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Csoma BALÁ, Sydó N, SZŰcs G, Seres É, Erdélyi T, Horváth G, Csulak E, Merkely B, Müller V. Exhaled and Systemic Biomarkers to Aid the Diagnosis of Bronchial Asthma in Elite Water Sports Athletes. Med Sci Sports Exerc 2024; 56:1256-1264. [PMID: 38650115 DOI: 10.1249/mss.0000000000003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Our aim was to evaluate the accuracy of a combined airway inflammatory biomarker assessment in diagnosing asthma in elite water sports athletes. METHODS Members of the Hungarian Olympic and Junior Swim Team and elite athletes from other aquatic disciplines were assessed for asthma by objective lung function measurements, and blood eosinophil count (BEC), serum total immunoglobulin E (IgE), fractional exhaled nitric oxide (F ENO ) measurements, and skin prick testing were performed. A scoring system from BEC, F ENO , serum IgE, and skin test positivity was constructed by dichotomizing the variables and assigning a score of 1 if the variable is elevated. These scores were summed to produce a final composite score ranging from 0 to 4. RESULTS A total of 48 participants were enrolled (age 21 ± 4 yr, 42% male), of which 22 were diagnosed with asthma. Serum total IgE and F ENO levels were higher in asthmatic individuals (68 [27-176] vs 24 [1-43], P = 0.01; 20 [17-26] vs 15 [11-22], P = 0.02), and positive prick test was also more frequent (55% vs 8%, P < 0.01). Asthmatic participants had higher composite variable scores (2 [1-3] vs 1 [0-1], P = 0.02). Receiver operating characteristic analysis showed that total IgE, F ENO , and composite variable were suitablefor identifying asthmatic participants (area under the curve = 0.72, P = 0.01; 0.70, P = 0.02, and 0.69, P = 0.03). A composite score of >2 reached a specificity of 96.2%, a sensitivity of 36.4%, and a likelihood ratio of 9.5. Logistic regression model revealed a strong association between the composite variable and the asthma diagnosis (OR = 2.71, 95% confidence interval = 1.17-6.23, P = 0.02). CONCLUSIONS Our data highlight the diagnostic value of combined assessment of Th2-type inflammation in elite water sports athletes. The proposed scoring system may be helpful in ruling in asthma in this population upon clinical suspicion.
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Affiliation(s)
- BALÁzs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Nóra Sydó
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Gergő SZŰcs
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Éva Seres
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Tamás Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Gábor Horváth
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Emese Csulak
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
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Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports 2024; 34:e14358. [PMID: 36965010 DOI: 10.1111/sms.14358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.
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Affiliation(s)
- Morten Hostrup
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erik S H Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Søren Jessen
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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3
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Goossens J, Jonckheere AC, Seys SF, Dilissen E, Decaesteker T, Goossens C, Peers K, Vanbelle V, Stappers J, Aertgeerts S, De Wilde B, Leus J, Verelst S, Raes M, Dupont L, Bullens DM. Activation of epithelial and inflammatory pathways in adolescent elite athletes exposed to intense exercise and air pollution. Thorax 2023; 78:775-783. [PMID: 36927754 PMCID: PMC10359548 DOI: 10.1136/thorax-2022-219651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
RATIONALE Participation in high-intensity exercise in early life might act as stressor to the airway barrier. OBJECTIVES To investigate the effect of intense exercise and associated exposure to air pollution on the airway barrier in adolescent elite athletes compared with healthy controls and to study exercise-induced bronchoconstriction (EIB) in this population. METHODS Early-career elite athletes attending 'Flemish-Elite-Sports-Schools' (12-18 years) of 4 different sport disciplines (n=90) and control subjects (n=25) were recruited. Presence of EIB was tested by the eucapnic voluntary hyperventilation (EVH) test. Markers at mRNA and protein level; RNA-sequencing; carbon load in airway macrophages were studied on induced sputum samples. RESULTS 444 genes were differentially expressed in sputum from athletes compared with controls, which were related to inflammation and epithelial cell damage and sputum samples of athletes contained significantly more carbon loaded airway macrophages compared with controls (24%, 95% CI 20% to 36%, p<0.0004). Athletes had significantly higher substance P (13.3 pg/mL, 95% CI 2.0 to 19.2) and calprotectin (1237 ng/mL, 95% CI 531 to 2490) levels as well as IL-6, IL-8 and TNF-α mRNA levels compared with controls (p<0.05). The incidence of EIB in athletes was 9%. The maximal fall in forced expiratory volume in 1 s (%) after EVH test in athletes was significantly associated with prior PM10 and PM2.5 exposure. CONCLUSION Early-career elite athletes showed increased markers of air pollution exposure, epithelial damage and airway inflammation compared with controls. Acute exposure to increased air pollution PM10 levels was linked to increased airway hyper-reactivity. TRIAL REGISTRATION NUMBER NCT03587675.
