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Verhey JT, Poon SK. General Medical Emergencies in Athletes. Clin Sports Med 2023; 42:427-440. [PMID: 37208057 DOI: 10.1016/j.csm.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article focuses on the management of the most common on-field medical emergencies. As with any discipline in medicine, a well-defined plan and systematic approach is the cornerstone of quality health care delivery. In addition, the team-based collaboration is necessary for the safety of the athlete and the success of the treatment plan.
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Affiliation(s)
- Jens T Verhey
- Orthopaedic Surgery Residency, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Steven K Poon
- Sports Medicine Section, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
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2
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Hansen NB, Henriksen M, Dall CH, Vest S, Larsen L, Suppli Ulrik C, Backer V. Physical activity, physical capacity and sedentary behavior among asthma patients. Eur Clin Respir J 2022; 9:2101599. [PMID: 36105719 PMCID: PMC9467604 DOI: 10.1080/20018525.2022.2101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND: Although exercise and daily physical activity (PA) have long been known to benefit patients with chronic disorders, knowledge is limited regarding asthma. OBJECTIVE: In a Danish setting, our aim was to measure physical activity, sedentary behavior, and physical capacity among patients with asthma. We hypothesized that people with severe asthma would be less active and more sedentary than their mild-moderate counterparts. METHODS: Adults with asthma were recruited through respiratory outpatient clinics and subsequently examined twice, 4 weeks apart. At each visit, participants underwent a series of lung function tests, questionnaires, and maximum oxygen uptake testing (VO2max). Between the visits, participants wore an accelerometer continuously for 4 weeks, measuring sedentary time and daily steps. Sixty patients, 27 with mild-moderate asthma (GINA 1–3) and 33 with severe asthma (GINA 4–5), completed both visits and had valid accelerometer measurements. RESULTS: No significant differences between the two groups were found in sedentary time, number of steps or VO2max. VO2max was significantly correlated with FeNO (r = −0.30, p < 0.05), Short Form-12 Mental Health (r = 0.37, p < 0.05), Asthma Control Questionnaire (r = −0.35, p < 0.05), and Mini Asthma Quality of Life Questionnaire (r = 0.36, p < 0.05). CONCLUSION: No differences were observed between patients with mild-moderate and severe asthma regarding sedentary behavior, daily steps or level of cardiopulmonary fitness. Furthermore, patients with the highest VO2max had the higher quality of life scores. Abbreviations: VO2max: Maximal Oxygen Uptake; CPET: Cardiopulmonary Exercise Testing; BMI: Body Mass Index; FEV1: Forced Expired Volume in the First Second; FVC: Forced Vital Capacity; PEF: Peak Expiratory Flow; EIB: Exercise-Induced Bronchoconstriction; COPD: Chronic Obstructive Pulmonary Disease; ACQ: Asthma Control Questionnaire; Mini-AQLQ: Mini Asthma Quality of Life Questionnaire; SF-12: Short Form 12 Health Survey; SNOT-22: Sino-Nasal Outcome Test 22; GINA: The Global Initiative for Asthma; CRP: C-reactive Protein; Hgb:Hemoglobin count; EOS: Eosinophil count; EVH: Eucapnic Voluntary Hyperventilation; FeNO: Fractional Exhaled Nitric Oxide; PA: Physical Activity ERS: European Respiratory Society; ATS: American Thoracic Society; CRS: Chronic Rhinosinusitis; AHR: Airway Hyperresponsiveness
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Affiliation(s)
- Nikolaj Brix Hansen
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Christian Have Dall
- The Parker Institute, Copenhagen University Hospital - Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Susanne Vest
- Department of Respiratory and Infection Medicine, North Zealand Hospital, Hilleroed, Denmark
| | - Lotte Larsen
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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3
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Birat A, Garnier Y, Dodu A, Grossoeuvre C, Dupont AC, Mucci P, Blazevich A, Rance M, Morel C, Nottin S, Ratel S. Changes in pulmonary function after long-duration adventure racing in adolescent athletes. Int J Sports Med 2021; 43:687-693. [PMID: 34875701 DOI: 10.1055/a-1715-7199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study investigated the acute effects of a mixed-modality, long-duration adventure race on pulmonary function in adolescent athletes. Twenty male adolescents aged 14 to 17 years volunteered to participate in a wilderness adventure race of 68.5-km. Expiratory function was evaluated before, immediately after, and 24 h after race completion. Measurements included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF). Maximal inspiratory and expiratory mouth static pressures (MIP and MEP, respectively) were also measured using a portable hand-held mouth pressure meter across the same time points. The mean completion time of the race was 05:38 ± 00:20 hours. A significant post-race decrease in FVC was observed immediately after the race (-5.2%, p = 0.01). However, no significant changes were observed for FEV1, PEF and the FEV1/FVC and FEV1/PEF ratios. In addition, estimates of respiratory muscle strength (MIP and MEP) were unaffected by the race. The long-duration adventure race induced no marked reduction in expiratory pulmonary function and this response was associated with no apparent respiratory muscle fatigue. Therefore, the pulmonary system of trained adolescent athletes was sufficiently robust to sustain the mixed-modality, long-duration adventure race of ∽5-6 h.
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Affiliation(s)
- Anthony Birat
- Fédération Française de Triathlon, Fédération Française de Triathlon et des Disciplines Enchaînées, Saint-Denis, France.,AME2P, Clermont Auvergne University, Aubière, France
| | - Yoann Garnier
- AME2P, Clermont Auvergne University, Aubière, France
| | - Alexandre Dodu
- Fédération Française de Triathlon, Fédération Française de Triathlon et des Disciplines Enchaînées, Saint-Denis, France
| | - Claire Grossoeuvre
- Fédération Française de Triathlon, Fédération Française de Triathlon et des Disciplines Enchaînées, Saint-Denis, France
| | - Anne-Charlotte Dupont
- Fédération Française de Triathlon, Fédération Française de Triathlon et des Disciplines Enchaînées, Saint-Denis, France.,Imagerie Adaptative Diagnostique et Interventionnelle, Université de Lorraine, Nancy, France
| | - Patrick Mucci
- Faculté des Sciences du Sport, University of Lille, Lille, France
| | - Anthony Blazevich
- Centre for Exercise and Sports Science Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Mélanie Rance
- CREPS, Centre de Ressources d'Expertise et de Performance Sportive, Bellerive-sur-Allier, France
| | - Claire Morel
- CREPS, Centre de Ressources d'Expertise et de Performance Sportive, Bellerive-sur-Allier, France
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Hodgson JR, Chapman L, Pope FD. The Diamond League athletic series: does the air quality sparkle? INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1427-1442. [PMID: 33760979 PMCID: PMC7988253 DOI: 10.1007/s00484-021-02114-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Urban air pollution can have negative short- and long-term impacts on health, including cardiovascular, neurological, immune system and developmental damage. The irritant qualities of pollutants such as ozone (O3), nitrogen dioxide (NO2) and particulate matter (PM) can cause respiratory and cardiovascular distress, which can be heightened during physical activity and particularly so for those with respiratory conditions such as asthma. Previously, research has only examined marathon run outcomes or running under laboratory settings. This study focuses on elite 5-km athletes performing in international events at nine locations. Local meteorological and air quality data are used in conjunction with race performance metrics from the Diamond League Athletics series to determine the extent to which elite competitors are influenced during maximal sustained efforts in real-world conditions. The findings from this study suggest that local meteorological variables (temperature, wind speed and relative humidity) and air quality (ozone and particulate matter) have an impact on athletic performance. Variation between finishing times at different race locations can also be explained by the local meteorology and air quality conditions seen during races.
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Affiliation(s)
- James R Hodgson
- School of Geography, Earth and Environmental Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | - Lee Chapman
- School of Geography, Earth and Environmental Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, B15 2TT, Birmingham, UK.
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5
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Rodriguez Bauza DE, Silveyra P. Sex Differences in Exercise-Induced Bronchoconstriction in Athletes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197270. [PMID: 33027929 PMCID: PMC7579110 DOI: 10.3390/ijerph17197270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. It is estimated that about 90% of patients with underlying asthma (a sexually dimorphic disease) experience EIB; however, sex differences in EIB have not been studied extensively. With the goal of better understanding the prevalence of EIB in males and females, and because atopy has been reported to occur at higher rates in athletes, in this study, we investigated sex differences in EIB and atopy in athletes. A systematic literature review identified 60 studies evaluating EIB and/or atopy in post-pubertal adult athletes (n = 7501). Collectively, these studies reported: (1) a 23% prevalence of EIB in athletes; (2) a higher prevalence of atopy in male vs. female athletes; (3) a higher prevalence of atopy in athletes with EIB; (4) a significantly higher rate of atopic EIB in male vs. female athletes. Our analysis indicates that the physiological changes that occur during exercise may differentially affect male and female athletes, and suggest an interaction between male sex, exercise, and atopic status in the course of EIB. Understanding these sex differences is important to provide personalized management plans to athletes with underlying asthma and/or atopy.
