quality in a chlorinated Olympic-size swimming pool. ENVIRONMENT INTERNATIONAL 2020; 136:105401. [PMID: 31884411 DOI: 10.1016/j.envint.2019.105401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/03/2019] [Accepted: 12/07/2019] [Indexed: 06/10/2023]
Abstract
Elite swimmers and swimming pool employees are likely to be at greater health risk due to their regular and intense exposure to air stressors in the indoor swimming pool environment. Since data on the real long-term exposure is limited, a long-term monitoring and sampling plan (22 non-consecutive days, from March to July 2017) was carried out in an indoor Olympic-size pool with a chlorine-based disinfection method to characterize indoor environments to which people involved in elite swimming and maintenance staff may be exposed to. A comprehensive set of parameters related with comfort and environmental conditions (temperature, relative humidity (RH), carbon dioxide (CO2) and monoxide and ultrafine particles (UFP)) were monitored both indoors and outdoors in order to determine indoor-to-outdoor (I/O) ratios. Additionally, an analysis of volatile organic compounds (VOC) concentration and its dynamics was implemented in three 1-hr periods: early morning, evening elite swimmers training session and late evening. Samplings were simultaneously carried out in the air layer above the water surface and in the air surrounding the pool, selected to be representative of swimmers and coaches/employees' breathing zones, respectively. The results of this work showed that the indoor climate was very stable in terms of air temperature, RH and CO2. In terms of the other measured parameters, mean indoor UFP number concentrations (5158 pt/cm3) were about 50% of those measured outdoors whereas chloroform was the predominant substance detected in all samples collected indoors (13.0-369.3 µg/m3), among a varied list of chemical compounds. An I/O non-trihalomethanes (THM) VOC concentration ratio of 2.7 was also found, suggesting that, beyond THM, other potentially hazardous VOC have also their source(s) indoors. THM and non-THM VOC concentration were found to increase consistently during the evening training session and exhibited a significant seasonal pattern. Compared to their coaches, elite swimmers seemed to be exposed via inhalation to significantly higher total THM levels, but to similar concentrations of non-THM VOC, during routine training activities. Regarding swimming employees, the exposure to THM and other VOC appeared to be significantly minimized during the early morning period. The air/water temperature ratio and RH were identified as important parameters that are likely to trigger the transfer processes of volatile substances from water to air and of their accumulation in the indoor environment of the swimming pool, respectively.
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Affiliation(s)
- Fátima Felgueiras
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Zenaida Mourão
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Catarina Morais
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Hugo Santos
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Marta Fonseca Gabriel
- INEGI, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal.
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Kotsiou OS, Peletidou S, Vavougios G, Karetsi E, Stavrou V, Zakynthinos G, Gourgoulianis KI, Daniil Z. Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers. Ann Allergy Asthma Immunol 2019; 123:249-255. [PMID: 31247303 DOI: 10.1016/j.anai.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Swimming is recommended for people with asthma. However, the inevitable exposure to chlorine and its disinfectant byproducts in indoor swimming pools could be responsible for bronchial inflammation and asthma development. Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation that predicts asthma exacerbations. OBJECTIVES To evaluate pretraining and posttraining FeNO levels in young swimmers with asthma attending an indoor chlorinated pool compared with a set of healthy swimmers and to examine the potential risk of exposure to chlorine as a factor associated with bronchial inflammation. METHODS A total of 146 children (8-18 years old) constantly attending an indoor chlorinated swimming pool were enrolled. Spirometry and FeNO measurements were performed 30 minutes after their arrival at the pool and immediately after exercise. Pre-exercise and postexercise spirometric and FeNO levels were assessed in a random subgroup of 14 swimmers (10 with asthma and 4 without) who performed cardiopulmonary exercise testing. RESULTS Asthma was detected in 23 swimmers. In swimmers with asthma, preswimming FeNO values were significantly elevated compared with swimmers without asthma and their FeNO values measured before cardiopulmonary exercise testing. Postexercise FeNO values were significantly decreased by approximately one-third in healthy children and children with asthma in all sporting backgrounds. However, postswimming FeNO values remained significantly higher in swimmers with asthma compared with those without asthma. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio values showed no significant difference before and after 2 types of activity. CONCLUSION Elevated FeNO levels before and after swimming were recorded in swimmers with asthma not observed in a different exercise field. The presence of chlorine in the indoor swimming pool seems to explain this finding.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Sotiria Peletidou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Vavougios
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Karetsi
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Stavrou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Zakynthinos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Gheibi M, Karrabi M, Eftekhari M. Designing a smart risk analysis method for gas chlorination units of water treatment plants with combination of Failure Mode Effects Analysis, Shannon Entropy, and Petri Net Modeling. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 171:600-608. [PMID: 30658295 DOI: 10.1016/j.ecoenv.2019.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
Today, all modern industrial units acknowledge the necessity of efficient and effective safety, health, and environment (HSE) systems. To become practical, these systems must be localized and customized to serve the exact needs of the industry. Nevertheless, most HSE plans are developed upon a set of common presumptions. In the water industry, gas chlorination units require strong HSE plans to mitigate the possibility of chlorine explosion and leak. This study aimed to provide an efficient HSE system for gas chlorination process within water treatment plants. This goal was achieved through a case study performed on a water treatment plant in Razavi-Khorasan province, Iran. In the first stage of this study, the researchers made combined use brainstorming sessions and modified Delphi technique to identify the risk factors of gas chlorination units and classify them into six groups in terms of association with chlorination unit building, gas cylinder storage, technical details of gas cylinders, gas cylinder transport, chlorinator connections, and chlorination unit management. In the second stage, the extracted factors were analyzed by Failure Mode Effects Analysis (FMEA) and Shannon Entropy approaches using two different panels of experts, and the results were compared for validation. Finally, the analysis results were structured by Petri Net modeling. The results showed that, according to FMEA, the risk factors with risk priority number (RPN) of over 46 are of highest importance for the studied unit. Once observed, these factors necessitate shutting down the operation until a risk mitigation solution is reached. Among the analyzed factors, (i) the presence of compounds such as NH3, O2, gas and liquid hydrocarbons and oil in gas chlorine cylinders and (ii) non-vertical and non-mechanized handling of full and empty cylinders during loading and unloading, with RPNs of respectively 160 and 120, were found to be significantly more important than others. In the SE analysis, in addition to the above factors, poor implementation of airflow control mechanism inside the chlorination chamber (W = 0.359), storage of chlorine cylinders near electrical and mechanical installations such as elevators or power panels (W = 0.327), poor pipe placement for connecting the injector to the water inlet and the possibility of air suction (W = 0.433), and failure to provide scientific and practical training to the chlorination staff (W = 0.342) were found to be of highest importance.
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Affiliation(s)
- Mohammad Gheibi
- Department of Civil Engineering, Faculty of Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mohsen Karrabi
- Department of Civil Engineering, Faculty of Engineering, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Mohammad Eftekhari
- Department of Chemistry, Faculty of Sciences, University of Neyshabur, Neyshabur, Iran
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Asthma and exercise-induced respiratory disorders in athletes. The position paper of the Polish Society of Allergology and Polish Society of Sports Medicine. Postepy Dermatol Alergol 2019; 36:1-10. [PMID: 30858772 PMCID: PMC6409872 DOI: 10.5114/ada.2019.82820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/19/2019] [Indexed: 11/27/2022] Open
Abstract
Exercise-induced respiratory symptoms describe acute airway narrowing that occurs as a result of exercise. It includes exercise-induced bronchoconstriction (EIB) and exercise-induced asthma (EIA) issues. To provide clinicians with practical guidelines, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB/EIA and to develop evidence-based guidelines for the diagnosis and treatment. Recommendations for the diagnosis and treatment of EIB were developed. High-intensity exercise in polluted environment (cold air, humidity, contamination, allergens) may increase the risk of EIB and asthma symptoms in athletes. Diagnostic procedures should include history taking, physical examination, atopy assessment and functional tests of the respiratory system. A strong recommendation was made for regular use of inhaled glucocorticosteroids and avoidance of short-acting β2-agonists as the only treatment. The treatment of asthma in athletes should always take into account current anti-doping regulations. This position paper reflects the currently available evidence.
