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Baker JG, Shaw DE. Asthma and COPD: A Focus on β-Agonists - Past, Present and Future. Handb Exp Pharmacol 2023. [PMID: 37709918 DOI: 10.1007/164_2023_679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Asthma has been recognised as a respiratory disorder for millennia and the focus of targeted drug development for the last 120 years. Asthma is one of the most common chronic non-communicable diseases worldwide. Chronic obstructive pulmonary disease (COPD), a leading cause of morbidity and mortality worldwide, is caused by exposure to tobacco smoke and other noxious particles and exerts a substantial economic and social burden. This chapter reviews the development of the treatments of asthma and COPD particularly focussing on the β-agonists, from the isolation of adrenaline, through the development of generations of short- and long-acting β-agonists. It reviews asthma death epidemics, considers the intrinsic efficacy of clinical compounds, and charts the improvement in selectivity and duration of action that has led to our current medications. Important β2-agonist compounds no longer used are considered, including some with additional properties, and how the different pharmacological properties of current β2-agonists underpin their different places in treatment guidelines. Finally, it concludes with a look forward to future developments that could improve the β-agonists still further, including extending their availability to areas of the world with less readily accessible healthcare.
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Affiliation(s)
- Jillian G Baker
- Department of Respiratory Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Cell Signalling, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
| | - Dominick E Shaw
- Nottingham NIHR Respiratory Biomedical Research Centre, University of Nottingham, Nottingham, UK
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2
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Helge T, Godhe M, Berglund B, Ekblom B. Inhaling salbutamol may decrease time to exhaustion in some contexts of heavy endurance performances. Eur J Sport Sci 2022; 23:766-773. [PMID: 35392766 DOI: 10.1080/17461391.2022.2063071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To study the effect of inhaling a beta-agonist (salbutamol) compared to placebo on skiing and cycling performance in well-trained elite athletes. METHODS Three different exercise protocols were used, all with a cross-over double blind placebo-controlled design. Participants inhaled 800 µg salbutamol or a placebo prior to the test, which was repeated on a following day with the participants inhaling the other substance. Fifteen junior elite skiers performed four free-style high intensity sprints (1100 m/work time 3.5 - 4.5 min). Twelve elite cyclists carried out a short cycling protocol, starting with two 5 min submaximal workloads followed by a maximal intermittent performance test to exhaustion. Another 12 elite cyclists performed the maximal intermittent performance test to exhaustion after a 150 min long submaximal cycling protocol. RESULTS Group mean time for the ski sprints increased, with no difference between treatment groups. In the short cycling protocol time to exhaustion was 9.1% (95% CI 52 to 161) lower after inhaling salbutamol compared to placebo and in the long cycling protocol time to exhaustion was 9.1% (95% CI -121 to 267) lower after inhaling salbutamol compared to placebo. Blood lactate, heart rate and ventilation increased during submaximal exercise with salbutamol compared to placebo in the short cycling protocol (p < 0.05). CONCLUSION This study could not confirm any positive performance effects from inhaling 800 µg salbutamol compared to placebo in skiing and cycling high-intensity intermittent performance. Instead, time to exhaustion in the maximal intermittent performance test was lower in both cycling protocols.
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Affiliation(s)
- T Helge
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - M Godhe
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - B Berglund
- Inst. Med, Karolinska University Hospital, Stockholm, Sweden
| | - B Ekblom
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Overuse of Short-Acting Beta-2 Agonists (SABAs) in Elite Athletes: Hypotheses to Explain It. Sports (Basel) 2022; 10:sports10030036. [PMID: 35324645 PMCID: PMC8952427 DOI: 10.3390/sports10030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/17/2022] Open
Abstract
The use of short-acting beta-2 agonists (SABAs) is more common in elite athletes than in the general population, especially in endurance sports. The World Anti-Doping Code places some restrictions on prescribing inhaled β2-agonists. These drugs are used in respiratory diseases (such as asthma) that might reduce athletes’ performances. Recently, studies based on the results of the Olympic Games revealed that athletes with confirmed asthma/airway hyperresponsiveness (AHR) or exercise-induced bronchoconstriction (EIB) outperformed their non-asthmatic rivals. This overuse of SABA by high-level athletes, therefore, raises some questions, and many explanatory hypotheses are proposed. Asthma and EIB have a high prevalence in elite athletes, especially within endurance sports. It appears that many years of intensive endurance training can provoke airway injury, EIB, and asthma in athletes without any past history of respiratory diseases. Some sports lead to a higher risk of asthma than others due to the hyperventilation required over long periods of time and/or the high environmental exposure while performing the sport (for example swimming and the associated chlorine exposure). Inhaled corticosteroids (ICS) have a low efficacy in the treatment of asthma and EIB in elite athletes, leading to a much greater use of SABAs. A significant proportion of these high-level athletes suffer from non-allergic asthma, involving the th1-th17 pathway.