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Affiliation(s)
- Janne Goossens
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Anne-Charlotte Jonckheere
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Sven F Seys
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Ellen Dilissen
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Tatjana Decaesteker
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Camille Goossens
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Koen Peers
- Sport Medical Advice Centre, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Sven Aertgeerts
- Academic Centre for General Practitioners, Catholic University, Leuven, Belgium
| | | | - Jasmine Leus
- Pediatric Allergy, AZ Maria Middelares, Sint-Niklaas, Belgium
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
| | - Sophie Verelst
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
- Pediatrics, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium
| | - Marc Raes
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
- Pediatrics, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium
| | - Lieven Dupont
- Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dominique M Bullens
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
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Xiang W, Wang W, Du L, Zhao B, Liu X, Zhang X, Yao L, Ge M. Toxicological Effects of Secondary Air Pollutants. Chem Res Chin Univ 2023; 39:326-341. [PMID: 37303472 PMCID: PMC10147539 DOI: 10.1007/s40242-023-3050-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 06/13/2023]
Abstract
Secondary air pollutants, originating from gaseous pollutants and primary particulate matter emitted by natural sources and human activities, undergo complex atmospheric chemical reactions and multiphase processes. Secondary gaseous pollutants represented by ozone and secondary particulate matter, including sulfates, nitrates, ammonium salts, and secondary organic aerosols, are formed in the atmosphere, affecting air quality and human health. This paper summarizes the formation pathways and mechanisms of important atmospheric secondary pollutants. Meanwhile, different secondary pollutants' toxicological effects and corresponding health risks are evaluated. Studies have shown that secondary pollutants are generally more toxic than primary ones. However, due to their diverse source and complex generation mechanism, the study of the toxicological effects of secondary pollutants is still in its early stages. Therefore, this paper first introduces the formation mechanism of secondary gaseous pollutants and focuses mainly on ozone's toxicological effects. In terms of particulate matter, secondary inorganic and organic particulate matters are summarized separately, then the contribution and toxicological effects of secondary components formed from primary carbonaceous aerosols are discussed. Finally, secondary pollutants generated in the indoor environment are briefly introduced. Overall, a comprehensive review of secondary air pollutants may shed light on the future toxicological and health effects research of secondary air pollutants.
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Affiliation(s)
- Wang Xiang
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
| | - Weigang Wang
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
| | - Libo Du
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
| | - Bin Zhao
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- College of Chemistry and Material Science, Hebei Normal University, Shijiazhuang, 050024 P. R. China
| | - Xingyang Liu
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
| | - Xiaojie Zhang
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
| | - Li Yao
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
| | - Maofa Ge
- State Key Laboratory for Structural Chemistry of Unstable and Stable Species, Beijing National Laboratory for Molecular Sciences, CAS Research/Education Center for Excellence in Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190 P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049 P. R. China
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5
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Rasmussen SM, Hansen ESH, Backer V. Asthma in elite athletes - do they have Type 2 or non-Type 2 disease? A new insight on the endotypes among elite athletes. FRONTIERS IN ALLERGY 2022; 3:973004. [PMID: 36340019 PMCID: PMC9633848 DOI: 10.3389/falgy.2022.973004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Asthma and exercise-induced bronchoconstriction are highly prevalent in elite athletes compared with the general population. Some athletes have classic asthma with allergic sensitization; however, it seems that a proportion of athletes develop asthma as a result of several years of intensive training. It leads us to believe that asthma in athletes consists of at least two distinct endotypes - classic early-onset, Type 2 mediated asthma, and asthma with later onset caused by exercise which might be classified as non-Type 2 asthma. The purpose of this review is to evaluate the current literature on asthma in athletes focusing on inflammation and examine if asthma in athletes could be characterized as either Type 2- or non-Type 2 asthma.