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Araneda OF, Contreras-Briceño F, Cavada G, Viscor G. Swimming versus running: effects on exhaled breath condensate pro-oxidants and pH. Eur J Appl Physiol 2018; 118:2319-2329. [PMID: 30094648 DOI: 10.1007/s00421-018-3958-0] [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] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The respiratory redox-state of swimmers can be affected by chronic exposures to chlorinated pools, and the effects of different exercises on it are unknown. Our aim was to compare two exercises performed at high-intensity and under habitual environmental conditions (swimming indoor vs. running outdoor) on the production of pro-oxidants (hydrogen peroxide and nitrite) and pH in exhaled breath condensate (EBC) and spirometry parameters in competitive swimmers chronically exposed to chlorinated pools. METHODS Seventeen men and women (mean age ± SD = 21 ± 2 years) swam 3.5 km in an indoor pool treated with Cl2, and after 2-weeks, they ran 10 km outdoors. The pHEBC, [H2O2]EBC, [NO2-]EBC, [NO2-]EBC/[NO2-]Plasma and spirometry parameters were analyzed pre-exercise and 20 min and 24 h after exercise ended. RESULTS Two mixed models were applied to compare EBC parameters between swimming and running. Lower levels of [H2O2]EBC and [NO2-]EBC (p = 0.008 and p = 0.018, respectively) were found 24-h post-swimming, and the same trend was observed for [NO2-]EBC/[NO2-]Plasma (p = 0.062). Correlations were found in both exercises between pre-exercise levels of pHEBC, [H2O2]EBC, [NO2-]EBC, and [NO2-]EBC/[NO2-]Plasma and their changes (Δ) after 24-h as well as between [H2O2]EBC and [NO2-]EBC for basal levels and for changes after 24 h. A relationship was also found for running exercise between pulmonary ventilation and changes after 24 h in [H2O2]EBC. Spirometry data were unaffected in both types of exercise. CONCLUSION In competitive swimmers, at 24-h acute post-exercise follow-up, swimming decreased and running increased pro-oxidant biomarkers of pulmonary origin, without changes in lung function.
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Affiliation(s)
- Oscar F Araneda
- Laboratorio de Fisiología Integrativo de Biomecánica y Fisiología Integrativa (LIBFE), Escuela de Kinesiología, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile.
| | - Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health of Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | - Gabriel Cavada
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
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Kurowski M, Jurczyk J, Jarzębska M, Wardzyńska A, Krysztofiak H, Kowalski ML. Serum but not exhaled breath condensate periostin level is increased in competitive athletes. CLINICAL RESPIRATORY JOURNAL 2018; 12:1919-1926. [PMID: 29316316 DOI: 10.1111/crj.12759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/01/2017] [Accepted: 12/14/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Periostin is a matricellular protein expressed by many tissues. Its release may be enhanced, among others, through mechanical stimulation of muscles and bones as well as by cytokines of allergic inflammation. OBJECTIVES Our aim was to assess periostin levels in serum and exhaled breath condensate (EBC) of professional athletes, asthmatics and healthy controls. We also sought to determine whether acute treadmill exercise influences serum and EBC periostin. METHODS Study groups included 9 competitive swimmers, 10 mild-to-moderate asthmatics and 7 healthy controls. Athletes were assessed twice (in- and off-training period) while asthmatics and controls in one time-point. Data on demographics, allergy symptoms and exercise load were acquired through Allergy Questionnaire for Athletes (AQUA) and International Physical Activity Questionnaire (IPAQ). Serum and EBC were collected before and after treadmill exercise challenge. RESULTS Baseline serum periostin in swimmers during training period was significantly higher (5- to 7-fold) than in asthmatics (P = .01) and controls (P < .05). In EBC, lowest periostin levels were seen in athletes in-training as compared with off-training period (P < .01) and with asthmatics (P < .03). Acute bout of exercise did not induce significant changes neither in serum nor in EBC periostin in any group. CONCLUSION Increased serum, but not EBC, periostin levels in competitive athletes are probably because of permanently increased exercise load leading to stimulation, injury and regeneration of musculoskeletal tissues. Periostin may be considered marker of long-term exercise overload after confirmation in larger groups.
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Affiliation(s)
- Marcin Kurowski
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Centre, Medical University of Łódź, Łódź, Poland
| | - Janusz Jurczyk
- National Center for Sports Medicine (COMS), Warsaw, Poland
| | - Marzanna Jarzębska
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Centre, Medical University of Łódź, Łódź, Poland
| | - Aleksandra Wardzyńska
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Centre, Medical University of Łódź, Łódź, Poland
| | - Hubert Krysztofiak
- National Center for Sports Medicine (COMS), Warsaw, Poland.,Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Healthy Ageing Research Centre, Medical University of Łódź, Łódź, Poland
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Stang J, Stensrud T, Mowinckel P, Carlsen KH. Parasympathetic Activity and Bronchial Hyperresponsiveness in Athletes. Med Sci Sports Exerc 2017; 48:2100-2107. [PMID: 27285494 DOI: 10.1249/mss.0000000000001008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE A high prevalence of asthma and bronchial hyperresponsiveness (BHR) is reported in swimmers and cross-country skiers. It has been suggested that increased parasympathetic nervous activity is involved in asthma development in endurance athletes. We aimed to assess the associations of BHR to parasympathetic activity in healthy and asthmatic swimmers and cross-country skiers and healthy nonathletes. METHODS Parasympathetic activity was measured by pupillometry and heart rate variability at the onset of exercise with the cardiac vagal index calculated in 28 cross-country skiers (♂18/♀10), 29 swimmers (♂17/♀12), and 30 healthy nonathlete controls (♂14/♀16) on two different days. All subjects performed a methacholine bronchial challenge with the provocation dose causing 20% decrease in the forced expiratory volume in 1 s calculated (PD20met). Data were analyzed by robust regression analysis and presented as β coefficients with 95% confidence intervals (CI). RESULTS PD20met was negatively associated with cardiac vagal index (-13.9, 95% CI = -26.8 to -1.0) in all subjects. When adjusted to the type of sport, this association was stronger in swimmers (-8.3, 95% CI = -13.0 to -3.6) as compared with controls and nonsignificant in cross-country skiers. Percent pupil constriction was significantly associated with PD20met in swimmers (-9.4, 95% CI = -15.4 to -3.4) only after adjusting for the type of sport. Fourteen swimmers (48%) and 16 cross-country skiers (57%) had doctor-diagnosed asthma in combination with current BHR and/or current use of asthma drugs. Seventy-two percent swimmers, 44% cross-country skiers, and 39% controls had a PD20met ≤8 μmol (P = 0.015). Fourteen swimmers had a PD20met ≤2 μmol as compared with one cross-country skier (P < 0.001). CONCLUSION Parasympathetic activity measured in the heart is more closely related to BHR as compared with parasympathetic activity measured in the pupils. The type of sport influences BHR severity and its relationship to parasympathetic activity.
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Affiliation(s)
- Julie Stang
- 1Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY; 2Department of Pediatrics, Oslo University Hospital, NORWAY; and 3Faculty of Medicine, University of Oslo, NORWAY
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Rundell KW, Anderson SD, Sue-Chu M, Bougault V, Boulet LP. Air quality and temperature effects on exercise-induced bronchoconstriction. Compr Physiol 2016; 5:579-610. [PMID: 25880506 DOI: 10.1002/cphy.c130013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is exaggerated constriction of the airways usually soon after cessation of exercise. This is most often a response to airway dehydration in the presence of airway inflammation in a person with a responsive bronchial smooth muscle. Severity is related to water content of inspired air and level of ventilation achieved and sustained. Repetitive hyperpnea of dry air during training is associated with airway inflammatory changes and remodeling. A response during exercise that is related to pollution or allergen is considered EIB. Ozone and particulate matter are the most widespread pollutants of concern for the exercising population; chronic exposure can lead to new-onset asthma and EIB. Freshly generated emissions particulate matter less than 100 nm is most harmful. Evidence for acute and long-term effects from exercise while inhaling high levels of ozone and/or particulate matter exists. Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool. Swimmers typically do not respond in the pool; however, a large percentage responds to a dry air exercise challenge. Studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic. Winter sport athletes and swimmers have a higher prevalence of EIB, asthma and airway remodeling than other athletes and the general population. Because of fossil fuel powered ice resurfacers in ice rinks, ice rink athletes have shown high rates of EIB and asthma. For the athlete training in the urban environment, training during low traffic hours and in low traffic areas is suggested.