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Affiliation(s)
| | - Patricia Silveyra
- Biobehavioral Laboratory, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27713, USA
- Correspondence:
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6
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Nitter TB, Hirsch Svendsen KV. Covariation amongst pool management, trichloramine exposure and asthma for swimmers in Norway. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 723:138070. [PMID: 32217397 DOI: 10.1016/j.scitotenv.2020.138070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 03/18/2020] [Indexed: 06/10/2023]
Abstract
The association between asthma and exposure to the air in swimming facilities has been acknowledged. However, the variation in, long-term exposure to and management of the respiratory irritant trichloramine (NCl3) is not well understood. In this study, 313 swimmers above 18 years of age licensed by the Norwegian Swimming Association answered a questionnaire about health and swimming. The prevalence of asthma amongst the most-exposed swimmers was 36%. Two facilities, those with the highest and lowest reported prevalence of asthma, were chosen for further investigation. For each facility, a one-week-long monitoring campaign was performed, during which pool management, air and water quality were investigated. The results of this study showed that time of day, occupancy and pool management affect the concentration of NCl3, which ranged from 58 μg/m3 to 461 μg/m3. Furthermore, in one of the facilities, the concentration of CO2 was measured to evaluate whether this contaminant could be used to predict the number of pool occupants as well as the concentration of NCl3 in the air. The concentration of CO2 was significantly correlated with occupancy level (ρ = 0.82, p = 0.01) and NCl3 concentration (r = 0.80, p = 0.01). Furthermore, according to the random intercept model the concentration of CO2 explained 52% of the variation observed in the air concentration of NCl3. CO2 sensors to control the air supply can help reduce the air concentrations of NCl3 and balance the air supply based on occupancy level.
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Affiliation(s)
- Therese Bergh Nitter
- Department of Civil and Environmental Engineering, Norwegian University of Science and Technology (NTNU), Norway; Department of Industrial Economics and Technology Management, NTNU, Norway.
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Swinarew AS, Stanula AJ, Gabor J, Raif P, Paluch J, Karpiński J, Kubik K, Okła H, Ostrowski A, Tkacz E, Skoczyński S, Waśkiewicz Z, Rosemann T, Nikolaidis PT, Knechtle B. The influence of chlorine in indoor swimming pools on the composition of breathing phase of professional swimmers. Respir Res 2020; 21:88. [PMID: 32295600 PMCID: PMC7161211 DOI: 10.1186/s12931-020-01350-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/02/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Swimming is one of the most popular forms of physical activity. Pool water is cleaned with chlorine, which - in combination with compounds contained in water - could form chloramines and trichloromethane in the swimmer's lungs. The aim of the present study was to examine the effect of swimming training in an indoor pool on the composition of swimmers' respiratory phase metabolomics, and develop a system to provide basic information about its impact on the swimmer's airway mucosa metabolism, which could help to assess the risk of secondary respiratory tract diseases i.e. sport results, condition, and health including lung acute and chronic diseases). DESIGN A group of competitive swimmers participated in the study and samples of their respiratory phase before training, immediately after training, and 2 h after training were assessed. METHODS Sixteen male national and international-level competitive swimmers participated in this study. Respiratory phase analysis of the indoor swimming pool swimmers was performed. Gas chromatography combined with mass spectrometry (GCMS) was used in the measurements. All collected data were transferred to numerical analysis for trends of tracking and mapping. The breathing phase was collected on special porous material and analyzed using GCMS headspace. RESULTS The obtained samples of exhaled air were composed of significantly different metabolomics when compared before, during and after exercise training. This suggests that exposition to indoor chlorine causes changes in the airway mucosa. CONCLUSION This phenomenon may be explained by occurrence of a chlorine-initiated bio-reaction in the swimmers' lungs. The obtained results indicate that chromatographic exhaled gas analysis is a sensitive method of pulmonary metabolomic changes assessment. Presented analysis of swimmers exhaled air indicates, that indoor swimming may be responsible for airway irritation caused by volatile chlorine compounds and their influence on lung metabolism.
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Affiliation(s)
- Andrzej S. Swinarew
- Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Arkadiusz J. Stanula
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Jadwiga Gabor
- Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Paweł Raif
- Department of Biosensors and Biomedical Signals Processing, Faculty of Biomedical Engineering, Silesian University of Technology in Gliwice, Gliwice, Poland
| | - Jarosław Paluch
- Department of Laryngology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jakub Karpiński
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Klaudia Kubik
- Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Hubert Okła
- Faculty of Science and Technology, University of Silesia in Katowice, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Andrzej Ostrowski
- Department of Water Sports, Academy of Physical Education, Kraków, Poland
| | - Ewaryst Tkacz
- Department of Biosensors and Biomedical Signals Processing, Faculty of Biomedical Engineering, Silesian University of Technology in Gliwice, Gliwice, Poland
| | - Szymon Skoczyński
- Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Waśkiewicz
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
- Department of Sports Medicine and Medical Rehabilitation, Sechenov University, Moscow, 119991 Russia
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, Vadianstrasse 26, 9001 St. Gallen, Switzerland
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Stensrud T, Rossvoll Ø, Mathiassen M, Melau J, Illidi C, Østgaard HN, Hisdal J, Stang J. Lung function and oxygen saturation after participation in Norseman Xtreme Triathlon. Scand J Med Sci Sports 2020; 30:1008-1016. [PMID: 32153035 DOI: 10.1111/sms.13651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine evidence of exercise-induced bronchoconstriction (EIB) defined as ≥10% reduction in forced expiratory volume in one second (FEV1 ) and exercise-induced arterial hypoxemia (EIAH) defined as ≥4% reduction in oxygen saturation (SpO2 ) from before to after participation in the Norseman Xtreme Triathlon. Secondarily, to assess whether changes in FEV1 and SpO2 are related to respiratory symptoms, training volume, and race time. METHODS In this quasi-experimental non-controlled study, we included 63 triathletes (50♂/13♀) aged 40.3 (±9.0) years (mean ± SD). Fifty-seven (46♂/11♀) measured lung function and 54 (44♂/10♀) measured SpO2 before the race, 8-10 minutes after the race (post-test 1) and the day after the race (post-test 2). Respiratory symptoms and training volume were recorded with modified AQUA questionnaire. ANOVA for repeated measures was used to detect differences in lung function and SpO2 . Statistical significance was accepted at 0.05 level. RESULTS Twenty-six participants (46%) presented with EIB at post-test 1 and 16 (28%) at post-test 2. Lung function variables were significantly reduced from baseline to post-test 1 and 2. Thirty-five participants (65%) showed evidence of mild to moderate EIAH. No significant correlations were observed except a weak correlation between maximal reduction in FEV1 and respiratory symptoms (r = 0.35, P = .016). CONCLUSION Our results demonstrated that 46% of the participants presented with EIB and 65% showed evidence of EIAH after the Norseman Xtreme Triathlon. Changes in FEV1 and SpO2 were not correlated to weekly training hours or race time. We observed a weak correlation between maximal reduction in FEV1 and respiratory symptoms.
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Affiliation(s)
- Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Øyvind Rossvoll
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Jørgen Melau
- Prehospital Division, Vestfold Hospital Trust, Tønsberg, Norway
| | - Camilla Illidi
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Centre of Health, Exercise and Performance, College of health & Life Sciences, Brunel University, London, UK
| | - Hege N Østgaard
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jonny Hisdal
- Department of vascular surgery, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Julie Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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9
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Exercise-induced bronchoconstriction in elite or endurance athletes:: Pathogenesis and diagnostic considerations. Ann Allergy Asthma Immunol 2020; 125:47-54. [PMID: 32035936 DOI: 10.1016/j.anai.2020.01.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review the pathogenesis and evaluation of exercise-induced bronchoconstriction pertaining to the elite or endurance athlete, as well as propose a diagnostic algorithm based on the current literature. DATA SOURCES Studies were identified using Ovid MEDLINE and reference lists of key articles. STUDY SELECTIONS Randomized controlled trials were selected when available. Systematic reviews and meta-analyses of peer-reviewed literature were included, as were retrospective studies and observational studies of clinical interest. RESULTS Exercise-induced bronchoconstriction (EIB) is the physiologic entity in which exercise induces acute narrowing of the airways and occurs in patients both with and without asthma. It may present with or without respiratory symptoms, and the underlying cause is likely attributable to environment stressors to the airway encountered during exercise. These include the osmotic effects of inhaled dry air, temperature variations, autonomic nervous system dysregulation, sensory nerve reactivity, and airway epithelial injury. Deposition of allergens, particulate matter, and gaseous pollutants into the airway also contribute. Elite and endurance athletes are exposed to these stressors more frequently and in greater duration than the general population. CONCLUSION A greater awareness of EIB among elite and endurance athletes is needed, and a thorough evaluation should be performed if EIB is suspected in this population. We propose an algorithm to aid in this evaluation. Symptoms should not be solely relied on for diagnosis but should be taken into the context of bronchoprovocative challenges, which should replicate the competitive environment as closely as possible. Further research is needed to validate these tests' predictive values.