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Affiliation(s)
- Søren Malte Rasmussen
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark,Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark,Correspondence: Søren Malte Rasmussen
| | - Erik Sören Halvard Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark,Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Hospital, Hvidovre, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark,Department of Otorhinolaryngology Head / Neck surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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6
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Xu Y, Zhong F, Zheng X, Lai HY, Wu C, Huang C. Disparity of Gut Microbiota Composition Among Elite Athletes and Young Adults With Different Physical Activity Independent of Dietary Status: A Matching Study. Front Nutr 2022; 9:843076. [PMID: 35369075 PMCID: PMC8975590 DOI: 10.3389/fnut.2022.843076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
ObjectiveThis study aimed to investigate the disparity of gut microbiota among elite athletes and young adults with different physical activity independent of dietary status.MethodsIn Hangzhou, China, an age and sex matching study was conducted between April and May 2021. A total of 66 Chinese young adults were recruited in this study and divided into an elite athlete group, physically active group, and physically inactive group. Fecal samples were collected to assess gut microbiota composition. Dietary status was measured using a food-frequency questionnaire. Comparisons in gut microbiota and blood biomarkers among three groups were analyzed by using the analysis of covariance.ResultsThe findings depicted a tendency to form clusters for beta diversity among three groups, while no significant difference was observed in both alpha and beta diversity. In the multiple analysis model, by adjusting dietary status, a significantly higher abundance of Clostridiaceae (p = 0.029) and Megamonas_rupellensis (p = 0.087) was observed in elite athletes compared to that in general young adults. Furthermore, inflammation-related bacteria such as Bilophila (p = 0.011) and Faecalicoccus (p = 0.050) were enriched in physically inactive young adults compared to two other groups. Pearson's correlation analysis showed a positive association between Bilophila and circulating white body cell count (r = 0.332, p = 0.006) and its subtypes including neutrophils (r = 0.273, p = 0.027), and lymphocytes (r = 0.327, p = 0.007). Megamonas_rupellensis has been shown associated positively with serum lymphocytes levels (r = 0.268, p = 0.03). Although no significant differences were observed, the elite athletes tended to have lower levels of blood biomarkers of immunity within a normal range, which may reflect a better immune function.ConclusionThis matching study indicated that physically inactive young adults are more likely to have a lower immune function and a higher abundance of pro-inflammatory gut bacteria than elite athletes and physically active young adults. Dietary status should be considered as an important factor that may affect the association of physical activity with immune function and gut microbiota.
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Affiliation(s)
- Yongjin Xu
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Fei Zhong
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Xiaoqian Zheng
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Hsin-Yi Lai
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University School of Medicine, Hangzhou, China
- Department of Neurology of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunchun Wu
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Cong Huang
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
- Department of Medicine and Science in Sports and Exercise, Tohoku University Graduate School of Medicine, Sendai, Japan
- *Correspondence: Cong Huang
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7
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Shim J, Lee H, Park D, Won Lee J, Bae B, Chang Y, Kim J, Kim HY, Kang H. Aggravation of asthmatic inflammation by chlorine exposure via innate lymphoid cells and CD11c intermediate macrophages. Allergy 2020; 75:381-391. [PMID: 31402462 DOI: 10.1111/all.14017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chlorine is widely used in daily life as disinfectant. However, chronic exposure to chlorine products aggravates allergic TH 2 inflammation and airway hyperresponsiveness (AHR). Innate lymphoid cells (ILCs) in airways contribute to the inception of asthma in association with virus infection, pollution, and excess of nutrient, but it is not known whether chronic chlorine exposure can activate innate immune cells. The aim of this study was to evaluate the impact of chlorine inhalation on the innate immunity such as ILCs and macrophages in relation with the development of asthma by using murine ovalbumin (OVA) sensitization/challenge model. METHODS Six-week-old female BALB/c mice were sensitized and challenged with OVA in the presence and absence of chronic low-dose chlorine exposure by inhalation of naturally vaporized gas of 5% sodium hypochlorite solution. AHR, airway inflammatory cells, from BALF and the population of ILCs and macrophages in the lung were evaluated. RESULTS The mice exposed to chlorine with OVA (Cl + OVA group) showed enhanced AHR and eosinophilic inflammation compared to OVA-treated mice (OVA group). The population of TH 2 cells, ILC2s, and ILC3s increased in Cl + OVA group compared with OVA group. CD11cint macrophages also remarkably increased in Cl + OVA group compared with OVA group. The deletion of macrophages by clodronate resulted in reduction of ILC2s and ILC3s population which was restored by adoptive transfer of CD11cint macrophages. CONCLUSIONS Chronic chlorine inhalation contributes to the exacerbation of airway inflammation in asthmatic airway by mobilizing pro-inflammatory macrophage into the lung as well as stimulating group 2 and 3 ILCs.