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Affiliation(s)
- Kenneth W Rundell
- Department of The Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
| | - Sandra D Anderson
- Clinical Professor Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Malcolm Sue-Chu
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015. [PMID: 26672959 DOI: 10.3402/ecrj.v2.27984.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Gleeson M, Pyne DB. Respiratory inflammation and infections in high-performance athletes. Immunol Cell Biol 2015; 94:124-31. [PMID: 26568028 PMCID: PMC7165758 DOI: 10.1038/icb.2015.100] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 02/06/2023]
Abstract
Upper respiratory illness is the most common reason for non-injury-related presentation to a sports medicine clinic, accounting for 35-65% of illness presentations. Recurrent or persistent respiratory illness can have a negative impact on health and performance of athletes undertaking high levels of strenuous exercise. The cause of upper respiratory symptoms (URS) in athletes can be uncertain but the majority of cases are related to common respiratory viruses, viral reactivation, allergic responses to aeroallergens and exercise-related trauma to the integrity of respiratory epithelial membranes. Bacterial respiratory infections are uncommon in athletes. Undiagnosed or inappropriately treated asthma and/or allergy are common findings in clinical assessments of elite athletes experiencing recurrent URS. High-performance athletes with recurrent episodes of URS should undergo a thorough clinical assessment to exclude underlying treatable conditions of respiratory inflammation. Identifying athletes at risk of recurrent URS is important in order to prescribe preventative clinical, training and lifestyle strategies. Monitoring secretion rates and falling concentrations of salivary IgA can identify athletes at risk of URS. Therapeutic interventions are limited by the uncertainty of the underlying cause of inflammation. Topical anti-inflammatory sprays can be beneficial for some athletes. Dietary supplementation with bovine colostrum, probiotics and selected antioxidants can reduce the incidence or severity of URS in some athletes. Preliminary studies on athletes prone to URS indicate a genetic predisposition to a pro-inflammatory response and a dysregulated anti-inflammatory cytokine response to intense exercise as a possible mechanism of respiratory inflammation. This review focuses on respiratory infections and inflammation in elite/professional athletes.
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Affiliation(s)
- Maree Gleeson
- Hunter Medical Research Institute and School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - David B Pyne
- Department of Physiology, Sports Science and Medicine, Australian Institute of Sport, Belconnen, Australian Capital Territory, Australia.,Research Institute for Sports and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015; 2:27984. [PMID: 26672959 PMCID: PMC4653278 DOI: 10.3402/ecrj.v2.27984] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/04/2015] [Indexed: 01/03/2023] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Silva D, Moreira A. The role of sports and exercise in allergic disease: drawbacks and benefits. Expert Rev Clin Immunol 2015; 11:993-1003. [PMID: 26099040 DOI: 10.1586/1744666x.2015.1058158] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although training and exercise have several benefits, overdoing it might not necessarily be a good thing. For instance, elite athletes have an increased risk for asthma and allergy. Several mechanisms can be implicated for this risk, which include the interplay between environmental training factors and athlete's personal risk factors, such as genetic susceptibility, neurogenic-mediated inflammation, and epithelial sensitivity. However, an overwhelming amount of scientific evidence shows the positive effects of sports as part of a healthy lifestyle. Training reduces breathlessness and asthma symptoms and attenuates Th2-mediated inflammatory responses. Taken together, the benefits far outweigh the potential hazards of training. An easily administered therapeutic healthy lifestyle intervention, which could be used alongside current treatment, must be developed.
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Affiliation(s)
- Diana Silva
- Centro Hospitalar São João & Faculty of Medicine, University of Porto, Portugal, Europe
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Price OJ, Ansley L, Menzies-Gow A, Cullinan P, Hull JH. Airway dysfunction in elite athletes--an occupational lung disease? Allergy 2013; 68:1343-52. [PMID: 24117544 DOI: 10.1111/all.12265] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Abstract
Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete's respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.
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Affiliation(s)
- O. J. Price
- Faculty of Health and Life Sciences; Northumbria University; Newcastle UK
| | - L. Ansley
- Faculty of Health and Life Sciences; Northumbria University; Newcastle UK
| | - A. Menzies-Gow
- Department of Respiratory Medicine; Royal Brompton Hospital; London UK
- National Heart and Lung Institute; Imperial College London; London UK
| | - P. Cullinan
- Department of Respiratory Medicine; Royal Brompton Hospital; London UK
- National Heart and Lung Institute; Imperial College London; London UK
| | - J. H. Hull
- Faculty of Health and Life Sciences; Northumbria University; Newcastle UK
- Department of Respiratory Medicine; Royal Brompton Hospital; London UK
- National Heart and Lung Institute; Imperial College London; London UK
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16
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Fernández-Luna Á, Burillo P, Felipe JL, Gallardo L, Tamaral FM. Concentración de cloro en el aire de las piscinas cubiertas y sus efectos en la salud de los trabajadores a pie de piscina. GACETA SANITARIA 2013; 27:411-7. [DOI: 10.1016/j.gaceta.2013.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 01/18/2013] [Accepted: 02/01/2013] [Indexed: 11/29/2022]
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Abstract
Concerns have been expressed about the possible detrimental effects of chlorine derivatives in indoor swimming pool environments. Indeed, a controversy has arisen regarding the possibility that chlorine commonly used worldwide as a disinfectant favors the development of asthma and allergic diseases. The effects of swimming in indoor chlorinated pools on the airways in recreational and elite swimmers are presented. Recent studies on the influence of swimming on airway inflammation and remodeling in competitive swimmers, and the phenotypic characteristics of asthma in this population are reviewed. Preventative measures that could potentially reduce the untoward effects of pool environment on airways of swimmers are discussed.
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Affiliation(s)
- Valérie Bougault
- Department of Sport sciences and Physical education, Université Droit et Santé Lille 2, E.A. 4488, Lille F-59000, France.
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18
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Wuestenfeld JC, Wolfarth B. Special considerations for adolescent athletic and asthmatic patients. Open Access J Sports Med 2013; 4:1-7. [PMID: 24379703 PMCID: PMC3871903 DOI: 10.2147/oajsm.s23438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Asthma is defined as a chronic inflammatory disorder of the airways with bronchial hyperresponsiveness and variable bronchoconstriction, and is one of the most common diseases in childhood and adolescence. Exercise-induced asthma-like symptoms and asthma are also frequently seen in highly trained athletes. Exercise-induced asthma (EIA) and exercise-induced bronchoconstriction (EIB) are found in 8%–10% of healthy school-aged children and in 35% of children with asthma. Highly increased ventilation, inhalation of cold, dry air and air pollutants (eg, chlorine) are thought to be important triggers for EIA and EIB. EIA is often experienced concurrently with vocal cord dysfunction, which needs to be considered during the differential diagnosis. The pharmacological treatment of EIA is similar to the treatment of asthma in nonexercising adolescents. The therapy is based on anti-inflammatory drugs (eg, inhaled glucocorticosteroids) and bronchodilators (eg, β2-agonists). The treatment of EIB is comparable to the treatment of EIA and leukotriene modifiers offer a new and promising treatment option, particularly in EIB. Generally, athletes may not use β2-agonists according to the prohibited list of the World Anti-Doping Agency (WADA). However, the WADA list contains specific β2-agonistic substances that are permitted to be used by inhalation.