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Hammer IJ, Halvorsen T, Vollsaeter M, Hilland M, Heimdal JH, Røksund OD, Clemm HH. Conundrums in the breathless athlete; exercise induced laryngeal obstruction or asthma? Scand J Med Sci Sports 2022; 32:1041-1049. [PMID: 35114031 PMCID: PMC9303344 DOI: 10.1111/sms.14137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) are two disorders commonly considered when athletes complain of exertional dyspnea. They are highly different but often confused. We aimed to address this diagnostic challenge and its consequences in elite athletes. METHODS We included all athletes competing at national or international level, referred to our institution for workup for EILO during 2013-2016. We diagnosed EILO from video-recorded laryngoscopy performed during maximal cardiopulmonary treadmill exercise (CLE-test). Symptoms and previous diagnostic evaluations were obtained from referral letters and chart reviews. RESULTS EILO was diagnosed in 73/101 referred athletes, of whom 70/73 had moderate/severe supraglottic obstruction and 3/73 had primarily glottic obstruction with only minor supraglottic involvement. Of the 73 athletes with EILO, we were able to identify objective tests for asthma in 55 participants, of whom 22 had findings supporting asthma. However, 58/73 had used asthma therapy at some time previously, with current use in 28. Only three reported that asthma medication had improved their exercise related breathing problems, two of whom with tests confirming asthma. Treatment for EILO improved breathing problems in all but four. CONCLUSIONS Objective testing verified EILO in most of the referred athletes. EILO coexisting with asthma was common, and large proportions had used asthma medication; however, few reported effect on exercise related breathing problems. Unexplained persistent exertional dyspnoea must not lead to indiscriminate escalation of asthma treatment, but instead incite investigation for EILO, either as a co-morbidity or as a differential diagnosis.
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Affiliation(s)
- Ida Jansrud Hammer
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thomas Halvorsen
- Norwegian School of Sports Sciences, Oslo, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Vollsaeter
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Magnus Hilland
- Department of Otolaryngology/Head and Neck surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otolaryngology/Head and Neck surgery, Haukeland University Hospital, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ola Drange Røksund
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Otolaryngology/Head and Neck surgery, Haukeland University Hospital, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hege Havstad Clemm
- Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Greiwe J, Cooke A, Nanda A, Epstein SZ, Wasan AN, Shepard KV, Capão-Filipe M, Nish A, Rubin M, Gregory KL, Dass K, Blessing-Moore J, Randolph C. Work Group Report: Perspectives in Diagnosis and Management of Exercise-Induced Bronchoconstriction in Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2542-2555. [PMID: 32636147 DOI: 10.1016/j.jaip.2020.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
Exercise-induced bronchoconstriction, otherwise known as exercise-induced bronchoconstriction with asthma or without asthma, is an acute airway narrowing that occurs as a result of exercise and can occur in patients with asthma. A panel of members from the American Academy of Allergy, Asthma & Immunology Sports, Exercise, & Fitness Committee reviewed the diagnosis and management of exercise-induced bronchoconstriction in athletes of all skill levels including recreational athletes, high school and college athletes, and professional athletes. A special emphasis was placed on the recommendations and regulations set forth by professional athletic organizations after a detailed review of their collective bargaining agreements, substance abuse policies, antidoping program manuals, and the World Anti-Doping Agency antidoping code. The recommendations in this review are based on currently available evidence in addition to providing guidance for athletes of all skill levels as well as their treating physicians to better understand which pharmaceutical and nonpharmaceutical management options are appropriate as well as which medications are permitted or prohibited, and the proper documentation required to remain compliant.
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Affiliation(s)
- Justin Greiwe
- Bernstein Allergy Group Inc, Cincinnati, Ohio; Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew Cooke
- Lake Allergy, Asthma & Immunology PA, Tavares, Fla
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Kirk V Shepard
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Hospital, Tampa, Fla
| | | | - Andy Nish
- Northeast Georgia Physician's Group Allergy and Asthma, Gainesville, Ga
| | - Mark Rubin
- Asthma and COPD Emmi Solutions, Chicago, Ill; CME Education Program Steering Committee, The France Foundation, Old Lyme, Conn
| | - Karen L Gregory
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Okla; School of Nursing and Health Studies, Georgetown University, Washington, DC
| | - Kathleen Dass
- Michigan Allergy, Asthma & Immunology Center PLLC, Oak Park, Mich; Division of Immunology/Allergy Section, Department of Internal Medicine, Oakland University William Beaumont Hospital, Rochester, Mich
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Zeiger JS, Weiler JM. Special Considerations and Perspectives for Exercise-Induced Bronchoconstriction (EIB) in Olympic and Other Elite Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2194-2201. [PMID: 32006727 DOI: 10.1016/j.jaip.2020.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
Diagnosing and treating elite and Olympic athletes with exercise-induced bronchoconstriction has been well established. However, a subset of elite and Olympic athletes with exercise-induced bronchoconstriction experience symptoms of breathlessness due to lack of adherence, improper medications, and/or generalized breathing dysfunction. A short review of traditional treatment plans for elite and Olympic athletes is presented along with the challenges of adherence, managing dysfunctional breathing, and measuring and treating mental skills deficits that may impact breathing. Elite and Olympic athletes may not respond to traditional treatment for exercise-induced bronchospasm, and we present some of the reasons why the athletes fail to respond. Furthermore, we present information on how to detect and treat elite and Olympic athletes with difficult-to-treat asthma. As part of this review we developed a flow diagram for medical providers to identify the reasons for lack of response to traditional treatment plans for exercise-induced bronchoconstriction with options for other treatment modalities.