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Affiliation(s)
- Ji‐Su Shim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
- Department of Internal Medicine Ewha Womans University College of Medicine Seoul Korea
| | - Hyun‐Seung Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center Seoul National University College of Medicine Seoul Korea
| | - Da‐Eun Park
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center Seoul National University College of Medicine Seoul Korea
| | - Ji Won Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center Seoul National University College of Medicine Seoul Korea
| | - Boram Bae
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center Seoul National University College of Medicine Seoul Korea
| | - Yuna Chang
- Laboratory of Mucosal Immunology in Department of Biomedical Sciences Seoul National University College of Medicine Seoul Korea
| | - Jihyun Kim
- Laboratory of Mucosal Immunology in Department of Biomedical Sciences Seoul National University College of Medicine Seoul Korea
| | - Hye Young Kim
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center Seoul National University College of Medicine Seoul Korea
- Laboratory of Mucosal Immunology in Department of Biomedical Sciences Seoul National University College of Medicine Seoul Korea
| | - Hye‐Ryun Kang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine Seoul National University College of Medicine Seoul Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center Seoul National University College of Medicine Seoul Korea
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8
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Stang J, Sikkeland LIB, Tufvesson E, Holm AM, Stensrud T, Carlsen KH. The Role of Airway Inflammation and Bronchial Hyperresponsiveness in Athlete's Asthma. Med Sci Sports Exerc 2019; 50:659-666. [PMID: 29189668 DOI: 10.1249/mss.0000000000001478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Asthma is frequently reported in endurance athletes. The aim of the present study was to assess the long-term airway inflammatory response to endurance exercise in high-level athletes with and without asthma. METHODS In a cross-sectional design, 20 asthmatic athletes (10 swimmers and 10 cross-country skiers), 19 athletes without asthma (10 swimmers and 9 cross-country skiers), and 24 healthy nonathletes completed methacholine bronchial challenge, lung function tests, and sputum induction on two separate days. All athletes competed on a national or international level and exercised ≥10 h·wk. The nonathletes exercised ≤5 h·wk and reported no previous lung disease. Bronchial hyperresponsiveness (BHR) was defined as a methacholine provocation dose causing 20% decrease in the forced expiratory volume in 1 s of ≤8 μmol. RESULTS BHR was present in 13 asthmatic athletes (62%), 11 healthy athletes (58%), and 8 healthy nonathletes (32%), and the prevalence differed among groups (P = 0.005). Sputum inflammatory and epithelial cell counts did not differ between groups and were within the normal range. Median (25th to 75th percentiles) sputum interleukin-8 was elevated in both asthmatic (378.4 [167.0-1123.4]) and healthy (340.2 [175.5-892.4]) athletes as compared with healthy nonathletes (216.6 [129.5-314.0], P = 0.02). No correlations were found between provocation dose causing 20% decrease and sputum cell counts. CONCLUSION Independent of asthma diagnosis, a high occurrence of BHR and an increased sputum interleukin-8 were found in athletes as compared with nonathletes. Airway inflammation or epithelial damage was not related to BHR.
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Affiliation(s)
- Julie Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Liv Ingunn Bjoner Sikkeland
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Ellen Tufvesson
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Are Martin Holm
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Kai-Håkon Carlsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY
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9
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Cavaleiro Rufo J, Paciência I, Silva D, Martins C, Madureira J, de Oliveira Fernandes E, Padrão P, Moreira P, Delgado L, Moreira A. Swimming pool exposure is associated with autonomic changes and increased airway reactivity to a beta-2 agonist in school aged children: A cross-sectional survey. PLoS One 2018. [PMID: 29529048 PMCID: PMC5846785 DOI: 10.1371/journal.pone.0193848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. Methods A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. Results Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case-case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. Conclusions Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
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Affiliation(s)
- João Cavaleiro Rufo
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- * E-mail:
| | - Inês Paciência
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Carla Martins
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Joana Madureira
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Eduardo de Oliveira Fernandes
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
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Boulet LP, Moreau SP, Villeneuve HÉ, Turmel J. Athletes Do Not Condition Inspired Air More Effectively than Nonathletes during Hyperpnea. Med Sci Sports Exerc 2017; 49:200-205. [PMID: 27471787 DOI: 10.1249/mss.0000000000001064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endurance athletes have a high prevalence of airway diseases, some possibly representing adaptive mechanisms to the need of conditioning large volumes of inspired air during high ventilation in specific environments. The aim of this study is to assess the ability to condition (warm and humidify) inspired air in athletes by measuring the difference between inhaled and exhaled air temperature (ΔT) during and after eucapnic voluntary hyperpnea (EVH) test. METHODS Twenty-three endurance athletes from various sports, 12 with airway hyperresponsiveness (AHR) and/or exercise-induced bronchoconstriction (EIB) (A+), 11 without AHR and/or EIB (A-), 12 nonathletes with AHR and/or EIB (C+), and 11 nonathletes without AHR and/or EIB (C-) were recruited. All subjects attended the laboratory on three occasions, twice for baseline characterization, including questionnaires, pulmonary function, methacholine bronchoprovocation, allergy skin prick tests, exhaled nitric oxide measurement, and a standard EVH, and once to perform a modified EVH to assess ΔT. Inspired and expired air temperatures were measured with a high-precision probe during EVH and at regular intervals until 30 min after the end of the test. RESULTS The global ΔT during the EVH was +5.8°C ± 1.5°C and +4.7°C ± 1.5°C during the 30 min after the EVH. No difference was found between groups for either the ΔT or the slope of ΔT, during and after the EVH. CONCLUSION This study shows no evidence of improved capacity to condition inspired air in endurance athletes, which could have suggested an increased bronchial blood flow or another adaptive mechanism. The absence of an adaptive mechanism could therefore contribute to airway damage observed in athletes in allowing colder but mainly dryer air to penetrate deeper in the lung.