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Affiliation(s)
- Jan C Wuestenfeld
- Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Munich, Germany ; Institute for Applied Training Science (IAT), Leipzig, Germany
| | - Bernd Wolfarth
- Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Munich, Germany ; Institute for Applied Training Science (IAT), Leipzig, Germany
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19
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Päivinen M, Putus T, Kalliokoski P, Tikkanen H. Airway obstruction in competitive swimmers. Health (London) 2013. [DOI: 10.4236/health.2013.53062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Boskabady MH, Esmaeilizadeh M, Boskabady M. The effect of exposure to chlorine on pulmonary function tests and respiratory and allergic symptoms in Iranian lifeguards. Toxicol Ind Health 2012; 30:218-24. [PMID: 22851523 DOI: 10.1177/0748233712454465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lifeguards are frequently exposed to various irritant chemicals including chlorine during work, which can induce respiratory and allergic disorders. In this study, pulmonary function tests (PFTs) and self-reported respiratory and allergic symptoms in lifeguards were compared with matched control subjects. The frequency of respiratory and allergic symptoms was evaluated in a sample of 38 Iranian male lifeguards and 38 control subjects with similar age, having other jobs from the general population, using a questionnaire including questions on work-related respiratory and allergic symptoms in the past year, smoking habits, and duration of working as a lifeguard. PFTs were also measured in lifeguard subjects before and 15 min after 200 µg inhaled salbutamol and baseline PFT in controls. A total of 22 (55%) participants reported work-related respiratory symptoms. Sputum (39.4%) and cough (18.4%) were the most common symptoms and only 7.9% and 15.8% of lifeguards reported wheezing and shortness of breath, respectively. Both sputum and breathlessness were significantly higher in lifeguards than control group (p < 0.05 and p < 0.005, respectively). Most allergic symptoms (sneezing and runny nose) in lifeguards were also significantly greater than control group (p < 0.05 for both cases). In addition, all respiratory (except sputum and wheezing) and allergic symptoms were significantly higher in lifeguards during work compared with rest period (p < 0.05 to p < 0.005). Most PFT values were also significantly lower in lifeguards than control subjects (p < 0.05 to p < 0.001). In addition, most (all) PFT values were significantly improved after 200 µg inhaled salbutamol (p < 0.05 to p < 0.001). These results showed that lifeguards have higher frequencies of work related respiratory symptoms and allergic symptoms particularly during the work period. PFT values were also significantly reduced among lifeguards.
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Affiliation(s)
- M H Boskabady
- 1Department of Physiology and Pharmaceutical Research Center, School of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Islamic Republic of Iran
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21
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Weiss P, Rundell KW. Exercise-Induced Lung Disease: Too Much of a Good Thing? PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:149-157. [PMID: 35927868 DOI: 10.1089/ped.2011.0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exercise in children has important health benefits. However, in elite endurance athletes, there is an increased prevalence of exercise-induced bronchoconstriction and airway inflammation. Particularly at risk are those who practice in cold weather, ice rinks, swimming pools, and air pollution. The inflammation is caused by repetitive episodes of hyperventilation of cold, dry air, allergens, or toxins such as chlorine or air pollution. Children may be particularly at risk for lung injury under these conditions because of the immaturity and ongoing development of their lung. However, studies in pediatric athletes and exercising young children are sparse. Epithelial injury associated with hyperventilation of cold, dry air has not been described in children. However, exercise in the presence of air pollution and chlorine is associated with airway injury and the development of asthma in children; the effect appears to be modulated by both atopy and genetic polymorphisms. While management of exercise-induced bronchoconstriction and asthma is well established, there is little data to guide treatment or prevention of remodeling in athletes or inhalational lung injury in children. Studies underscore the need to maintain high levels of air quality. More investigations should be undertaken to better define the natural history, pathophysiology, and treatment of exercise-induced pulmonary inflammation in both elite athletes and exercising children.
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Affiliation(s)
- Pnina Weiss
- Department of Pediatric Respiratory Medicine, Yale University, New Haven, Connecticut
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22
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Sacha JJ, Quinn JM. The environment, the airway, and the athlete. Ann Allergy Asthma Immunol 2011; 106:81-7; quiz 88. [PMID: 21277508 DOI: 10.1016/j.anai.2010.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the interaction of environmental factors with host conditions, including atopy, the potential resulting impaired upper and lower airway function, and diagnostic and therapeutic considerations in the athlete. DATA SOURCES OVID, MEDLINE, and PubMed searches were performed cross-referencing the keywords asthma, athlete, atopy, bronchospasm, exercise, pollution, and rhinitis. STUDY SELECTION Articles were selected based on relevance to the subject matter. RESULTS Recent studies have yielded significant advances in our understanding of how intrinsic and extrinsic factors can potentially result in impaired function of the airways of athletes. Extrinsic factors include environmental exposure to temperature, humidity, aeroallergens, irritants, and pollution. Intrinsic factors include atopy, allergic rhinitis, asthma, and anatomical variants. These intrinsic and extrinsic factors can affect both the athlete's quality of life and athletic performance. However, uncertainty remains regarding relative contributions of these factors in explaining the high degree of bronchospasm seen in various populations of athletes with and without asthma, and no consensus exists regarding the most appropriate diagnostic and therapeutic modalities. CONCLUSIONS Great variability exists in the presentation, laboratory findings, diagnostic maneuvers, and response to therapeutic measures among populations of athletes in different sports and among individuals. An improved understanding of the unique exposures faced by athletes in different disciplines, of the available tests for pursuing the appropriate diagnosis, and of the available therapies will allow the allergist to provide clinical improvement and allow the athlete to find relief and achieve his/her full potential.
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Affiliation(s)
- Joshua J Sacha
- Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236, USA.
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23
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Päivinen MK, Keskinen KL, Tikkanen HO. Swimming and asthma: factors underlying respiratory symptoms in competitive swimmers. CLINICAL RESPIRATORY JOURNAL 2010; 4:97-103. [PMID: 20565483 DOI: 10.1111/j.1752-699x.2009.00155.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Swimming is recommended for asthmatics. However, many competitive swimmers report asthmatic symptoms. While some studies identify the swimming environment as a trigger for allergy and asthmatic symptoms, even more studies suggest swimming to be suitable for people with allergies and asthma. The factors behind the symptoms were studied first by determining the prevalence of asthma, allergy and self-reported asthmatic symptoms in experienced Finnish swimmers and then by examining the relationships between the reported symptoms and the main triggering factors: medical history, environment and exercise intensity. MATERIALS AND METHODS Top swimmers (n = 332) of the Finnish Swimming Association registry (N = 4578) were asked to complete a structured questionnaire on their medical history, swimming background, swimming environment and symptoms in different swimming intensities. Two hundred experienced swimmers, 107 females and 93 males, with an average age of 18.5 [standard deviation (SD) = 3.0] years and a swimming training history of 9 (SD = 3.8) years completed the questionnaire. RESULTS Physician-diagnosed asthma was reported by 32 swimmers (16%), including 24 (12%) with exercise-induced asthma. Physician-diagnosed allergy was reported by 81 (41%) swimmers. Asthmatic symptoms during swimming were described by 84 subjects (42%). Most symptoms occurred when swimming exceeded speeds corresponding to the lactic/anaerobic threshold. Family history of asthma was significant and the most important risk factor for asthmatic symptoms. CONCLUSIONS The prevalence of asthma in swimmers was higher than in the general population but not different from that in other endurance athletes. Family history of asthma and increased swimming intensity had the strongest associations with the reported asthmatic symptoms.
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Affiliation(s)
- Marja Kristiina Päivinen
- Unit for Sport and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
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24
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Wolfarth B, Wuestenfeld JC, Kindermann W. Ergogenic effects of inhaled beta2-agonists in non-asthmatic athletes. Endocrinol Metab Clin North Am 2010; 39:75-87, ix. [PMID: 20122451 DOI: 10.1016/j.ecl.2009.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The potential ergogenic effects of asthma medication in athletes have been controversially discussed for decades. The prevalence of asthma is higher in elite athletes than in the general population. The highest risk for developing asthmatic symptoms is found in endurance athletes and swimmers. In addition, asthma seems to be more common in winter-sport athletes. Asthmatic athletes commonly use inhaled beta2-agonists to prevent and treat asthmatic symptoms. However, beta2-agonists are prohibited according to the "Prohibited List of the World Anti-Doping Agency" (WADA). Until the end of 2009 an exception was only allowed for the substances formoterol, salbutamol, salmeterol, and terbutaline by inhalation, as long as a so-called therapeutic use exemption has been applied for and was granted by the relevant anti-doping authorities. From 2010 salbutamol and salmeterol are allowed by inhalation requiring a so called declaration of use.
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Affiliation(s)
- Bernd Wolfarth
- Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich, Munich, Germany.