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Abstract
Asthma is a chronic lower respiratory disease that is very common worldwide, and its incidence is increasing year by year. Since the 1970s, asthma has become widespread, with approximately 300 million people affected worldwide and about 250,000 people have lost their lives. Asthma seriously affects people's physical and mental health, resulting in reduced learning efficiency, limited physical activities, and decreased quality of life. Therefore, raising awareness of the risk of asthma and how to effectively treat asthma have become important targets for the prevention and management of asthma in recent years. For patients with asthma, exercise training is a widely accepted adjunct to drug-based and non-pharmacological treatment. It has been recommended abroad that exercise prescriptions are an important part of asthma management.
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Affiliation(s)
- Shengguang Ding
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chongjun Zhong
- Department of Thoracic and Cardiovascular Surgery, The Second Affiliated Hospital of Nantong University, Nantong, China
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11
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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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Jones AW, Davison G. Exercise, Immunity, and Illness. MUSCLE AND EXERCISE PHYSIOLOGY 2019. [PMCID: PMC7149380 DOI: 10.1016/b978-0-12-814593-7.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
It is generally accepted that moderate amounts of exercise improve immune system functions and hence reduce the risk of infection whereas athletes engaged in regular prolonged and/or intensive training have a higher than “normal” incidence of minor infections, especially of the upper respiratory tract (URT, e.g., common cold and influenza). This is likely related to regular acute (and possibly chronic) periods of exercise-induced changes in immune function. URT infections can compromise performance directly if suffered shortly before or during competition or indirectly if suffered at other times via effects on training and/or physiological adaptations. This chapter covers the effects of exercise (acute and chronic), both positive and negative, on immune function and consequent infection risk, and considers the current state-of-the-art for monitoring and assessing this in athletes.
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13
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de Genaro IS, de Almeida FM, Hizume-Kunzler DC, Moriya HT, Silva RA, Cruz JCG, Lopes RB, Righetti RF, de Paula Vieira R, Saiki M, Martins MA, Tibério IDFLC, Arantes-Costa FM, Saraiva-Romanholo BM. Low dose of chlorine exposure exacerbates nasal and pulmonary allergic inflammation in mice. Sci Rep 2018; 8:12636. [PMID: 30135462 PMCID: PMC6105688 DOI: 10.1038/s41598-018-30851-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/31/2018] [Indexed: 01/22/2023] Open
Abstract
Work-exacerbated asthma (WEA) is defined as preexisting asthma that worsens with exposure to irritants [e.g., chlorine (Cl2) derivatives] in the workplace. The maximum allowable concentration in the workplace of Cl2 exposure is 3 mg/ m3 (described in OSHA). We investigated in an experimental asthma model in mice the effects of a single exposure to a sodium hypochlorite dose with this allowed chlorine concentration and a tenfold higher dose. Acute chlorine exposure at 3.3 mg/m3 in the OVA-sensitized group increased eosinophils in the peribronquial infiltrate, cytokine production, nasal mucus production and the number of iNOS positive cells in the distal lung compared to only sensitized mice. The exposure to a higher dose of 33.3 mg/m3 in the OVA-sensitized group resulted in an increase in respiratory system elastance, in the total and differential numbers of inflammatory cells in bronchoalveolar lavage fluid, IL-4, IL-5, and IL-17 in the lungs, eosinophils in peribronquial infiltrate and mucus content in nasal compared to non-exposed and sensitized animals. In this asthma model, chorine exposures at an allowable dose, contributed to the potentiation of Th2 responses. The functional alterations were associated with increased iNOS and ROCK-2 activation in the distal lung.
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Affiliation(s)
- Isabella Santos de Genaro
- Public Employee of Sao Paulo Hospital (IAMSPE), Sao Paulo, Brazil.,Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Deborah Camargo Hizume-Kunzler
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Department of Physical Therapy (LaPEx), State University of Santa Catarina, Florianopolis, Brazil
| | - Henrique Takachi Moriya
- Biomedical Engineering Laboratory, Escola Politecnica, University of Sao Paulo, Sao Paulo, Brazil
| | - Ronaldo Aparecido Silva
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Renato Fraga Righetti
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Sírio-Libanês Hospital, Sao Paulo, Brazil
| | - Rodolfo de Paula Vieira
- Universidade Brasil, Post-graduation Program in Bioengenering, São Paulo, Brazil and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São José dos Campos, Brazil
| | - Mitiko Saiki
- Nuclear and Energy Research Institute, IPEN-CNEN/SP, Sao Paulo, Brazil
| | - Milton Arruda Martins
- Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Beatriz Mangueira Saraiva-Romanholo
- Public Employee of Sao Paulo Hospital (IAMSPE), Sao Paulo, Brazil. .,Department of Medicine (LIM 20), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. .,University City of Sao Paulo (UNICID), Sao Paulo, Brazil.
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14
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Steelant B, Hox V, Hellings PW, Bullens DM, Seys SF. Exercise and Sinonasal Disease. Immunol Allergy Clin North Am 2018; 38:259-269. [DOI: 10.1016/j.iac.2018.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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15
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Salcedo PA, Lindheimer JB, Klein-Adams JC, Sotolongo AM, Falvo MJ. Effects of Exercise Training on Pulmonary Function in Adults With Chronic Lung Disease: A Meta-Analysis of Randomized Controlled Trials. Arch Phys Med Rehabil 2018; 99:2561-2569.e7. [PMID: 29678450 DOI: 10.1016/j.apmr.2018.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To quantify the effect of exercise training on indices of pulmonary function in adults with chronic lung disease using meta-analytic techniques. DATA SOURCES Eligible trials were identified using a systematic search of MEDLINE, Web of Science, Physiotherapy Evidence Database, and GoogleScholar databases. STUDY SELECTION Randomized controlled trials that evaluated pulmonary function before and after whole-body exercise training among adult patients (aged ≥19y) with chronic lung disease were included. DATA EXTRACTION Data were independently extracted from each study by 3 authors. Random-effects models were used to aggregate a mean effect size (Hedges' d; Δ) and 95% confidence interval (CI), and multilevel linear regression with robust maximum likelihood estimation was used to adjust for potential nesting effects. DATA SYNTHESIS Among 2923 citations, a total of 105 weighted effects from 21 randomized controlled trials were included. After adjusting for nesting effects, exercise training resulted in a small (Δ=.18; 95% CI, .07-.30) and significant (P=.002) improvement in a composite measure of pulmonary function. Tests of heterogeneity of the mean effect size were nonsignificant. CONCLUSIONS Contrary to prior assumptions, whole-body exercise training is effective for improving pulmonary function in adults with chronic lung disease, particularly spirometric indices. Subsequent studies are necessary to determine the optimal exercise training characteristics to maximize functional improvement.
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Affiliation(s)
- Pablo A Salcedo
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ
| | - Jacob B Lindheimer
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ; Department of Kinesiology, University of Wisconsin-Madison, Madison, WI
| | - Jacquelyn C Klein-Adams
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ
| | - Anays M Sotolongo
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ
| | - Michael J Falvo
- War Related Illness and Injury Study Center, Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ.
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16
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Couto M, Kurowski M, Moreira A, Bullens DMA, Carlsen K, Delgado L, Kowalski ML, Seys SF. Mechanisms of exercise-induced bronchoconstriction in athletes: Current perspectives and future challenges. Allergy 2018; 73:8-16. [PMID: 28599081 DOI: 10.1111/all.13224] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 01/08/2023]
Abstract
The evidence of exercise-induced bronchoconstriction (EIB) without asthma (EIBwA ) occurring in athletes led to speculate about different endotypes inducing respiratory symptoms within athletes. Classical postulated mechanisms for bronchial obstruction in this population include the osmotic and the thermal hypotheses. More recently, the presence of epithelial injury and inflammation in the airways of athletes was demonstrated. In addition, neuronal activation has been suggested as a potential modulator of bronchoconstriction. Investigation of these emerging mechanisms is of major importance as EIB is a significant problem for both recreational and competitive athletes and is the most common chronic condition among Olympic athletes, with obvious implications for their competing performance, health and quality of life. Hereby, we summarize the latest achievements in this area and identify the current gaps of knowledge so that future research heads toward better defining the etiologic factors and mechanisms involved in development of EIB in elite athletes as well as essential aspects to ultimately propose preventive and therapeutic measures.