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Valeriani F, Protano C, Vitali M, Romano Spica V. Swimming attendance during childhood and development of asthma: Meta-analysis. Pediatr Int 2017; 59:614-621. [PMID: 28032933 DOI: 10.1111/ped.13230] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/02/2016] [Accepted: 12/27/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between asthma and swimming pool attendance has not been demonstrated and currently there are conflicting results. In order to clarify the association between asthma diagnosis in children and swimming pool attendance, and to assess the consistency of the available epidemiological studies, we completed a literature analysis on the relationship between the exposure to disinfection by-products in indoor swimming pools during childhood and asthma diagnosis. METHODS Following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, a systematic review and meta-analysis was performed by searching MEDLINE via PubMed, TOXNET, and Scopus databases (from inception to 20 April 2015) using the key word "Asthma" together with "swimming pool", "disinfection by-products", "indoor air pollution" and "children". Inclusion criteria were: English language, a complete analytic study design involving a cohort of children (0-16 years), a well-defined definition of exposure, and the presence of data on effect and variance. Studies on in vivo, in vitro or professional and accidental exposure were excluded. RESULTS After a screening process, seven reports (n = 5851 subjects) were included out of a total of 2928 references. The reported OR of the association between swimming pool attendance and asthma prevalence ranged from 0.58 to 2.30. The present meta-analysis failed to identify a significant difference in asthma development between children attending swimming pools and controls (OR, 1.084; 95% CI: 0.89-1.31). CONCLUSIONS Swimming in childhood does not increase the likelihood of doctor-diagnosed asthma. Based on this meta-analysis review, the association of the disease with indoor pool attendance is still unclear.
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Affiliation(s)
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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12
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McGovern T, Goldberger M, Chen M, Allard B, Hamamoto Y, Kanaoka Y, Austen KF, Powell WS, Martin JG. CysLT1 Receptor Is Protective against Oxidative Stress in a Model of Irritant-Induced Asthma. THE JOURNAL OF IMMUNOLOGY 2016; 197:266-77. [PMID: 27226094 DOI: 10.4049/jimmunol.1501084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 04/20/2016] [Indexed: 12/30/2022]
Abstract
The bronchoconstrictive and proinflammatory properties of cysteinyl leukotrienes (cysLTs) in allergic asthma mediate their effects predominantly through the cysLT1 receptor (cysLT1R). However, the role of cysLTs and cysLT1R in innate immune-triggered asthma is largely unexplored. We explored the synthesis of cysLTs and cysLT1R as determinants of airway responses in an oxidative stress-induced model of irritant asthma. Wild-type (WT) mice exposed to 100 ppm Cl2 for 5 min had airway neutrophilia, increased cysLT production, and pulmonary expression of cysLT-related biosynthetic genes. CysLT1R-deficient (CysLTr1(-/-)) mice that were exposed to Cl2 demonstrated airway hyperresponsiveness to inhaled methacholine significantly greater than in WT BALB/c mice. Compared to WT mice, airway neutrophilia and keratinocyte chemoattractant production levels were higher in CysLTr1(-/-) mice and airway hyperresponsiveness was ameliorated using a granulocyte depletion Ab. CysLTr1(-/-) mice also demonstrated prolonged bronchial epithelial cell apoptosis following Cl2 WT mice showed increased antioxidant and NF erythroid 2-related factor 2 (Nrf2) gene expression, Nrf2 nuclear translocation in bronchial epithelial cells, and increased reduced glutathione/oxidized glutathione following Cl2 exposure whereas CysLTr1(-/-) mice did not. Furthermore, CysLTr1(-/-) mice demonstrated increased pulmonary E-cadherin expression and soluble E-cadherin shedding compared with WT mice. Loss of a functional cysLT1R results in aberrant antioxidant response and increased susceptibility to oxidative injury, apparently via a cysLT1R-dependent impairment of Nrf2 function.
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Affiliation(s)
- Toby McGovern
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Madison Goldberger
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Michael Chen
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Benoit Allard
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Yoichiro Hamamoto
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Yoshihide Kanaoka
- Department of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA 02130; and Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - K Frank Austen
- Department of Allergy and Immunology, Brigham and Women's Hospital, Boston, MA 02130; and Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - William S Powell
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada
| | - James G Martin
- Meakins-Christie Laboratories, McGill University Health Centre and McGill University, Montreal, Quebec H4A 3J1, Canada;
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Abstract
The prevalence of airway dysfunction in elite swimmers is among the highest in elite athletes. The traditional view that swimmers naturally gravitate toward swimming because of preexisting respiratory disorders has been challenged. There is now sufficient evidence that the higher prevalence of bronchial tone disorders in elite swimmers is not the result of a natural selection bias. Rather, the combined effects of repeated chlorine by-product exposure and chronic endurance training can lead to airway dysfunction and atopy. This review will detail the underpinning causes of airway dysfunction observed in elite swimmers. It will also show that airway dysfunction does not prevent success in elite level swimming. Neither does it inhibit lung growth and might be partially reversible when elite swimmers retire from competition.