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25
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Fiks IN, Santos LCA, Antunes T, Gonçalves RC, Carvalho CRFD, Carvalho CRR. Incidence of asthma symptoms and decreased pulmonary function in young amateur swimmers. J Bras Pneumol 2009; 35:206-12. [PMID: 19390717 DOI: 10.1590/s1806-37132009000300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 09/05/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil. METHODS The study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest. RESULTS The overall incidence of asthma symptoms (ISAAC score > 6) among the swimmers was 16.8%. Of the 119 swimmers submitted to spirometry, 39 (32.7%) presented spirometric alterations (FEV1/FVC < 0.75). Among those with an ISAAC score > 6, there were 10 (31.2%) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24% made use of bronchodilators but not of corticosteroids. CONCLUSIONS The incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.
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Bernard A, Nickmilder M, Voisin C, Sardella A. Impact of chlorinated swimming pool attendance on the respiratory health of adolescents. Pediatrics 2009; 124:1110-8. [PMID: 19752078 DOI: 10.1542/peds.2009-0032] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to estimate the burden of allergic diseases associated with chlorinated pool exposure among adolescents. METHODS We examined 847 students, 13 to 18 years of age, who had attended outdoor or indoor chlorinated pools at various rates. Of them, 114 had attended mainly a copper-silver pool and served as a reference group. We measured total and aeroallergen-specific immunoglobulin E (IgE) levels in serum and screened for exercise-induced bronchoconstriction. Outcomes were respiratory symptoms, hay fever, allergic rhinitis, and asthma that had been diagnosed at any time (ever asthma) or was being treated with medication and/or was associated with exercise-induced bronchoconstriction (current asthma). RESULTS Among adolescents with atopy with serum IgE levels of>30 kIU/L or aeroallergen-specific IgE, the odds ratios (ORs) for asthma symptoms and for ever or current asthma increased with the lifetime number of hours spent in chlorinated pools, reaching values of 7.1 to 14.9 when chlorinated pool attendance exceeded 1000 hours. Adolescents with atopy with chlorinated pool attendance of >100 hours had greater risk of hay fever (OR: 3.3-6.6), and those with attendance of >1000 hours had greater risk of allergic rhinitis (OR: 2.2-3.5). Such associations were not found among adolescents without atopy or with copper-silver pool attendance. The population attributable risks for chlorinated pool-related ever-diagnosed asthma, hay fever, and allergic rhinitis were 63.4%, 62.1%, and 35.0%, respectively. CONCLUSION Chlorinated pool exposure exerts an adjuvant effect on atopy that seems to contribute significantly to the burden of asthma and respiratory allergies among adolescents.
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Affiliation(s)
- Alfred Bernard
- Department of Public Health, Catholic University of Louvain, Brussels, Belgium.
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Abstract
Regular physical activity is recognized as an effective health promotion measure. Among various activities, swimming is preferred by a large portion of the population. Although swimming is generally beneficial to a person's overall health, recent data suggest that it may also sometimes have detrimental effects on the respiratory system. Chemicals resulting from the interaction between chlorine and organic matter may be irritating to the respiratory tract and induce upper and lower respiratory symptoms, particularly in children, lifeguards and high-level swimmers. The prevalence of atopy, rhinitis, asthma and airway hyper-responsiveness is increased in elite swimmers compared with the general population. This may be related to the airway epithelial damage and increased nasal and lung permeability caused by the exposure to chlorine subproducts in indoor swimming pools, in association with airway inflammatory and remodelling processes. Currently, the recommended management of swimmers' respiratory disorders is similar to that of the general population, apart from the specific rules for the use of medications in elite athletes. Further studies are needed to better understand the mechanisms related to the development or worsening of respiratory disorders in recreational or competitive swimmers, to determine how we can optimize treatment and possibly help prevent the development of asthma.
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Affiliation(s)
- Valérie Bougault
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
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28
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Santa Marina L, Ibarluzea J, Basterrechea M, Goñi F, Ulibarrena E, Artieda J, Orruño I. Contaminación del aire interior y del agua de baño en piscinas cubiertas de Guipúzcoa. GACETA SANITARIA 2009; 23:115-20. [DOI: 10.1016/j.gaceta.2008.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 02/20/2008] [Accepted: 01/28/2008] [Indexed: 10/20/2022]
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Sallaoui R, Chamari K, Mossa A, Tabka Z, Chtara M, Feki Y, Amri M. Exercise-induced bronchoconstriction and atopy in Tunisian athletes. BMC Pulm Med 2009; 9:8. [PMID: 19196480 PMCID: PMC2661040 DOI: 10.1186/1471-2466-9-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 02/05/2009] [Indexed: 11/11/2022] Open
Abstract
Background This study is a cross sectional analysis, aiming to evaluate if atopy is as a risk factor for exercise induced bronchoconstriction (EIB) among Tunisian athletes. Methods Atopy was defined by a skin prick test result and EIB was defined as a decrease of at least 15% in forced expiratory volume in one second (FEV1) after 8-min running at 80–85% HRmaxTheo. The study population was composed of 326 athletes (age: 20.8 ± 2.7 yrs – mean ± SD; 138 women and 188 men) of whom 107 were elite athletes. Results Atopy was found in 26.9% (88/326) of the athletes. Post exercise spirometry revealed the presence of EIB in 9.8% of the athletes including 13% of the elite athletes. Frequency of atopy in athletes with EIB was significantly higher than in athletes without EIB [62.5% vs 23.1%, respectively]. Conclusion This study showed that atopic Tunisian athletes presented a higher risk of developing exercise induced bronchoconstriction than non-atopic athletes.
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Affiliation(s)
- Ridha Sallaoui
- ISSEP-Sfax, Unité de Recherche Les déterminants psychoculturels et biologiques de l'accès à la haute performance sportive, Sfax, Tunisia.
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Drobnic F. Impacto sobre la salud de los compuestos utilizados en el tratamiento del agua en las piscinas. Estado de la cuestión. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1886-6581(09)70107-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Denguezli M, Ben Chiekh I, Ben Saad H, Zaouali-Ajina M, Tabka Z, Zbidi A. One-year endurance training: Effects on lung function and airway inflammation. J Sports Sci 2008; 26:1351-9. [DOI: 10.1080/02640410802123177] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Athletes' symptoms may only occur in extreme conditions, which are far from normal. Exercise may increase ventilation up to 200 l/min for short periods in speed and power athletes, and for longer periods in endurance athletes such as swimmers and cross-country skiers. Increasing proportions of young athletes are atopic, i.e. they show signs of IgE-mediated allergy which is, along with the sport event (endurance sport), a major risk factor for asthma and respiratory symptoms. Mechanisms in the etiology and clinical phenotypes vary between disciplines and individuals, and it may be an oversimplification to discuss athlete's asthma as a distinct and unambiguous disease. Nevertheless, the experience on Finnish Olympic athletes suggests at least two different clinical phenotypes, which may reflect different underlying mechanisms. The pattern of 'classical asthma' is characterized by early onset childhood asthma, methacholine responsiveness, atopy and signs of eosinophilic airway inflammation, reflected by increased exhaled nitric oxide levels. Another distinct phenotype includes late onset symptoms (during sports career), bronchial responsiveness to eucapnic hyperventilation test, but not necessarily to inhaled methacholine, and a variable association with atopic markers and nitric oxide. A mixed type of eosinophilic and neutrophilic airway inflammation seems to affect especially swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a multifactorial trauma, in which both allergic and irritant mechanisms play a role. There is a significant problem of both under- and overdiagnosing asthma in athletes and the need for objective testing is emphasized. Follow-up studies are needed to assess the temporal relationship between asthma and competitive sporting, taking better into account individual disposition, environmental factors (exposure), intensity of training and potential confounders.
