Self-reported asthma and allergies in top athletes compared to the general population - results of the German part of the GA2LEN-Olympic study 2008

The Practical Management of Rhinitis in Athletes

OBJECTIVE

Exercise-induced rhinitis (EIR) is a poorly understood condition that can have a massive impact within elite sport. This was epitomized in 2019 when British cyclist and Tour de France winner Chris Froome lost control of his bike at 37 mph while wiping his nose, resulting in an admission to intensive care. We aim to produce a comprehensive resource to guide the assessment and management of rhinitis in athletes.

DESIGN

Rhinitis is a common condition which can be broadly divided into allergic rhinitis (AR) and non-AR (NAR), a subset of which is known as vasomotor rhinitis. Exercise-induced rhinitis is an important but understudied subcategory of NAR. The pathophysiology of the disease is broadly believed to be an imbalance of the sympathetic and parasympathetic nervous systems, leading to symptoms of watery rhinorrhea, nasal congestion, and paroxysmal sneezing. Up to 50% of people suffer from some degree of EIR, which impedes their nasal breathing and affects performance. The assessment of the athlete with rhinitis requires consideration of both allergic and vasomotor contributions to ensure optimal management is introduced. There is no clear guidance for the management of EIR, with uncertainty regarding the most effective pharmaceuticals and optimizing the timing of treatment to enable peak performance.

SETTING

N/A.

PATIENTS/PARTICIPANTS

N/A.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

N/A.

RESULTS AND CONCLUSIONS

Based on expert clinical experience in a busy ear, nose, and throat center and a systematic review of current literature, this article proposes a step-wise, incremental approach to the management of EIR symptoms. In an industry where marginal gains give athletes a competitive edge, optimal management of EIR is crucial.

History of Multiple Allergies and Gradual Onset Running-Related Injuries in Distance Runners: SAFER XXXV

OBJECTIVE

To determine if any gradual onset running-related injury (GORRI) was associated with any allergies, multiple allergies (allergies to animals, plants, medication), and allergy medication use.

DESIGN

Cross-sectional descriptive study.

SETTING

Two Oceans Marathons (56 km, 21.1 km), South Africa.

PARTICIPANTS

A total of 76 654 race entrants (2012-2015).

INDEPENDENT VARIABLES

The prevalence (%) and prevalence ratios (PR; 95% confidence intervals) for history of (1) any allergies, (2) multiple allergies to broad categories of allergens (animal material, plant material, allergies to medication, and other allergies), and (3) allergy medication use.

MAIN OUTCOME MEASURES

Using a compulsory online screening questionnaire, the outcome was a history of any GORRIs, and subcategories of GORRIs (muscle, tendon) in the past 12 months and history of GORRIs (and subtypes of GORRIs) were reported.

RESULTS

In 68 258 records with injury and allergy data, the following were significantly associated with reporting any GORRIs: a history of any allergy (PR = 2.2; P < 0.0001), a history of allergies to broad categories of allergens (animal, plant, medication allergy, other) (P < 0.0001), and the use of allergy medication (P < 0.0001). A history of any allergies (PR = 2.4; P < 0.0001), all broad categories of allergies, and allergy medication use were significantly associated with muscle (P < 0.0001) and tendon injuries (P < 0.0001). The risk of reporting a GORRI increased as the number of reported categories of allergies increased (P < 0.0001).

CONCLUSIONS

A novel finding was the cumulative risk effect with a history of multiple allergies. Further studies should aim to determine the underlying mechanism relating allergies and GORRIs.

Use of pharmaceuticals amongst athletes tested by Anti-Doping Norway in a five-year period

Introduction

The aim of the study was to map the use of pharmaceuticals by Norwegian athletes registered on doping control forms (DCFs) in a five-year period to examine general and some class specific use of pharmaceuticals across sports and athlete levels.

Method

Anonymous data from DCFs collected in 2015-2019 were manually entered into a database using the Anatomical Therapeutic Chemical (ATC) system for classification of the pharmaceuticals. Variables entered were year of control, gender, age group, athlete level, sport, test type, nationality, and pharmaceuticals (and dietary supplements) used.

Results

Pain killers in the ATC groups M01 A (Nonsteroidal anti-inflammatory drugs - NSAIDs) and N02 B (other analgesics), and anti-asthmatics in ATC groups R03 A and R03 B were the most frequently used pharmaceuticals. National level athletes reported more use of pharmaceuticals (1.4 ± 1.7 pharmaceuticals per form) than recreational level athletes (0.9 ± 1.2). The highest proportion of DCFs containing information about at least one pharmaceutical were found in speed skating (79.1%), alpine skiing (74.0%), rowing (72.4%) and cross-country skiing (71.7%). Painkillers were most frequently used in muscular endurance sports (30.4% and 21.2 % for M01A and N02 B, respectively) and ball and team sports (17.9% and 17.0%). Use of hypnotics was reported from ice-hockey players and alpine skiers in around 8% of the cases.

Coclusion

Use of anti-asthmatics was most often reported amongst athletes specially exposed to cold, chemicals and heavy endurance training. Athletes in specialized sports requiring high levels of strength and/or endurance reported a higher use of pharmaceuticals out-of-competition compared to in-competition, while there was no such difference in complex sports, such as team, gymnastic, aiming and combat sports.

Acute Effects of Single Versus Combined Inhaled β2-Agonists Salbutamol and Formoterol on Time Trial Performance, Lung Function, Metabolic and Endocrine Variables

BACKGROUND

High prevalence rates of β2-agonist use among athletes in competitive sports makes it tempting to speculate that illegitimate use of β2-agonists boosts performance. However, data regarding the potential performance-enhancing effects of inhaled β2-agonists and its underlying molecular basis are scarce.