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Affiliation(s)
- Mitch Lomax
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
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Update on the Mechanisms of Pulmonary Inflammation and Oxidative Imbalance Induced by Exercise. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:4868536. [PMID: 26881028 PMCID: PMC4736402 DOI: 10.1155/2016/4868536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/02/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022]
Abstract
The mechanisms involved in the generation of oxidative damage and lung inflammation induced by physical exercise are described. Changes in lung function induced by exercise involve cooling of the airways, fluid evaporation of the epithelial surface, increased contact with polluting substances, and activation of the local and systemic inflammatory response. The present work includes evidence obtained from the different types of exercise in terms of duration and intensity, the effect of both acute performance and chronic performance, and the influence of special conditions such as cold weather, high altitude, and polluted environments. Levels of prooxidants, antioxidants, oxidative damage to biomolecules, and cellularity, as well as levels of soluble mediators of the inflammatory response and its effects on tissues, are described in samples of lung origin. These samples include tissue homogenates, induced sputum, bronchoalveolar lavage fluid, biopsies, and exhaled breath condensate obtained in experimental protocols conducted on animal and human models. Finally, the need to simultaneously explore the oxidative/inflammatory parameters to establish the interrelation between them is highlighted.
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Mazic S, Lazovic B, Djelic M, Suzic-Lazic J, Djordjevic-Saranovic S, Durmic T, Soldatovic I, Zikic D, Gluvic Z, Zugic V. Respiratory parameters in elite athletes--does sport have an influence? REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:192-7. [PMID: 25926244 DOI: 10.1016/j.rppnen.2014.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/29/2014] [Accepted: 12/12/2014] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Unlike large population studies about cardiovascular components and how they adapt to intensive physical activity, there is less research into the causes of enlargement of the respiratory system in athletes (e.g. vital capacity, maximum flow rates and pulmonary diffusion capacity). The purpose of this research was to study and compare pulmonary function in different types of sports and compare them with controls in order to find out which sports improve lung function the most. MATERIALS AND METHOD Pulmonary functional capacities, vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and maximum voluntary ventilation (MVV) of 493 top athletes belonging to 15 different sports disciplines and of 16 sedentary individuals were studied. Pulmonary function test was performed according to ATS/ERS guidelines. RESULTS Basketball, water polo players and rowers had statistically higher vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) than the healthy sedentary control individuals. Football and volleyball players had lower VC while FVC was higher in the football group compared to controls. Peak expiratory flow was lower in boxing, kayak, rugby, handball, taekwondo and tennis. The maximum voluntary ventilation (MVV) was significantly higher in water polo players and rowers. Boxers had statistically lower MVV than the controls. Players of other sports did not differ from the control group. CONCLUSION The study suggests that specific type of training used in basketball, water polo or rowing could have potential for improving pulmonary function and rehabilitation.
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Affiliation(s)
- S Mazic
- Institute of Medical Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - B Lazovic
- University Hospital Center Zemun-Belgrade, Internal Medicine Clinic, Belgrade, Serbia.
| | - M Djelic
- Institute of Medical Physiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - J Suzic-Lazic
- University Hospital Center Dr Dragisa Misovic, Internal Medicine Clinic, Belgrade, Serbia
| | | | - T Durmic
- University Hospital Center Zemun-Belgrade, Internal Medicine Clinic, Belgrade, Serbia
| | - I Soldatovic
- Institute of Statistics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Zikic
- Institute of Medical Biophysics, School of Medicine, Belgrade University, Belgrade, Serbia
| | - Z Gluvic
- University Hospital Center Zemun-Belgrade, Internal Medicine Clinic, Belgrade, Serbia
| | - V Zugic
- School of Medicine, University of Belgrade, Clinic for Lung Diseases, Clinical Center of Serbia, Belgrade, Serbia
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Triki M, Rebai H, Aouichaoui C, Shamssain M, Masmoudi K, Fellmann N, Zouari H, Zouari N, Tabka Z. Comparative Study of Bronchial Hyperresponsiveness Between Football and Judo Groups in Prepubertal Boys. Asian J Sports Med 2015; 6:e24043. [PMID: 26448837 PMCID: PMC4592761 DOI: 10.5812/asjsm.6(2)2015.24043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/09/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exercise induced bronchospasm (EIB) commonly occurs during exercise. The comparative effects of different sports on airway responsiveness among prepubertal boys remain to be determined. OBJECTIVES To assess differences in post exercise spirometry between footballers, judokas and a control group in prepubertal boys. PATIENTS AND METHODS A total of ninety six prepubertal boys were studied. Bronchial hyper responsiveness (BHR) to exercise challenge test was defined by a diagnosis of baseline spirometry, followed by an incremental exercise test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity exercise. A 10% or greater post-challenge fall in forced expiratory volume in FEV1 is used as a diagnostic criterion. RESULTS There was no significant difference in baseline spirometry between all groups (P > 0.05). The post exercise spirometry test revealed the presence of EIB in 16 of 32 (50%) footballers against 9 out of 32 (28.12%) in both judokas and control subjects at 5 min after the exercise. Also, there was a significantly higher decrease (P < 0.05) in mean FEV1 at 5 minuts in footballers (-9.60 ± 6.18) compared to judokas (-5.41 ± 5.85). CONCLUSIONS The footballers have more BHR than judokas, especially at 5min after the exercise. This may be due to prolonged hyperventilation, atopy and increased exposure to inhaled allergens and pollutants during training and competition.