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Affiliation(s)
- T Haahtela
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
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Carlsen KH, Anderson SD, Bjermer L, Bonini S, Brusasco V, Canonica W, Cummiskey J, Delgado L, Del Giacco SR, Drobnic F, Haahtela T, Larsson K, Palange P, Popov T, van Cauwenberge P. Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN. Allergy 2008; 63:387-403. [PMID: 18315727 DOI: 10.1111/j.1398-9995.2008.01662.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features of these conditions and to make recommendations for their diagnosis. METHODS The Task Force reviewed present literature by searching Medline up to November 2006 for relevant papers by the search words: asthma, bronchial responsiveness, EIB, athletes and sports. Sign criteria were used to assess level of evidence and grades of recommendation. RESULTS The problems of sports-related asthma and allergy are outlined. Epidemiological evidence for an increased prevalence of asthma and BHR among competitive athletes, especially in endurance sports, is provided. The mechanisms for development of asthma and bronchial hyperresponsiveness in athletes are outlined. Criteria are given for the diagnosis of asthma and exercise induced asthma in the athlete. CONCLUSIONS The prevalence of asthma and bronchial hyperresponsiveness is markedly increased in athletes, especially within endurance sports. Environmental factors often contribute. Recommendations for the diagnosis of asthma in athletes are outlined.
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Affiliation(s)
- K H Carlsen
- Voksentoppen, Department of Paediatrics, Faculty of Medicine, University of Oslo, Rikshospitalet, Norwegian School of Sport Sciences, Oslo, Norway
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Belda J, Ricart S, Casan P, Giner J, Bellido-Casado J, Torrejon M, Margarit G, Drobnic F. Airway inflammation in the elite athlete and type of sport. Br J Sports Med 2007; 42:244-8; discussion 248-9. [PMID: 17711871 DOI: 10.1136/bjsm.2007.036335] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The prevalence of asthma and bronchial hyper-responsiveness is greater in elite athletes than in the general population, and its association with mild airway inflammation has recently been reported. OBJECTIVE To study the relationship between the type of sport practised at the highest levels of competition (on land or in water) and sputum induction cell counts in a group of healthy people and people with asthma. MATERIAL AND METHODS In total, 50 athletes were enrolled. Medical history, results of methacholine challenge tests and sputum induced by hypertonic saline were analysed RESULTS Full results were available for 43 athletes, who were classified by asthma diagnosis and type of sport (land or water sports). Nineteen were healthy (10 land and 9 water athletes) and 24 had asthma (13 land and 11 water athletes). Although the eosinophil counts of healthy people and people with asthma were significantly different (mean difference 3.1%, 95% CI 0.4 to 6.2, p = 0.008), analysis of variance showed no effect on eosinophil count for either diagnosis of asthma or type of sport. However, an effect was found for neutrophil counts (analysis of variance: F = 2.87, p = 0.04). There was also a significant correlation between neutrophil counts and both duration of training and bronchial hyper-responsiveness among athletes exposed to water (Spearman's rank correlations, 0.36 and 0.47, p = 0.04 and 0.04, respectively). CONCLUSIONS Elite athletes who practice water sports have mild neutrophilic inflammation, whether or not asthma is present, related to the degree of bronchial hyper-reactivity and the duration of training in pool water.
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Affiliation(s)
- J Belda
- Hospital General Universitario de Valencia, Valencia, Spain
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Lakind JS, Holgate ST, Ownby DR, Mansur AH, Helms PJ, Pyatt D, Hays SM. A critical review of the use of Clara cell secretory protein (CC16) as a biomarker of acute or chronic pulmonary effects. Biomarkers 2007; 12:445-67. [PMID: 17701745 DOI: 10.1080/13547500701359327] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Biomarkers associated with asthma aetiology and exacerbation have been sought to shed light on this multifactorial disease. One candidate is the serum concentration of the Clara cell secretory protein (CC16, sometimes referred to as CC10 or uteroglobin). In this review, we examine serum CC16's relation to asthma aetiology and exacerbation. There is evidence that acute exposures to certain pulmonary irritants can cause a transient increase in serum CC16 levels, and limited evidence also suggests that a transient increase in serum CC16 levels can be caused by a localized pulmonary inflammation. Research also indicates that a transient increase in serum CC16 is not associated with measurable pulmonary damage or impairment of pulmonary function. The biological interpretation of chronic changes in serum CC16 is less clear. Changes in serum CC16 concentrations (either transient or chronic) are not specific to any one agent, disease state, or aetiology. This lack of specificity limits the use of serum CC16 as a biomarker of specific exposures. To date, many of the critical issues that must be understood before serum CC16 levels can have an application as a biomarker of effect or exposure have not been adequately addressed.
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Affiliation(s)
- J S Lakind
- LaKind Associates, LLC, Catonsville, MD, USA.
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Kindermann W. Do inhaled beta(2)-agonists have an ergogenic potential in non-asthmatic competitive athletes? Sports Med 2007; 37:95-102. [PMID: 17241101 DOI: 10.2165/00007256-200737020-00001] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The prevalence of asthma is higher in elite athletes than in the general population. The risk of developing asthmatic symptoms is the highest in endurance athletes and swimmers. Asthma seems particularly widespread in winter-sport athletes such as cross-country skiers. Asthmatic athletes commonly use inhaled beta(2)-agonists to prevent and treat asthmatic symptoms. However, beta(2)-agonists are prohibited according to the Prohibited List of the World Anti-Doping Agency. An exception can be made only for the substances formoterol, salbutamol, salmeterol and terbutaline by inhalation, as long as a therapeutic use exemption has been applied for and granted. In this context, the question arises of whether beta(2)-agonists have ergogenic benefits justifying the prohibition of these substances. In 17 of 19 randomised placebo-controlled trials in non-asthmatic competitive athletes, performance-enhancing effects of the inhaled beta(2)-agonists formoterol, salbutamol, salmeterol and terbutaline could not be proved. This is particularly true for endurance performance, anaerobic power and strength performance. In three of four studies, even supratherapeutic doses of salbutamol (800-1200 microg) had no ergogenic effect. In contrast to inhaled beta(2)-agonists, oral administration of salbutamol seems to be able to improve the muscle strength and the endurance performance. There appears to be no justification to prohibit inhaled beta(2)-agonists from the point of view of the ergogenic effects.
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Affiliation(s)
- Wilfried Kindermann
- Institute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany.
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Denguezli-Bouzgarrou M, Ben Saad H, Ben Chiekh I, Gaied S, Tabka Z, Zbidi A. Role of lung inflammatory mediators as a cause of training-induced lung function changes in runners. Sci Sports 2007. [DOI: 10.1016/j.scispo.2006.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kindermann W, Meyer T. Inhaled beta2 agonists and performance in competitive athletes. Br J Sports Med 2006; 40 Suppl 1:i43-7. [PMID: 16799103 PMCID: PMC2657501 DOI: 10.1136/bjsm.2006.027748] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To provide an overview of the current literature on the use of inhaled beta2 agonists in non-asthmatic competitive athletes, and to assess the performance enhancing effect of inhaled beta2 agonists. METHODS Review of the literature. RESULTS Twenty randomised, placebo controlled studies (19 double blind, one single blind) were located. Only three studies reported a performance enhancing effect of inhaled beta2 agonists. However, methodological shortcomings were most likely responsible for these findings (for example, non-elite athletes, inconsistent results in different tests, subgroups with above-average responsiveness). CONCLUSIONS This review reveals that there is no ergogenic potential of inhaled beta2 agonists in non-asthmatic athletes. In view of the epidemiology of asthma in athletes and the considerable workload involved in provision of therapeutic use exemptions the inclusion of inhaled beta2 agonists on the list of prohibited substances should be reconsidered.
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Affiliation(s)
- W Kindermann
- Institute of Sports and Preventive Medicine, Faculty of Clinical Medicine, University of Saarland, Saarbrücken, Germany.
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39
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Abstract
Highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many inhalant irritants and allergens all year round. Asthma occurs most commonly in athletes engaging in endurance events such as cross-country skiing, swimming, or long-distance running. As well as the type of training, a major risk factor is atopic disposition. A mixed type of eosinophilic and neutrophilic airway inflammation has been shown to affect elite swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a form of repeated thermal, mechanical, or osmotic airway trauma resulting in a healing or remodelling process. Elite athletes commonly use antiasthma drugs to treat exercise-induced bronchial symptoms. Only a few controlled studies have been conducted on the effects of antiasthma drugs on asthma symptoms, bronchial hyperresponsiveness and airway inflammation in elite athletes. Inhaled beta(2)-adrenoceptor agonists are effective against exercise-induced bronchospasm. In contrast, airway inflammation, bronchial hyperresponsiveness and symptoms have responded poorly to inhaled corticosteroids and leukotriene antagonists. As discontinuing high-level exercise has proved effective in reducing eosinophilic airway inflammation, exercise or training should be restricted in athletes having troublesome symptoms and sputum eosinophilia. Switching training to less irritating environments should be considered whenever possible. It appears to be difficult to change the 'natural course' of asthma in athletes by anti-inflammatory treatment.