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Lemminger AK, Jessen S, Habib S, Onslev J, Xu SFS, Backer V, Bangsbo J, Hostrup M. Effect of beta2‐adrenergic agonist and resistance training on maximal oxygen uptake and muscle oxidative enzymes in men. Scand J Med Sci Sports 2019; 29:1881-1891. [DOI: 10.1111/sms.13544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Anders Krogh Lemminger
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Søren Jessen
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Sajad Habib
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Johan Onslev
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Stella Feng Sheng Xu
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Vibeke Backer
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Jens Bangsbo
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Morten Hostrup
- Section of Integrative Physiology Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
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DAVIES RACHELLED, PARENT ERICC, STEINBACK CRAIGD, KENNEDY MICHAELD. The Effect of Different Training Loads on the Lung Health of Competitive Youth Swimmers. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2018; 11:999-1018. [PMID: 30147830 PMCID: PMC6102193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Airway hyperresponsiveness (AHR), airway inflammation, and respiratory symptoms are common in competitive swimmers, however it is unclear how volume and intensity of training exacerbate these problems. Thus, our purpose was to measure AHR, inflammation, and respiratory symptoms after low, moderate, and high training loads in swimmers. Competitive youth swimmers (n=8) completed nine weeks of training split into three blocks (Low, Moderate, and High intensity). Spirometry at rest and post-bronchial provocation [Eucapnic Voluntary Hyperpnea (EVH)] and Fractional Exhaled Nitric Oxide (FeNO) were completed at the end of each training block. A weekly self-report questionnaire determined respiratory symptoms. Session Rating of Perceived Exertion (sRPE) quantified internal training loads. Internal load was significantly lower after Moderate training (4840 ± 971 AU) than after High training (5852 ± 737 AU) (p = 0.02, d = 1.17). Pre-EVH FEV1 was significantly decreased after Moderate (4.52 ± 0.69 L) compared to Low (4.74 ± 0.63 L) (p = 0.025, d = 0.326), but not different from High load. Post-EVH FeNO after Moderate training was significantly decreased (9.4 ± 4.9 ppb) compared to Low training (15.4 ± 3.6 ppb) (p = 0.012, r = 0.884). Respiratory symptom frequency was significantly correlated with percent decrease in FEV1 20 minutes post-EVH after Low and Moderate loads (both ρ = -0.71, sig = 0.05), and after High load was significantly correlated with percent decrease in FEV1 at 10 (ρ = -0.74, sig = 0.03), 15 (ρ = -0.91, sig = 0.00), and 20 minutes post (ρ = -0.75, sig = 0.03). In conclusion, Moderate load training resulted in the worst lung health results, suggesting there may be factors other than the total amount of stress within training blocks that influence lung health. Further research is needed to determine the effect of manipulating specific acute training load variables on the lung health of swimmers.
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Affiliation(s)
- RACHELLE D. DAVIES
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, CANADA
| | - ERIC C. PARENT
- Department of Physical Therapy, University of Alberta, Edmonton, AB, CANADA
| | - CRAIG D. STEINBACK
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, CANADA
| | - MICHAEL D. KENNEDY
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, CANADA
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Gaugg MT, Engler A, Nussbaumer-Ochsner Y, Bregy L, Stöberl AS, Gaisl T, Bruderer T, Zenobi R, Kohler M, Martinez-Lozano Sinues P. Metabolic effects of inhaled salbutamol determined by exhaled breath analysis. J Breath Res 2017; 11:046004. [DOI: 10.1088/1752-7163/aa7caa] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Thevis M, Kuuranne T, Geyer H, Schänzer W. Annual banned-substance review: analytical approaches in human sports drug testing. Drug Test Anal 2017; 9:6-29. [DOI: 10.1002/dta.2139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Mario Thevis
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6 50933 Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
| | - Tiia Kuuranne
- Swiss Laboratory for Doping Analyses; University Center of Legal Medicine; Genève and Lausanne, Centre Hospitalier Universitaire Vaudois and University of Lausanne Epalinges Switzerland
| | - Hans Geyer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6 50933 Cologne Germany
- European Monitoring Center for Emerging Doping Agents; Cologne Germany
| | - Wilhelm Schänzer
- Center for Preventive Doping Research - Institute of Biochemistry; German Sport University Cologne; Am Sportpark Müngersdorf 6 50933 Cologne Germany
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