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Affiliation(s)
- Moez Triki
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Haithem Rebai
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Chirine Aouichaoui
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Mohammed Shamssain
- Division School of Health Sciences, Darwin Building, University of Sunderland, Sunderland, UK
| | | | - Nicole Fellmann
- Laboratory of Sports Physiology and Biology, Faculty of medicine, University of Auvergne, Clermont-Ferrand, France
- G. Montpied Hospital, Clermont-Ferrand, France
| | - Hela Zouari
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Nouri Zouari
- Bourguiba Hospital of Sfax, University of Sfax, Sfax, Tunisia
| | - Zouhair Tabka
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
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Abstract
CONTEXT Acute febrile illnesses are common in athletes over the course of training and competition seasons. Complete recovery and rapid yet safe return to participation are critical for competitive athletes. Alterations in thermoregulation, metabolism, fluid homeostasis, muscle strength, and endurance, as well as potential complications for the athlete and others, must be considered. EVIDENCE ACQUISITION The PubMed database was searched (1970-2013) for all English-language articles related to febrile illness in sport, using the keywords fever, febrile, body temperature, thermoregulation, infection, illness, disease, exercise, athlete, sport, performance, return to play, metabolism, hydration, and dehydration. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Limited data confirm that febrile illness is correlated with alterations in the body's thermoregulatory system, with increases in metabolic rate, and with effects in fluid homeostasis. Human and animal studies demonstrate a decrease in muscle strength and endurance secondary to muscle catabolism in febrile illness. However, indirect evidence suggests that regular exercise enhances the immune response. No strong clinical research has been published on return to play during or following acute febrile illness, excluding mononucleosis and myocarditis. CONCLUSION Fever is correlated with an increase in insensible fluid losses, dehydration, metabolic demands, and dysregulation of body temperature. Fever can have detrimental effects on the musculoskeletal system, including decreasing strength and endurance, generalized muscle catabolism, and increase in perceived fatigue. Participating in strenuous exercise during febrile illness can worsen the illness and has demonstrated increased lethality in animal models. No consensus recommendations support return to activity before resolution of fever, and training should be resumed gradually once fever and dehydration have resolved.
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Affiliation(s)
- Natalie A. Dick
- Department of Family Medicine, Riverside Methodist Primary Care Sports Medicine Fellowship, Dublin, Ohio
| | - Jason J. Diehl
- Department of Family Medicine, OhioHealth/MAX Sports Medicine, Riverside Methodist Sports Medicine, Fellowship, Dublin, Ohio
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Effects of indoor swimming pools on the nasal cytology of pool workers. The Journal of Laryngology & Otology 2014; 128:442-6. [PMID: 24762781 DOI: 10.1017/s0022215114000784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to evaluate the relationship between swimming pool pollutants and allergic rhinitis in swimming pool workers. MATERIALS AND METHODS Twenty-seven indoor pool workers (group 1) and 49 control subjects (group 2) were enrolled in the study. A skin prick test was performed and a nasal smear was obtained from each subject to evaluate rhinitis. RESULTS When the groups were compared in terms of epithelial cells, group 1 had significantly more epithelial cells than group 2. When the groups were compared with regard to eosinophils, group 1 had significantly more eosinophils than group 2. The skin prick test results for both groups were not significantly different. CONCLUSION Indoor pool workers showed severe symptoms of rhinitis and eosinophilic nasal cytology, likely due to chlorine. Nasal cytology is an easy-to-administer diagnostic test and can be used to follow up rhinitis in indoor pool workers, along with nasal endoscopy, a detailed clinical history and a skin prick test.