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Affiliation(s)
- M. Couto
- Allergy Unit Hospital & Instituto CUF Porto Porto Portugal
| | - M. Kurowski
- Department of Immunology, Rheumatology and Allergy Healthy Ageing Research Centre Medical University of Łódź Łódź Poland
| | - A. Moreira
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar São João E.P.E. Porto Portugal
| | - D. M. A. Bullens
- Laboratory of Pediatric Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
- Division of Pediatrics UZ Leuven Leuven Belgium
| | - K.‐H. Carlsen
- Institute for Clinical Medicine University of Oslo Oslo Norway
| | - L. Delgado
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de Imunoalergologia Centro Hospitalar São João E.P.E. Porto Portugal
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy Healthy Ageing Research Centre Medical University of Łódź Łódź Poland
| | - S. F. Seys
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
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17
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Allergies and Exercise-Induced Bronchoconstriction in a Youth Academy and Reserve Professional Soccer Team. Clin J Sport Med 2017; 27:450-456. [PMID: 28829345 DOI: 10.1097/jsm.0000000000000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES A high prevalence of respiratory allergies and exercise-induced bronchoconstriction (EIB) has been reported among endurance athletes. This study was designed to analyze the frequency of sensitization to respiratory allergens and EIB in young soccer players. DESIGN Prospective cohort design. SETTING Youth academy and reserve professional soccer team during the seasons 2012 to 2013 and 2013 to 2014. PARTICIPANTS Eighty-five soccer players (mean age: 20 ± 4 years) participated. INTERVENTION Players underwent skin prick tests (SPTs) during the seasons 2012 to 2013 and 2013 to 2014. Spirometry and a eucapnic voluntary hyperpnea test were performed on soccer players during the first season 2012 to 2013 (n = 51) to detect EIB. Two self-administered questionnaires on respiratory history and allergic symptoms (European Community Respiratory Health Survey and Allergy Questionnaire for Athletes) were also distributed during both seasons (n = 59). MAIN OUTCOME MEASURES The number of positive SPTs, exercise-induced respiratory symptoms, presence of asthma, airway obstruction, and EIB. RESULTS Forty-nine percent of players were sensitized to at least one respiratory allergen, 33% reported an allergic disease, 1 player presented airway obstruction at rest, and 16% presented EIB. Factors predictive of EIB were self-reported exercise-induced symptoms and sensitization to at least 5 allergens. CONCLUSIONS Questioning players about exercise-induced respiratory symptoms and allergies as well as spirometry at the time of the inclusion medical checkup would improve management of respiratory health of soccer players and would constitute inexpensive preliminary screening to select players requiring indirect bronchial provocation test or SPTs. CLINICAL RELEVANCE This study showed that despite low frequencies, EIB and allergies are underdiagnosed and undertreated in young soccer players.
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18
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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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19
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Demoulin-Alexikova S, Marchal F, Bonabel C, Demoulin B, Foucaud L, Coutier-Marie L, Schweitzer CE, Ioan I. Down-Regulation of Cough during Exercise Is Less Frequent in Healthy Children than Adults. Role of the Development and/or Atopy? Front Physiol 2017; 8:304. [PMID: 28567019 PMCID: PMC5434114 DOI: 10.3389/fphys.2017.00304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/27/2017] [Indexed: 11/18/2022] Open
Abstract
Cough is typically associated with physical activity in children with asthma, but the characteristics of the relationship between cough and exercise has not been established under physiological conditions. The aim of the study was to describe the effect of exercise on the reflex cough response elicited by a single breath of capsaicin in non-asthmatic children. A group of non-asthmatic adults was studied as reference. Thirty children and 29 adults were recruited. The cough reflex sensitivity to capsaicin was first determined to establish the dose that provokes 5 cough efforts (C5). The number of coughs elicited by C5 (NC5) was then compared at baseline and during a standardized submaximal treadmill exercise. Data are expressed as median (interquartile range). Children and adults showed a significant decrease in NC5 (respectively from 5.0 (4.0–6.0) to 2.5 (2.0–4.0), p < 0.0005 and from 6.0 (5.0–7.0) to 2.0 (0.0–3.0, p < 0.0005). During exercise, NC5 was observed to decrease in all adult subjects, but in only 24/30 children (80%, p = 0.02). A trend for a higher incidence of personal and familial atopy was observed in children that lacked cough down-regulation during exercise compared with other children. It is concluded that the cough reflex response to capsaicin is down regulated by exercise in both children and adults. The effect however is less consistently observed in the former. The difference may reflect maturation of descending inhibitory pathways of the cough reflex, but may also be associated to atopy. The data stress the importance of assessing the time relationship of cough and exercise in questionnaire studies of asthma.
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Affiliation(s)
- Silvia Demoulin-Alexikova
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - François Marchal
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Claude Bonabel
- Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Bruno Demoulin
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France
| | - Laurent Foucaud
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France
| | - Laurianne Coutier-Marie
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Cyril E Schweitzer
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
| | - Iulia Ioan
- EA 3450 DevAH - Laboratoire de Physiologie, Faculty of Medicine, University of LorraineVandœuvre-lès-Nancy, France.,Service d'Explorations Fonctionnelles Pédiatriques, Hôpital d'enfants de Brabois - CHRU de NancyVandoeuvre-lès-Nancy, France
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20
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Russell MA, Janson C, Real FG, Johannessen A, Waatevik M, Benediktsdóttir B, Holm M, Lindberg E, Schlünssen V, Raza W, Dharmage SC, Svanes C. Physical activity and asthma: A longitudinal and multi-country study. J Asthma 2017. [PMID: 28635546 DOI: 10.1080/02770903.2017.1281293] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the impact of physical activity on asthma in middle-aged adults, in one longitudinal analysis, and one multi-centre cross-sectional analysis. METHODS The Respiratory Health in Northern Europe (RHINE) is a population-based postal questionnaire cohort study. Physical activity, height and weight were self-reported in Bergen, Norway, at RHINE II (1999-2001) and all centres at RHINE III (2010-2012). A longitudinal analysis of Bergen data investigated the association of baseline physical activity with follow-up asthma, incident asthma and symptoms, using logistic and zero-inflated Poisson regression (n = 1782). A cross-sectional analysis of all RHINE III centres investigated the association of physical activity with concurrent asthma and symptoms (n = 13,542) using mixed-effects models. Body mass index (BMI) was categorised (<20, 20-24.99, 25-29.99, 30+ kg/m2) and physical activity grouped by amount and frequency of lighter (no sweating/heavy breathing) and vigorous (sweating/heavy breathing) activity. RESULTS In the Bergen longitudinal analysis, undertaking light activity 3+ times/week at baseline was associated with less follow-up asthma (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.22, 0.89), whilst an effect from undertaking vigorous activity 3+ times/week was not detected (OR 1.22, 95% CI 0.44, 2.76). The associations were attenuated with BMI adjustment. In the all-centre cross-sectional analysis an interaction was found, with the association between physical activity and asthma varying across BMI categories. CONCLUSION These findings suggest potential longer-term benefit from lighter physical activity, whilst improvement in asthma outcomes from increasing activity intensity was not evident. Additionally, it appears the benefit from physical activity may differ according to BMI.
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Affiliation(s)
- Melissa A Russell
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health , University of Melbourne , Melbourne , Australia.,b Gastro & Food Allergy Group , Murdoch Children's Research Institute , Melbourne , Australia
| | - Christer Janson
- c Department of Medical Sciences: Respiratory , Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Francisco Gómez Real
- d Department of Clinical Science , University of Bergen , Bergen , Norway.,e Department of Gynaecology and Obstetrics , Haukeland University Hospital , Bergen , Norway
| | - Ane Johannessen
- f Center for International Health , University of Bergen , Bergen , Norway
| | - Marie Waatevik
- g Center for Clinical Research , Haukeland University Hospital , Bergen , Norway
| | - Bryndis Benediktsdóttir
- h Faculty of Medicine , University of Iceland , Reykjavik , Iceland.,i Department of Respiratory Medicine and Sleep , The National University Hospital of Iceland , Reykjavik , Iceland
| | - Mathias Holm
- j Department of Occupational and Environmental Medicine , Sahlgrenska University Hospital , Göteborg , Sweden
| | - Eva Lindberg
- c Department of Medical Sciences: Respiratory , Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Vivi Schlünssen
- k Department of Public Health , Aarhus University , Aarhus , Denmark.,l The National Research Centre for the Working Environment , Copenhagen , Denmark
| | - Wasif Raza
- m Division of Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Shyamali C Dharmage
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health , University of Melbourne , Melbourne , Australia.,b Gastro & Food Allergy Group , Murdoch Children's Research Institute , Melbourne , Australia
| | - Cecilie Svanes
- f Center for International Health , University of Bergen , Bergen , Norway.,n Department of Occupational Medicine , Haukeland University Hospital , Bergen , Norway
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21
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Nair P, Martin JG, Cockcroft DC, Dolovich M, Lemiere C, Boulet LP, O'Byrne PM. Airway Hyperresponsiveness in Asthma: Measurement and Clinical Relevance. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:649-659.e2. [PMID: 28163029 DOI: 10.1016/j.jaip.2016.11.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
Airway hyperresponsiveness is a characteristic feature of asthma, and its measurement is an important tool in its diagnosis. With a few caveats, methacholine bronchial provocation by a 2-minute tidal breathing method is highly sensitive; a negative test result (PC20 > 16 mg/mL, PD20 > 400 μg) rules out current asthma with reasonable certainty. A PC20 value of less than 1 mg/mL/PD20 value of less than 25 μg is highly specific (ie, diagnostic) but quite insensitive for asthma. For accurate interpretation of the test results, it is important to control and standardize technical factors that have an impact on nebulizer performance. In addition to its utility to relate symptoms such as cough, wheeze, and shortness of breath to variable airflow obstruction (ie, to diagnose current asthma), the test is useful to make a number of other clinical assessments. These include (1) evaluation of patients with occupational asthma, (2) evaluation of patients with exercise-induced respiratory symptoms, (3) evaluation of novel asthma medications, (4) evaluation of relative potency of inhaled bronchodilators, (5) as a biomarker to adjust anti-inflammatory therapy to improve clinical outcomes, and (6) in the evaluation of patients with severe asthma to rule out masqueraders such as laryngeal dysfunction. The actual mechanism of altered smooth muscle behavior in asthma that is assessed by direct (eg, methacholine) or indirect (eg, allergen) bronchial provocation remains one of the most fundamental questions related to asthma that needs to be determined. The test is underutilized in clinical practice.