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Affiliation(s)
- Ilkka Helenius
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
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40
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Abstract
Exercise-induced bronchoconstriction (EIB) has a high prevalence in elite athletes, particularly endurance athletes, winter athletes and swimmers. Recent studies have shown that a clinical diagnosis of EIB has only a moderate sensitivity and specificity for EIB. This finding in conjunction with a recent ruling by the IOC-medical commission that all athletes competing in initially the 2003 Winter Olympic Games in Salt Lake City, and now the 2004 Summer Olympic Games in Athens require objective evidence of EIB, support the need for bronchial provocation challenge tests in the diagnosis of EIB. The recommended bronchial provocation challenge test is the eucapnic voluntary hyperpnea (EVH) challenge; this challenge test has been shown to have both a high sensitivity and specificity for EIB. Pharmacological challenge tests, such as the methacholine challenge test, have been shown to have only a low sensitivity but high specificity for EIB in elite athletes, and are thus not recommended in the athlete with pure EIB. Exercise challenge tests performed both in the laboratory and field have a high specificity for EIB; however those in the laboratory have only a moderate sensitivity for EIB in elite athletes, whilst those in the field are limited by problems with standardization. The osmotic challenge tests, such as the hypertonic saline and newer inhaled dry powder mannitol challenge have both a high sensitivity and specificity for EIB, and may be used as an alternative to the EVH challenge.
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Affiliation(s)
- Karen Holzer
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
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41
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Passàli D, Damiani V, Passàli GC, Passàli FM, Bellussi L. Alterations in rhinosinusal homeostasis in a sportive population: our experience with 106 athletes. Eur Arch Otorhinolaryngol 2003; 261:502-6. [PMID: 14685886 DOI: 10.1007/s00405-003-0723-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Accepted: 10/30/2003] [Indexed: 10/26/2022]
Abstract
The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 professional athletes (swimmers, skiers, boxers and runners) using objective rhinological methods. Every athlete underwent an accurate anamnesis, a complete objective ORL evaluation, an active anterior rhinomanometry, an acoustic rhinometry and an evaluation of mucociliary transport time (MCTt). Skiers were also submitted to a nasal decongestion test (NDT). In swimmers, the mean MCTt was 27.4+/-4.97 min (normal value: 13+/-3 min; P<0.0001). The average MCTt for the skier group was 19.58+/-1.92 min ( P<0.0001); the mean value of total basal nasal resistance was 0.37+/-0.05 Pa/ml per s (normal value =0.25 Pa/ml per s; P<0.001). After NDT, total nasal resistance was 0.18+/-0.02 Pa/ml per s. In the group of boxers, the total mean nasal resistance was 0.64+/-0.05 Pa/ml per s ( P<0.001); the mean cross-sectional area at the nasal valve level was 0.57+/-0.04 cm(2) (normal value =0.55+/-0.05 cm(2)) and at the inferior turbinate level 0.83+/-0.05 cm(2) (normal value =0.4+/-0.04 cm(2); P<0.001); the TMC average time was 27.35+/-2.21 min ( P<0.0001). Finally, for the runners, the mean MCT time was 20.56+/-2.35 min ( P<0.001). Knowing the alterations of the physiological nasal respiration is of extreme importance to develop a correct and timely therapeutic approach to be able to restore rhino-sinusal homeostasis. Athletes, in fact, need the earliest therapeutic aid in order to avoid the interference of prolonged rhino-sinusal alterations with their performance and also to avoid a more serious clinical situation concerning the inferior airways.
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Affiliation(s)
- Desiderio Passàli
- Department of Otorhinolaryngology, University of Sienna Medical School, V. le Bracci, 53100, Sienna, Italy.
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42
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Bonsignore MR, Morici G, Riccobono L, Profita M, Bonanno A, Paternò A, Di Giorgi R, Chimenti L, Abate P, Mirabella F, Maurizio Vignola A, Bonsignore G. Airway cells after swimming outdoors or in the sea in nonasthmatic athletes. Med Sci Sports Exerc 2003; 35:1146-52. [PMID: 12840635 DOI: 10.1249/01.mss.0000074581.08023.25] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Marathon runners and elite swimmers showed increased inflammatory cells in the airways at baseline. Although airway neutrophils increase further after a marathon race, the airway response to swimming is unknown. The aim of this study was to assess the effects of swimming on airway cells. To avoid the concomitant effects of chronic exposure to chlorine, the study was conducted in seven nonasthmatic swimmers [mean age (SD): 23.3 +/- 7.7 yr, training: 32 +/- 15 km.wk-1] habitually training in an outdoor pool (OP), i.e., a low-chlorine environment. METHODS Spirometry, exhaled nitric oxide (NO), induced sputum, and peripheral blood samples were obtained at baseline, after a 5-km trial in OP, and after a 5-km race in the sea (S), i.e., hypertonic airway exposure. RESULTS Airway neutrophil differential counts at baseline were higher in swimmers than in sedentary controls (N = 10), but cell counts, neutrophil elastase, and eosinophil cationic protein were unaffected by 5-km swimming. After swimming, L-selectin expression on airway cells decreased, suggesting exercise-induced cell mobilization into the airways and/or direct effects of hyperventilation on airway cells. After S, airway eosinophil differential counts increased slightly. Exhaled NO concentration was 19 +/- 6 ppb at baseline, 8 +/- 4 ppb after OP, and 21 +/- 7 ppb after S (P < 0.005 for OP vs baseline and S). CONCLUSIONS In swimmers not chronically exposed to high chlorine concentrations, data obtained at baseline suggest a direct relationship between airway neutrophilia and endurance training. The low L-selectin expression by airway cells postexercise suggests hyperventilation-induced cell recruitment or modulation of cell function. Hypertonic exposure of airways during exercise may slightly increase airway eosinophils and exhaled NO. Overall, 5-km swimming exerted smaller effects on airway cells than running a marathon.
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Affiliation(s)
- Maria R Bonsignore
- Institute of Medicine and Pneumology, University of Palermo, Palermo, Italy.
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43
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Bonsignore MR, Morici G, Vignola AM, Riccobono L, Bonanno A, Profita M, Abate P, Scichilone N, Amato G, Bellia V, Bonsignore G. Increased airway inflammatory cells in endurance athletes: what do they mean? Clin Exp Allergy 2003; 33:14-21. [PMID: 12534544 DOI: 10.1046/j.1365-2222.2003.01557.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inflammatory cells are increased in the airways of endurance athletes, but their role in causing exercise-induced respiratory symptoms and bronchoconstriction, or their possible long-term consequences, are uncertain. AIM To put the results of athlete studies in perspective, by analysing the pathogenesis of airway cell changes and their impact on respiratory function. RESULTS Athletes of different endurance sports at rest showed increased airway neutrophils. Elite swimmers and skiers also showed large increases in airway eosinophils and lymphocytes, possibly related to chronic, exercise-related exposure to irritants or cold and dry air, respectively. Post-exercise studies reported variable responses of airway cells to exercise, but found no evidence of inflammatory cell activation in the airways, at variance with exercise-induced neutrophil activation in peripheral blood. The increase in airway inflammatory cells in athletes can result from hyperventilation-induced increase in airway osmolarity stimulating bronchial epithelial cells to release chemotactic factors. Hyperosmolarity may also inhibit activation of inflammatory cells by causing shedding of adhesion molecules, possibly explaining why airway inflammation appears 'frustrated' in athletes. Data on exhaled nitric oxide are few and variable, not allowing conclusions about its usefulness as a marker of airway inflammation in athletes, or its role in modulating bronchial responsiveness. CONCLUSIONS The acute and long-term effects of exercise on airway cells need further study. Airway inflammatory cells are increased but not activated in athletes, both at rest and after exercise, and airway inflammation appears to regress in athletes quitting competitions. Altogether, these findings do not clearly indicate that habitual intense exercise may be detrimental for respiratory health. Rather, airway changes may represent chronic adaptive responses to exercise hyperventilation. An improved understanding of the effects of exercise on the airways will likely have a clinical impact on sports medicine, and on the current approach to exercise-based rehabilitation in respiratory disease.