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Myrianthefs P, Grammatopoulou I, Katsoulas T, Baltopoulos G. Spirometry may underestimate airway obstruction in professional Greek athletes. CLINICAL RESPIRATORY JOURNAL 2013; 8:240-7. [DOI: 10.1111/crj.12066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/25/2013] [Accepted: 10/13/2013] [Indexed: 12/23/2022]
Affiliation(s)
- Pavlos Myrianthefs
- Athens University School of Nursing; ICU at ‘Agioi Anargyroi’ General Hospital; Athens Greece
| | - Irini Grammatopoulou
- Athens University School of Nursing; ICU at ‘Agioi Anargyroi’ General Hospital; Athens Greece
| | - Theodoros Katsoulas
- Athens University School of Nursing; ICU at ‘Agioi Anargyroi’ General Hospital; Athens Greece
| | - George Baltopoulos
- Athens University School of Nursing; ICU at ‘Agioi Anargyroi’ General Hospital; Athens Greece
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Bougault V, Boulet LP. Is there a potential link between indoor chlorinated pool environment and airway remodeling/inflammation in swimmers? Expert Rev Respir Med 2013; 6:469-71. [PMID: 23134238 DOI: 10.1586/ers.12.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Marek E, Volke J, Mückenhoff K, Platen P, Marek W. Exercise in Cold Air and Hydrogen Peroxide Release in Exhaled Breath Condensate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 756:169-77. [DOI: 10.1007/978-94-007-4549-0_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Poussel M, Chenuel B. [Exercise-induced bronchoconstriction in non-asthmatic athletes]. Rev Mal Respir 2010; 27:898-906. [PMID: 20965404 DOI: 10.1016/j.rmr.2010.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A new clinical entity, exercise-induced bronchoconstriction (EIB), has been recently defined which describes bronchoconstriction occurring in association with exercise in susceptible non-asthmatic persons. STATE OF ART There is considerable evidence that the pathogenesis of this condition is related to airway injury, due to prolonged hyperventilation and aggressive environmental factors. If the objective diagnostic tests are identical for the diagnosis of exercise induced asthma and EIB, the diagnoses are established differently, according to the high sensitivity of provocation by exercise "in the field" or the eucapnic voluntary hyperventilation provocation test. PERSPECTIVES Current pharmacological treatment is based upon the inhalation of ß2-agonists prior to exercise, but to be granted permission to use them, athletes are required to provide documentation of objective evidence of EIB. Therefore, the diagnostic pathway in athletes is essential and respiratory physicians need to know the specific features of this new clinical entity. CONCLUSIONS EIB distinct from the presence of asthma is prevalent in elite athletes and its determinants should be well known by their health care providers to assure an optimal management of this peculiar disease, in respect to drug doping regulations.
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Affiliation(s)
- M Poussel
- Service des explorations fonctionnelles respiratoires et de l'aptitude à l'exercice, CHU de Nancy-Brabois Adultes, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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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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24
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Weisel CP, Richardson SD, Nemery B, Aggazzotti G, Baraldi E, Blatchley ER, Blount BC, Carlsen KH, Eggleston PA, Frimmel FH, Goodman M, Gordon G, Grinshpun SA, Heederik D, Kogevinas M, LaKind JS, Nieuwenhuijsen MJ, Piper FC, Sattar SA. Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:500-7. [PMID: 19440486 PMCID: PMC2679591 DOI: 10.1289/ehp.11513] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 09/30/2008] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children's exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue. DATA SOURCES A workshop was held in Leuven, Belgium, 21-23 August 2007, to evaluate the literature and to develop a research agenda to better understand children's exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs. SYNTHESIS Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection. CONCLUSIONS Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.
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Affiliation(s)
- Clifford P Weisel
- Environmental and Occupational Health Sciences Institute, Robert Wood Johnson Medical School/University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey 08854, USA.
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The acute effect of swimming on airway inflammation in adolescent elite swimmers. J Allergy Clin Immunol 2009; 123:502-4. [PMID: 19203664 DOI: 10.1016/j.jaci.2008.11.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Revised: 11/21/2008] [Accepted: 11/24/2008] [Indexed: 11/20/2022]
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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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Fitch KD, Sue-Chu M, Anderson SD, Boulet LP, Hancox RJ, McKenzie DC, Backer V, Rundell KW, Alonso JM, Kippelen P, Cummiskey JM, Garnier A, Ljungqvist A. Asthma and the elite athlete: summary of the International Olympic Committee's consensus conference, Lausanne, Switzerland, January 22-24, 2008. J Allergy Clin Immunol 2008; 122:254-60, 260.e1-7. [PMID: 18678340 DOI: 10.1016/j.jaci.2008.07.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 07/03/2008] [Accepted: 07/03/2008] [Indexed: 11/18/2022]
Abstract
Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled beta(2)-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to beta(2)-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale beta(2)-agonists will continue.
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Affiliation(s)
- Kenneth D Fitch
- School of Sports Science, Exercise and Health, Faculty of Life Sciences, University of Western Australia, Crawley, Australia.
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