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Affiliation(s)
- Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada.
| | - James G Martin
- Meakins Christie Laboratories and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Donald C Cockcroft
- Division of Respirology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Myrna Dolovich
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Catherine Lemiere
- Department of Medicine, Sacre Coeur Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Boulet
- Division of Respirology, Department of Medicine, University of Laval, Laval, Quebec, Canada
| | - Paul M O'Byrne
- Division of Respirology, Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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22
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Vakali S, Vogiatzis I, Florou A, Giavi S, Zakynthinos S, Papadopoulos NG, Gratziou C. Exercice-induced bronchoconstriction among athletes: Assessment of bronchial provocation tests. Respir Physiol Neurobiol 2016; 235:34-39. [PMID: 27677405 DOI: 10.1016/j.resp.2016.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
Abstract
Diagnosis of exercise-induced bronchoconstriction (EIB) requires the use of bronchial provocation tests (BPTs). We assessed exercise-induced respiratory symptoms (EIRS), EIB and asthma in athletes and evaluated the validity of BPTs in the diagnosis of EIB. Rhinitis and atopy were also assessed. Athletes with (n=55) and without previous asthma diagnosis (n=145) were tested by skin prick tests, lung function and eNO measurements. EIRS were recorded and EIB was assessed by methacholine (Mch), eucapnic voluntary hyperpnoea (EVH), mannitol and exercise test. EIRS were highly reported and history of asthma was common among athletes. A high prevalence of atopy (48.7%) and allergic rhinitis (30.5%) was found. Athletes with asthma had a higher response rate to Mch and to EVH, as compared with athletes without a previous asthma diagnosis (P=0.012 and P=0.017 respectively). Report of EIRS, rhinitis and atopy were not associated with a positive BPT response. Screening athletes for EIB using BPTs is suggested, irrespective of reported EIRS or a previous asthma diagnosis.
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Affiliation(s)
- S Vakali
- Asthma and Allergy Centre, Medical School, University of Athens, Evgenidio Hospital, Athens, Greece.
| | - I Vogiatzis
- Faculty of Physical Education and Sports Sciences and 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - A Florou
- Asthma and Allergy Centre, Medical School, University of Athens, Evgenidio Hospital, Athens, Greece
| | - S Giavi
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - S Zakynthinos
- Faculty of Physical Education and Sports Sciences and 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - N G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece; Centre for Pediatrics and Child Health, Institute of Human Development, University of Manchester, UK
| | - Ch Gratziou
- Asthma and Allergy Centre, Medical School, University of Athens, Evgenidio Hospital, Athens, Greece
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23
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Asthma as a disruption in iron homeostasis. Biometals 2016; 29:751-79. [PMID: 27595579 DOI: 10.1007/s10534-016-9948-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 12/28/2022]
Abstract
Over several decades, asthma has evolved from being recognized as a single disease to include a diverse group of phenotypes with dissimilar natural histories, pathophysiologies, responses to treatment, and distinctive molecular pathways. With the application of Occam's razor to asthma, it is proposed that there is one cause underlying the numerous phenotypes of this disease and that the responsible molecular pathway is a deficiency of iron in the lung tissues. This deficiency can be either absolute (e.g. asthma in the neonate and during both pregnancy and menstruation) or functional (e.g. asthma associated with infections, smoking, and obesity). Comparable associations between asthma co-morbidity (e.g. eczema, urticaria, restless leg syndrome, and pulmonary hypertension) with iron deficiency support such a shared mechanistic pathway. Therapies directed at asthma demonstrate a capacity to impact iron homeostasis, further strengthening the relationship. Finally, pathophysiologic events producing asthma, including inflammation, increases in Th2 cells, and muscle contraction, can correlate with iron availability. Recognition of a potential association between asthma and an absolute and/or functional iron deficiency suggests specific therapeutic interventions including inhaled iron.
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24
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Selge C, Thomas S, Nowak D, Radon K, Wolfarth B. Asthma prevalence in German Olympic athletes: A comparison of winter and summer sport disciplines. Respir Med 2016; 118:15-21. [PMID: 27578466 DOI: 10.1016/j.rmed.2016.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/21/2016] [Accepted: 07/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prevalence of asthma in elite athletes shows very wide ranges. It remains unclear to what extent this is influenced by the competition season (winter vs. summer) or the ventilation rate achieved during competition. The aim of this study was to evaluate prevalence of asthma in German elite winter and summer athletes from a wide range of sport disciplines and to identify high risk groups. METHODS In total, 265 German elite winter athletes (response 77%) and 283 German elite summer athletes (response 64%) answered validated respiratory questionnaires. Using logistic regression, the asthma risks associated with competition season and ventilation rate during competition, respectively, were investigated. A subset of winter athletes was also examined for their FENO-levels and lung function. RESULTS With respect to all asthma outcomes, no association was found with the competition season. Regarding the ventilation rate, athletes in high ventilation sports were at increased risk of asthma, as compared to athletes in low ventilation sports (doctors' diagnosed asthma: OR 2.32, 95% CI 1.19-4.53; use of asthma medication: OR 4.46, 95% CI 1.52-13.10; current wheeze or use of asthma medication: OR 2.78, 95% CI 1.34-5.76). Athletes with doctors' diagnosed asthma were at an approximate four-fold risk of elevated FENO-values. CONCLUSIONS The clinically relevant finding of this study is that athletes' asthma seems to be more common in sports with high ventilation during competition, whereas the summer or winter season had no impact on the frequency of the disease. Among winter athletes, elevated FENO suggested suboptimal control of asthma.
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Affiliation(s)
- Charlotte Selge
- Department of Neurology, University Hospital Munich (LMU), Munich, Germany.
| | - Silke Thomas
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany.
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.
| | - Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany.
| | - Bernd Wolfarth
- Department of Sport Medicine Humboldt University and Charité University School of Medicine, Berlin, Germany.
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Turner AM, Tamasi L, Schleich F, Hoxha M, Horvath I, Louis R, Barnes N. Clinically relevant subgroups in COPD and asthma. Eur Respir Rev 2016; 24:283-98. [PMID: 26028640 DOI: 10.1183/16000617.00009014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As knowledge of airways disease has grown, it has become apparent that neither chronic obstructive pulmonary disease (COPD) nor asthma is a simple, easily defined disease. In the past, treatment options for both diseases were limited; thus, there was less need to define subgroups. As treatment options have grown, so has our need to predict who will respond to new drugs. To date, identifying subgroups has been largely reported by detailed clinical characterisation or differences in pathobiology. These subgroups are commonly called "phenotypes"; however, the problem of defining what constitutes a phenotype, whether this should include comorbid diseases and how to handle changes over time has led to the term being used loosely. In this review, we describe subgroups of COPD and asthma patients whose clinical characteristics we believe have therapeutic or major prognostic implications specific to the lung, and whether these subgroups are constant over time. Finally, we will discuss whether the subgroups we describe are common to both asthma and COPD, and give some examples of how treatment might be tailored in patients where the subgroup is clear, but the label of asthma or COPD is not.