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Affiliation(s)
- M R Bonsignore
- Institute of Medicine and Pneumology, University of Palermo, Palermo, Italy.
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44
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Smith E, Mahony N, Donne B, O'Brien M. Prevalence of obstructive airflow limitation in Irish collegiate athletes. Ir J Med Sci 2002; 171:202-5. [PMID: 12647909 DOI: 10.1007/bf03170281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma prevalence in athletes is variable, depending on the sport and training conditions. AIMS To investigate the prevalence of obstructive airflow limitation, asthma control and lung volume differences in a control group and five groups of collegiate athletes--outdoor field, indoor court, endurance, combat sports and swimming. METHODS Three hundred and five athletes completed a respiratory questionnaire and performed spirometry during normal training conditions, to determine FEV1, FVC and PEFR pre- and at 5, 10 and 15 minutes post-exercise. Between and within group analysis was carried out using single factor and repeated measures ANOVA. RESULTS Previous diagnosis of asthma was reported by 24%, outdoor field sports 4.9%, indoor court sports 2.3%, endurance events 2.6%, combat sports 3%, swimming 6.9% and controls 4.3%. Mean FEV1 and FVC data, expressed as percentage of predicted, were greatest in swimming and lowest in controls. Swimming showed a significant rise in FEV1 post-exercise, indoor court and endurance sports demonstrated no change and outdoor field, combat and control groups showed a fall in FEV1 post-exercise. CONCLUSION Warm humid training conditions appear protective against exercise-induced asthma. The greatest reductions in lung volumes occurred following high intensity exercise under cool conditions in the poorly aerobically conditioned.
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Affiliation(s)
- E Smith
- Human Performance Laboratory, Trinity College, Dublin, Ireland
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45
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Helenius I, Rytilä P, Sarna S, Lumme A, Helenius M, Remes V, Haahtela T. Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: A 5-year prospective follow-up study of 42 highly trained swimmers. J Allergy Clin Immunol 2002. [DOI: 10.1067/mai.2002.124769] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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46
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Langdeau JB, Boulet LP. Prevalence and mechanisms of development of asthma and airway hyperresponsiveness in athletes. Sports Med 2002; 31:601-16. [PMID: 11475322 DOI: 10.2165/00007256-200131080-00005] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A high prevalence of asthma and airway hyperresponsiveness (AHR) has been reported in the athlete population. Factors potentially predisposing athletes to these conditions have not been clearly identified. Although moderate exercise has been shown to be beneficial in patients with asthma, repeated high-intensity exercise could possibly contribute to the development of asthma and AHR. This report provides an overview of the prevalence and possible mechanisms of development of asthma and AHR in the athlete population. The prevalence of asthma and AHR are higher in athletes than in the general population, particularly in swimmers and athletes performing sports in cold air environments. Possible mechanisms involved in the development of asthma in athletes are still uncertain; however, the content and physical characteristics of the inhaled air seem to be important factors, while immune and neurohumoral influences could play a modulatory role. This report stresses the need for further studies to better define the aetiologic factors and mechanisms involved in the development of asthma and AHR in athletes, and proposes relevant preventive and therapeutic measures.
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Affiliation(s)
- J B Langdeau
- Laval University Cardiothoracic Institute, Laval Hospital, Quebec City, Quebec, Canada
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47
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Drobnic F. [Misinformation about asthma in elite athletes: from Maimonides to the Olympic Games]. Arch Bronconeumol 2001; 37:363-5. [PMID: 11674933 DOI: 10.1016/s0300-2896(01)78814-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Chlorine is a reactive gas used by humanity for over two centuries. Exposure to chlorine has occurred in a number of situations, including as a chemical warfare agent, in industrial and domestic exposures, and as a result of accidents and spills. The toxicology of chlorine is related almost entirely to effects in the respiratory system. A consistent symptomology occurs in both animals and humans. This ranges from sensory irritation, to irritation and bronchospasm, to cellular changes to bronchioles and alveoli, to development of pulmonary disease. While full recovery from such injuries remains the most likely outcome, there is little doubt that permanent loss of function is possible in severe cases. In all industrial applications of chlorine, occupational exposures to chlorine should be controlled to at least the recommended exposure standard. However, a focus of activity on ensuring that excursions (such as leaks or "gassing" incidents) above these values do not occur is likely to be more beneficial. Treatment of chlorine exposure is essentially symptomatic, with the efficacy of some treatments (such as corticosteroid therapy) still not well established.
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Affiliation(s)
- C Winder
- School of Safety Science, University of New South Wales, Sydney, NSW, 2052, Australia.
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49
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Abstract
Exercise may increase ventilation up to 200 L/min for short periods of time in speed and power athletes, and for longer periods in endurance athletes, such as long-distance runners and swimmers. Therefore highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many pollen allergens in spring and summer. Competitive swimmers inhale and microaspirate large amounts of air that floats above the water surface, which means exposure to chlorine derivatives from swimming pool disinfectants. In the summer Olympic Games, 4% to 15% of the athletes showed evidence of asthma or used antiasthmatic medication. Asthma is most commonly found in endurance events, such as cycling, swimming, or long-distance running. The risk of asthma is especially increased among competitive swimmers, of which 36% to 79% show bronchial hyperresponsiveness to methacholine or histamine. The risk of asthma is closely associated with atopy and its severity among athletes. A few studies have investigated occurrence of exercise-induced bronchospasm among highly trained athletes. The occurrences of exercise-induced bronchospasm vary from 3% to 35% and depend on testing environment, type of exercise used, and athlete population tested. Mild eosinophilic airway inflammation has been shown to affect elite swimmers and cross-country skiers. This eosinophilic inflammation correlates with clinical parameters (ie, exercise-induced bronchial symptoms and bronchial hyperresponsiveness). Athletes commonly use antiasthmatic medication to treat their exercise-induced bronchial symptoms. However, controlled studies on their long-term effects on bronchial hyperresponsiveness and airway inflammation in the athletes are lacking. Follow-up studies on asthma in athletes are also lacking. What will happen to bronchial hyperresponsiveness and airway inflammation after discontinuation of competitional career is unclear. In the future, follow-up studies on bronchial responsiveness and airway inflammation, as well as controlled studies on both short- and long-term effects of antiasthmatic drugs in the athletes are needed.
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Affiliation(s)
- I Helenius
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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50
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Anderson SD, Holzer K. Exercise-induced asthma: is it the right diagnosis in elite athletes? J Allergy Clin Immunol 2000; 106:419-28. [PMID: 10984359 DOI: 10.1067/mai.2000.108914] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Exercise-induced asthma, as recognized in asthmatic subjects, is an exaggerated airway response to airway dehydration in the presence of inflammatory cells and their mediators. The airway narrowing is primarily caused by contraction of bronchial smooth muscle. The milder airway narrowing documented in response to exercise in elite athletes and otherwise healthy subjects may simply be the result of the physiologic responses and pathologic changes in airway cells arising from dehydration injury. These changes, which include excessive mucus production and airway edema, would serve both to cause cough and to amplify the narrowing effects of normal bronchial smooth muscle contraction, resulting in symptoms. These changes are more likely to occur in healthy subjects who exercise intensely for long periods of time breathing cold air, dry air, or both. Under these conditions, the ability to humidify inspired air may be overwhelmed, causing significant dehydration of the airway mucosa and an increase in osmolarity, even in small airways. In addition to dehydration injury, airway narrowing to pharmacologic and physical agents may occur as a result of injury caused by large volumes of air containing irritant gases, particulate matter, or allergens being inspired during exercise. As a result, the airways may become inflamed, and the airway smooth muscle may become more sensitive. These events could result in the same exaggerated airway response to dehydration, as documented in asthmatic subjects.
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Affiliation(s)
- S D Anderson
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
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