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Affiliation(s)
- Alice M Turner
- Clinical and Experimental Medicine, University of Birmingham, Queen Elizabeth Hospital Birmingham, Birmingham, UK Dept of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - Lilla Tamasi
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Mehmet Hoxha
- Service of Allergology and Clinical Immunology, UHC "Mother Teresa", Tirana, Albania
| | - Ildiko Horvath
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Renaud Louis
- Respiratory Medicine, CHU Sart-Tilman B35, Liege, Belgium
| | - Neil Barnes
- GlaxoSmithKline, Stockley Park West, Uxbridge, UK
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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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Llana-Belloch S, Priego Quesada JI, Pérez-Soriano P, Lucas-Cuevas ÁG, Salvador-Pascual A, Olaso-González G, Moliner-Martinez Y, Verdú-Andres J, Campins-Falco P, Gómez-Cabrera MC. Disinfection by-products effect on swimmers oxidative stress and respiratory damage. Eur J Sport Sci 2015; 16:609-17. [DOI: 10.1080/17461391.2015.1080306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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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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Stang J, Couto M, Carlsen KH, Stensrud T. Increased bronchial parasympathetic tone in elite cross-country and biathlon skiers: a randomised crossover study. Br J Sports Med 2014; 49:bjsports-2014-094053. [PMID: 25416197 DOI: 10.1136/bjsports-2014-094053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased parasympathetic activity in endurance-trained athletes has been reported by heart rate variability and pupillometry. Our primary objective was to assess parasympathetic activity and tone in the lower respiratory tract by investigating the effect of cholinergic antagonism by inhaled ipratropium bromide compared to the β2-receptor stimulating effect of inhaled salbutamol in elite cross-country and biathlon skiers. We also examined the medications' relationship to cholinergic sensitivity as measured by bronchial responsiveness to methacholine (PD20met). METHODS In a randomised crossover study, 20 cross-country and two biathlon skiers (14♂/8♀) aged 20-37 years from the Norwegian national teams measured reversibility to inhaled ipratropium bromide and inhaled salbutamol and PD20met on three separate days. A positive reversibility test was defined as an increase in forced expiratory volume in 1 s (FEV1) of ≥12%. Spirometry was performed before and 45 and 15 min after inhaled ipratropium bromide and inhaled salbutamol, respectively. Bronchodilating medication was withheld according to the European Respiratory Society (ERS) guidelines. Correlations were assessed by Pearson's correlation coefficient (r). RESULTS Five athletes had significant reversibility after inhaled ipratropium bromide, and none after inhaled salbutamol. Twelve athletes (54.5%) had PD20met <8 μmol (1.57 mg). PD20met correlated negatively with ▵FEV1 after inhaled ipratropium bromide (r=-0.85, p<0.0001), but not after inhaled salbutamol (r=-0.308, p=0.16). CONCLUSIONS In elite skiers, cholinergic sensitivity (PD20met) had a highly significant inverse correlation to the cholinergic antagonism of inhaled ipratropium bromide, but not at all to the bronchodilating inhaled salbutamol. This markedly increased bronchial parasympathetic tone may represent an important cholinergic role in the development of skier's asthma.
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Affiliation(s)
- J Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Couto
- Immunology Lab, Faculty of Medicine, University of Porto, Porto, Portugal Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - K-H Carlsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway Department of Pediatrics, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Bordeleau M, Turmel J, Boulet LP. Effects of ipratropium on exercise-induced cough in winter athletes: a hypothesis-generating study. PHYSICIAN SPORTSMED 2014; 42:7-13. [PMID: 25419883 DOI: 10.3810/psm.2014.11.2086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Exercise-induced cough (EIC) is frequently reported by winter athletes, but this symptom is not always associated with exercise-induced bronchoconstriction (EIB). The aims of this study were to determine if EIC can be inhibited or reduced with the inhalation of ipratropium, and if EIC in winter athletes is associated with EIB. METHODS On 2 visits, 24 cross-country skiers (10 males and 12 females, mean age 17 ± 3 years) performed an outdoor exercise in the winter (30-minute warm-up, followed by a 3-minute sprint), randomly preceded by the inhalation of ipratropium or a placebo. A spirometry was done at baseline and 20 minutes after inhalation of ipratropium or placebo. Exercise was then performed, followed by the measurement of forced expiratory volume in 1 second and the recording of the number of coughs until 60 minutes after exercise. Before and after exercise, the perception of cough intensity was evaluated using a modified Borg scale. RESULTS Twelve of 16 athletes who completed the study (75%) were symptomatic following exercise with placebo (number of coughs ≥ 5), but none developed EIB. For these athletes, the number of coughs after exercise (mean number of coughs ± standard deviation: placebo, 26 ± 14; ipratropium, 25 ± 23; P value, nonsignificant) and the maximal perception score for cough intensity (mean Borg score ± standard deviation: placebo, 1.9 ± 1.2; ipratropium, 2.0 ± 1.1; P value, nonsignificant) were not significantly different between ipratropium and placebo. A decrease in the number of coughs was observed in 6 of the symptomatic athletes and an increase was observed in the other 6, resulting in a nonsignificant mean effect. CONCLUSIONS Ipratropium does not appear to significantly influence the number and the perception of cough following exercise. Moreover, these results suggest that EIC is not mainly associated with EIB. However, a subgroup of athletes seems to show a beneficial response to ipratropium, suggesting different cough responses in this population.
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High-dose inhaled terbutaline increases muscle strength and enhances maximal sprint performance in trained men. Eur J Appl Physiol 2014; 114:2499-508. [DOI: 10.1007/s00421-014-2970-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/28/2014] [Indexed: 12/28/2022]
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Couillard S, Bougault V, Turmel J, Boulet LP. Perception of bronchoconstriction following methacholine and eucapnic voluntary hyperpnea challenges in elite athletes. Chest 2014; 145:794-802. [PMID: 24264387 DOI: 10.1378/chest.13-1413] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Self-reported respiratory symptoms are poor predictors of exercise-induced bronchoconstriction (EIB) in athletes. The objective of this study was to determine whether athletes have an inadequate perception of bronchoconstriction. METHODS One hundred thirty athletes and 32 nonathletes completed a standardized questionnaire and underwent eucapnic voluntary hyperpnea (EVH) and methacholine inhalation test. Perception scores were quoted on a modified Borg scale before each spirometry measurement for cough, breathlessness, chest tightness, and wheezing. Perception slope values were also obtained by plotting the variation of perception scores before and after the challenges against the fall in FEV1 expressed as a percentage of the initial value [(perception scores after - before)/FEV1]. RESULTS Up to 76% of athletes and 68% of nonathletes had a perception score of ≤0.5 at 20% fall in FEV1 following methacholine. Athletes with EIB/airway hyperresponsiveness (AHR) had lower perception slopes to methacholine than nonathletes with asthma for breathlessness only (P=.02). Among athletes, those with EIB/AHR had a greater perception slope to EVH for breathlessness and wheezing (P=.02). Female athletes had a higher perception slope for breathlessness after EVH and cough after methacholine compared with men (P<.05). The age of athletes correlated significantly with the perception slope to EVH for each symptom (P<.05). CONCLUSIONS Minimal differences in perception of bronchoconstriction-related symptoms between athletes and nonathletes were observed. Among athletes, the presence of EIB/AHR, older age, and female sex were associated with slightly higher perception scores.
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Affiliation(s)
- Simon Couillard
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada
| | - Valérie Bougault
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada; Université du Droit et de la Santé, Faculté des Sciences du Sport et de l'Éducation physique, Ronchin, France
| | - Julie Turmel
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada
| | - Louis-Philippe Boulet
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada.
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Abstract
During dynamic exercise, the healthy pulmonary system faces several major challenges, including decreases in mixed venous oxygen content and increases in mixed venous carbon dioxide. As such, the ventilatory demand is increased, while the rising cardiac output means that blood will have considerably less time in the pulmonary capillaries to accomplish gas exchange. Blood gas homeostasis must be accomplished by precise regulation of alveolar ventilation via medullary neural networks and sensory reflex mechanisms. It is equally important that cardiovascular and pulmonary system responses to exercise be precisely matched to the increase in metabolic requirements, and that the substantial gas transport needs of both respiratory and locomotor muscles be considered. Our article addresses each of these topics with emphasis on the healthy, young adult exercising in normoxia. We review recent evidence concerning how exercise hyperpnea influences sympathetic vasoconstrictor outflow and the effect this might have on the ability to perform muscular work. We also review sex-based differences in lung mechanics.
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Affiliation(s)
- Andrew William Sheel
- The School of Kinesiology, The University of British Columbia, Vancouver, Canada.
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Hostrup M, Kalsen A, Auchenberg M, Rzeppa S, Hemmersbach P, Bangsbo J, Backer V. Urine concentrations of oral salbutamol in samples collected after intense exercise in endurance athletes. Drug Test Anal 2013; 6:528-32. [DOI: 10.1002/dta.1568] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/26/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Morten Hostrup
- Respiratory Research Unit; Bispebjerg University Hospital; Copenhagen Denmark
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - Anders Kalsen
- Respiratory Research Unit; Bispebjerg University Hospital; Copenhagen Denmark
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - Michael Auchenberg
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - Sebastian Rzeppa
- Norwegian Doping Control Laboratory; Oslo University Hospital; Oslo Norway
| | - Peter Hemmersbach
- Norwegian Doping Control Laboratory; Oslo University Hospital; Oslo Norway
| | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - Vibeke Backer
- Respiratory Research Unit; Bispebjerg University Hospital; Copenhagen Denmark
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Denguezli Bouzgarou M, Ben Ali M, Ben Salem A, Gaied S, Aouichaoui C, Dessanges JF, Tabka Z. La pratique sportive en salle serait-elle un facteur de risque de rhinite allergique ? Rev Mal Respir 2013; 30:555-62. [DOI: 10.1016/j.rmr.2013.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
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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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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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Hox V, Vanoirbeek JA, Alpizar YA, Voedisch S, Callebaut I, Bobic S, Sharify A, De Vooght V, Van Gerven L, Devos F, Liston A, Voets T, Vennekens R, Bullens DMA, De Vries A, Hoet P, Braun A, Ceuppens JL, Talavera K, Nemery B, Hellings PW. Crucial Role of Transient Receptor Potential Ankyrin 1 and Mast Cells in Induction of Nonallergic Airway Hyperreactivity in Mice. Am J Respir Crit Care Med 2013; 187:486-93. [DOI: 10.1164/rccm.201208-1358oc] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Silvestri M, Crimi E, Oliva S, Senarega D, Tosca MA, Rossi GA, Brusasco V. Pulmonary function and airway responsiveness in young competitive swimmers. Pediatr Pulmonol 2013; 48:74-80. [PMID: 22431206 DOI: 10.1002/ppul.22542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 01/20/2012] [Indexed: 12/22/2022]
Abstract
RATIONALE Strong physical activities are often associated with large lung volumes and relatively reduced flow, which may represent a physiological variant but also an obstructive abnormality. Competitive swimmers have also spirometric values even larger than other athletes, although they are at increased risk for asthma or airway hyperresponsiveness. AIM We aimed to investigate whether lung volumes increase with duration of swimming training and are related to an obstructive abnormality associated with airway hyperresponsiveness and asthma-like symptoms. METHODS Forced expiratory volume in 1 sec (FEV(1)), forced vital capacity (FVC), airway responsiveness, and skin prick test were measured in 34 children/adolescents (age: 7-19 yrs old) trained for competitive swimming. Their "lifetime" exposure, i.e., the hours spent in pool was very strongly correlated with their age at the time of study. The effect of swimming activity was therefore estimated from the relationships between lung function data and age. RESULTS FVC Z-score was positively correlated with age, indicating that absolute values increased more than expected with normal growth, but FEV(1)/FVC was negatively correlated with age. Although the majority of subjects had allergic sensitization to aeroallergens and about one half had asthma-like symptoms and/or airway hyperresponsiveness, these conditions did not alter the relationships between lung function and age. CONCLUSION Intense swimming activity may cause a greater than normal lung growth, irrespective of the presence of allergic sensitization or airway hyperresponsiveness. The associated reduction of FEV(1) /FVC may represent a physiological variant rather than a true obstructive abnormality.
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Affiliation(s)
- Michela Silvestri
- Pediatric Pulmonology and Allergy Unit, G. Gaslini Institute, Genoa, Italy
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Turmel J, Poirier P, Bougault V, Blouin E, Belzile M, Boulet LP. Cardiorespiratory screening in elite endurance sports athletes: the Quebec study. PHYSICIAN SPORTSMED 2012; 40:55-65. [PMID: 23528622 DOI: 10.3810/psm.2012.09.1982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiorespiratory disorders are common in athletes. However, these conditions are often underdiagnosed, which potentially results in impaired performance and increased health risks. The aim of this study was to evaluate, in a research setting, the prevalence of cardiorespiratory disorders in athletes in order to determine the potential value of a screening program. METHODS One hundred thirty-three athletes were studied. Each subject underwent a physical examination. A eucapnic voluntary hyperventilation (EVH) test and a methacholine inhalation test were performed to confirm the diagnosis of asthma. A cardiovascular evaluation was also performed, including maximal exercise test with electrocardiogram, 24-hour ambulatory blood pressure monitoring, 24-hour Holter monitoring, and blood sampling. RESULTS Seventy-four (56%) athletes had airway hyperresponsiveness to EVH or the methacholine inhalation test. Among those with airway hyperresponsiveness, 45 (61%) athletes were only hyperresponsive to EVH, and 10 (14%) were only hyperresponsive to the methacholine inhalation test (using the criteria of a PC20 ≤ 4 mg/mL). Thirty-two (24%) athletes had a known diagnosis of asthma, while 34 (26%) athletes received a new asthma diagnosis. Ninety-seven (73%) athletes were sensitized to common airborne allergens. Forty-seven (35%) athletes completed the cardiovascular evaluation. Three (6%) and 7 (15%) athletes had a previous or new diagnosis of cardiovascular disease, respectively. Resting systemic hypertension was documented in 2 (4%) athletes and exaggerated blood pressure response to exercise was found in 12 (26%) athletes. CONCLUSION This cardiorespiratory screening data set in athletes showed a high prevalence of exercise-induced asthma and exercise hypertension, which in many cases were not previously diagnosed.
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Affiliation(s)
- Julie Turmel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
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Sposato B, Scalese M, Pammolli A, Scala R, Naldi M. Seasons can influence the results of the methacholine challenge test. Ann Thorac Med 2012; 7:61-8. [PMID: 22558009 PMCID: PMC3339205 DOI: 10.4103/1817-1737.94521] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/29/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study tried to evaluate whether a methacholine test may be influenced by the seasons. METHODS We considered 4826 consecutive subjects with normal spirometry (50.53% males; age: 35.1±16.2; forced expiratory volume in one second: 99.5±13.0%) who underwent a methacholine test for suspected asthma symptoms between 2000 and 2010. They were subdivided into four groups, like the seasons, according to the test dates. RESULTS A total of 1981 (41%) resulted normal (no PD(20) was obtained with 2400 μg of methacholine); the others showed a mean LogPD(20) of 2.52±0.5 μg. The number of subjects with bronchial hyper-responsiveness (BHR) found in autumn (789, 62.3%) was higher than in summer (583, 56.7%; P=0.03). A higher number of females and overweight/obese subjects showed a BHR in autumn compared with the other seasons. The spring mean LogPD(20) value (2.48±0.48 μg) was lower if compared with the one measured in summer (2.59±0.49 μg; P=0.05). LogPD(20) value was lower in females and non-smokers in spring compared with summer (P<0.05). Overweight/obese non-smokers showed a lower LogPD(20) in spring and autumn compared with that in summer (P<0.05). Autumn was a risk factor (OR: 1.378; P=0.001) for BHR (using a PD(20) <2 400 μg as BHR limit), while spring (OR: 1.330; P=0.021) and autumn (OR: 1.331; P=0.020) were risk factors for a more severe BHR (using a PD(20) <400 μg as BHR limit). CONCLUSION There was a higher probability of finding BHR in outpatients with suspected asthma in autumn and spring compared with summer. Spring is the season where BHR may be more severe. Females and overweight/obese subjects were those mainly involved in this seasonal variability of BHR.
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Affiliation(s)
- Bruno Sposato
- Unit of Pneumology, "Misericordia" Hospital, Grosseto, Italy
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Ali Z, Norsk P, Ulrik CS. Mechanisms and management of exercise-induced asthma in elite athletes. J Asthma 2012; 49:480-6. [PMID: 22515573 DOI: 10.3109/02770903.2012.676123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE AND METHODS Asthma is often reported by elite athletes, especially endurance athletes. The aim of this article is to review current knowledge of mechanisms and management of exercise-induced asthma (EIA) in adult elite athletes. RESULTS The mechanisms underlying EIA is incompletely understood, but the two prevailing hypotheses are the hyper-osmolarity and the thermal hypothesis. Both hypotheses consider inflammation and activation of mast cells as being crucial for the development of EIA, although the assumed mechanisms triggering the inflammatory response differ. Objective testing is of utmost importance in the diagnosis of EIA in elite athletes. Management of EIA can be divided into pharmacologic and non-pharmacologic treatment. The basic principles for the treatment of EIA in elite athletes should be as for any asthmatic individual, including use of inhaled corticosteroids (ICS), β(2)-agonists, and leukotriene antagonists. However, evidence suggests that daily use of β(2)-agonists might lead to the development of tolerance. ICS therapy is, due to its anti-inflammatory effects, the recommended primary therapy for EIA also in elite athletes. All doctors treating individuals with asthma, especially elite athletes, should remain updated on doping aspects of asthma therapy. Non-pharmacologic management of EIA in elite athletes includes physical warm-up, which takes advantage of the refractory period following an attack of EIA, whereas high intake of antioxidants may reduce airway inflammation. Wearing heat masks, specially designed for outdoor winter athletes, might protect against bronchoconstriction triggered by inhalation of cold and dry air. CONCLUSION EIA in elite athletes should be managed as in any individual with asthma, but the risk of developing tolerance to bronchodilators as well as doping aspects should always be taken into account.
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Affiliation(s)
- Zarqa Ali
- University of Copenhagen, Copenhagen, Denmark
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Bougault V, Loubaki L, Joubert P, Turmel J, Couture C, Laviolette M, Chakir J, Boulet LP. Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools. J Allergy Clin Immunol 2011; 129:351-8, 358.e1. [PMID: 22196771 DOI: 10.1016/j.jaci.2011.11.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/06/2011] [Accepted: 11/08/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Airway disorders are common in regular chlorinated swimming pool attendees, particularly competitive athletes, but the impact of intense swimming training on airway function and structure remains unclear. OBJECTIVE This study aimed to evaluate airway inflammation and remodeling in elite swimmers. METHODS Twenty-three elite swimmers were tested during off-training season. All had exhaled nitric oxide measurement, methacholine test, eucapnic voluntary hyperpnea challenge, allergy skin prick tests, and bronchoscopy with bronchial biopsies. Clinical data and tissues from 10 age-matched mild-asthmatic and 10 healthy nonallergic subjects were used for comparison. RESULTS Swimmers had increased airway mucosa eosinophil and mast cell counts than did controls (P < .05). They had more goblet cell hyperplasia and higher mucin expression than did healthy or asthmatic subjects (P < .05). A greater submucosal type I and III collagen expression and tenascin deposition was also observed in swimmers than in controls (P < .05). Neither exhaled nitric oxide nor airway responsiveness to methacholine or eucapnic voluntary hyperpnea challenge correlated with these inflammatory and remodeling changes. CONCLUSION Intense, long-term swimming training in indoor chlorinated swimming pools is associated with airway changes similar to those seen in mild asthma, but with higher mucin expression. These changes were independent from airway hyperresponsiveness. The long-term physiological and clinical consequences of these changes remain to be clarified.
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Affiliation(s)
- Valérie Bougault
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada.
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Abstract
Asthma is frequently found among elite athletes performing endurance sports such as swimming, rowing and cross-country skiing. Although these athletes often report symptoms while exercising, they seldom have symptoms at rest. Moreover, compared with nonathletic asthmatic individuals, elite athletes have been shown to have a different distribution of airway inflammation and unequal response to bronchial provocative test. Elite athletes display signs of exercise-induced symptoms, for example, nonasthmatic inspiratory wheeze, vocal cord dysfunction and cardiac arrhythmias, which could limit their physical capacity. Elite athletes should undergo comprehensive assessment to confirm an asthma diagnosis and determine its degree of severity. Treatment should be as for any other asthmatic individual, including the use of β2-agonist, inhaled steroid as well as leukotriene-antagonist. It should, however, be noted that daily use of β-agonists could expose elite athletes to the risk of developing tolerance towards these drugs. Use of β2-agonist should be replaced with daily inhaled corticosteroid treatment, the most important treatment of exercise-induced asthma. All physicians treating asthma should be aware of the doping aspects. Systemic β2-agonist intake is strictly prohibited, whereas inhaled treatment is allowed in therapeutic doses when asthma is documented and dispensation has been granted when needed.
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Affiliation(s)
- Jimmi Elers
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen NV, Denmark
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Pedersen L, Elers J, Backer V. Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment. PHYSICIAN SPORTSMED 2011; 39:163-71. [PMID: 22030952 DOI: 10.3810/psm.2011.09.1932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Elite athletes have a high prevalence of asthma and exercise-induced bronchoconstriction. Although respiratory symptoms can be suggestive of asthma, the diagnosis of asthma in elite athletes cannot be based solely on the presence or absence of symptoms; diagnosis should be based on objective measurements, such as the eucapnic voluntary hyperpnea test or exercise test. When considering that not all respiratory symptoms are due to asthma, other diagnoses should be considered. Certain regulations apply to elite athletes who require asthma medication for asthma. Knowledge of these regulations is essential when treating elite athletes. This article is aimed at physicians who diagnose and treat athletes with respiratory symptoms. It focuses on the pathogenesis of asthma and exercise-induced bronchoconstriction in elite athletes and how the diagnosis can be made. Furthermore, treatment of elite athletes with asthma, anti-doping regulations, and differential diagnoses such as exercise-induced laryngomalacia are discussed.
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Affiliation(s)
- Lars Pedersen
- Department of Medicine, Roskilde Hospital, Roskilde, Denmark.
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Hox V, Vanoirbeek JA, Callebaut I, Bobic S, De Vooght V, Ceuppens J, Hoet P, Nemery B, Hellings PW. Airway exposure to hypochlorite prior to ovalbumin induces airway hyperreactivity without evidence for allergic sensitization. Toxicol Lett 2011; 204:101-7. [PMID: 21570453 DOI: 10.1016/j.toxlet.2011.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/14/2011] [Accepted: 04/19/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some epidemiologic studies have indicated that attendance to chlorinated swimming pools is associated with airway hyperreactivity (AHR), allergies and asthma. AIM To investigate the effects of sodium hypochlorite (NaClO), the main pool disinfectant, on allergic sensitization and airway inflammation in mice. METHODS In a first series of experiments, mice were sensitized to ovalbumin (OVA), followed by OVA aerosols with or without prior nasal instillation of NaClO (3ppm active chlorine). In a second series, naïve mice received 1-7 nasal instillations of OVA, 10min after instillations of NaClO or water. After 1, 3, 5 and 7 exposures airway reactivity to methacholine, cellular inflammation in bronchoalveolar lavage (BAL), serum OVA-specific IgEs and lung Th2 cytokines were measured. RESULTS In the first mouse model, airway allergy parameters were not significantly altered upon NaClO administration. However in the second model, NaClO exposure prior to OVA did induce AHR, already after 1 combined application. Combined NaClO+OVA exposure did not lead to an influx of inflammatory cells in BAL fluid or production of anti-OVA IgEs. No AHR developed when OVA was heat-denatured, pre-chlorinated, or replaced by bovine serum albumin or lipopolysaccharide. CONCLUSION Nasal instillation of NaClO prior to OVA induces AHR without allergic sensitization. This response is OVA-specific.
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Affiliation(s)
- Valérie Hox
- Laboratory of Experimental Immunology, University Hospitals, Faculty of Medicine, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Bougault V, Turmel J, Boulet LP. Airway hyperresponsiveness in elite swimmers: Is it a transient phenomenon? J Allergy Clin Immunol 2011; 127:892-8. [DOI: 10.1016/j.jaci.2010.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 10/14/2010] [Accepted: 11/04/2010] [Indexed: 11/29/2022]
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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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Scichilone N, Morici G, Zangla D, Chimenti L, Davì E, Reitano S, Paternò A, Santagata R, Togias A, Bellia V, Bonsignore MR. Effects of exercise training on airway responsiveness and airway cells in healthy subjects. J Appl Physiol (1985) 2010; 109:288-94. [PMID: 20538849 DOI: 10.1152/japplphysiol.01200.2009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Airway responsiveness to methacholine (Mch) in the absence of deep inspirations (DIs) is lower in athletes compared with sedentary individuals. In this prospective study, we tested the hypothesis that a training exercise program reduces the bronchoconstrictive effect of Mch. Ten healthy sedentary subjects (M/F: 3/7; mean + or - SD age: 22 + or - 3 yr) entered a 10-wk indoor rowing exercise program on rowing ergometer and underwent Mch bronchoprovocation in the absence of DIs at baseline, at weeks 5 and 10, as well as 4-6 wk after the training program was completed. Exercise-induced changes on airway cells and markers of airway inflammation were also assessed by sputum induction and venous blood samples. Mean power output during the 1,000 m test was 169 + or - 49 W/stroke at baseline, 174 + or - 49 W/stroke at 5 wk, and 200 + or - 60 W/stroke at 10 wk of training (P < 0.05). The median Mch dose used at baseline was 50 mg/ml (range 25-75 mg/ml) and remained constant per study design. At the pretraining evaluation, the percent reduction in the primary outcome, the inspiratory vital capacity (IVC) after inhalation of Mch in the absence of DIs was 31 +/- 13%; at week 5, the Mch-induced reduction in IVC was 22 + or - 19%, P = 0.01, and it further decreased to 15 + or - 11% at week 10 (P = 0.0008). The percent fall in IVC 4-6 wk after the end of training was 15 + or - 11% (P = 0.87 vs. end of training). Changes in airway cells were not associated with changes in airway responsiveness. Our data show that a course of exercise training can attenuate airway responsiveness against Mch inhaled in the absence of DIs in healthy subjects and suggest that a sedentary lifestyle may favor development of airways hyperresponsiveness.
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Affiliation(s)
- Nicola Scichilone
- Dept. of Internal Medicine, Div. of Pulmonology (DIBIMIS Univ. of Palermo, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, 90146 Palermo, Italy.
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