METHODS

In total, 24 competitive endurance athletes (12f/12m) participated in a clinical double-blinded balanced four-way block cross-over trial to investigate single versus combined effects of β2-agonists salbutamol (SAL) and formoterol (FOR), to evaluate the potential performance enhancement of SAL (1200 µg, Cyclocaps, Pb Pharma GmbH), FOR (36 µg, Sandoz, HEXAL AG) and SAL + FOR (1200 µg + 36 µg) compared to placebo (PLA, Gelatine capsules containing lactose monohydrate, Pharmacy of the University Hospital Ulm). Measurements included skeletal muscle gene and protein expression, endocrine regulation, urinary/serum β2-agonist concentrations, cardiac markers, cardiopulmonary and lung function testing and the 10-min time trial (TT) performance on a bicycle ergometer as outcome variables. Blood and urine samples were collected pre-, post-, 3 h post- and 24 h post-TT.

RESULTS

Mean power output during TT was not different between study arms. Treatment effects regarding lung function (p < 0.001), echocardiographic (left ventricular end-systolic volume p = 0.037; endocardial global longitudinal strain p < 0.001) and metabolic variables (e.g. NR4A2 and ATF3 pathway) were observed without any influence on performance. In female athletes, total serum β2-agonist concentrations for SAL and FOR were higher. Microarray muscle gene analysis showed a treatment effect for target genes in energy metabolism with strongest effect by SAL + FOR (NR4A2; p = 0.001). Of endocrine variables, follicle-stimulating hormone (3 h Post-Post-TT), luteinizing hormone (3 h Post-Pre-TT) and insulin (Post-Pre-TT) concentrations showed a treatment effect (all p < 0.05).

CONCLUSIONS

No endurance performance-enhancing effect for SAL, FOR or SAL + FOR within the permitted dosages compared to PLA was found despite an acute effect on lung and cardiac function as well as endocrine and metabolic variables in healthy participants. The impact of combined β2-agonists on performance and sex-specific thresholds on the molecular and cardiac level and their potential long-term performance enhancing or health effects have still to be determined.

TRIAL REGISTRATION

Registered at Eudra CT with the number: 2015-005598-19 (09.12.2015) and DRKS with number DRKS00010574 (16.11.2021, retrospectively registered).

Air Quality Sensors Systems as Tools to Support Guidance in Athletics Stadia for Elite and Recreational Athletes

While athletes have high exposures to air pollutants due to their increased breathing rates, sport governing bodies have little guidance to support events scheduling or protect stadium users. A key limitation for this is the lack of hyper-local, high time-resolved air quality data representative of exposures in stadia. This work aimed to evaluate whether air quality sensors can describe ambient air quality in Athletics stadia. Sensing nodes were deployed in 6 stadia in major cities around the globe, monitoring NO₂, O₃, NO, PM₁₀, PM_2.5, PM₁, CO, ambient temperature, and relative humidity. Results demonstrated that the interpretation of hourly pollutant patterns, in combination with self-organising maps (SOMs), enabled the interpretation of probable emission sources (e.g., vehicular traffic) and of atmospheric processes (e.g., local vs. regional O formation). The ratios between PM size fractions provided insights into potential emission sources (e.g., local dust re-suspension) which may help design mitigation strategies. The high resolution of the data facilitated identifying optimal periods of the day and year for scheduling athletic trainings and/or competitions. Provided that the necessary data quality checks are applied, sensors can support stadium operators in providing athlete communities with recommendations to minimise exposure and provide guidance for event scheduling.

Overuse of Short-Acting Beta-2 Agonists (SABAs) in Elite Athletes: Hypotheses to Explain It

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.

The ELSA trial: single versus combinatory effects of non-prohibited beta-2 agonists on skeletal muscle metabolism, cardio-pulmonary function and endurance performance-study protocol for a randomized 4-way balanced cross-over trial

BACKGROUND

Asthma and/or airway hyper-responsiveness (AHR) are common in elite endurance athletes with a high prevalence rate of beta-2 adrenoreceptor (beta-2) agonists use. Nevertheless, there are data on dose-dependent ergogenic effects of beta-2 agonists suggesting increased muscle strength, endurance and neuromuscular performance. Therefore, most beta-2 agonists belong to the World Anti Doping Agency (WADA) list of prohibited substances and it is tempting to speculate that illegitimate use of beta-2 agonists might be a common practice to boost performance in competitive sports. It is currently unknown whether or not inhaled beta-2 agonists enhance performance by stimulatory effects in skeletal and cardiac muscle.

METHODS

The ELSA trial is a double-blinded, placebo-controlled, randomized, balanced, four-way cross-over study. Study participants (n=24, 12 ♀, 12 ♂) complete four study arms (i.e. periods with treatment A, placebo; B, salbutamol; C, formoterol; D, formoterol + salbutamol) in random order after an initial preliminary testing session. Participants inhale the study medication 20 min before the 10-min time trial (TT; exercise performance test), where participants cycle 10 min at the highest possible workload. Cardiac output is measured continuously. A skeletal muscle biopsy is collected 3 h after the TT. Study endpoints include measures of skeletal muscle expression of nuclear receptors, hormones and cytokine levels, urinary and plasma concentrations of salbutamol and formoterol, circulating cardiac markers, cardiopulmonary function and exercise performance (average power and peak power during the TT). Blood and urine are collected and respiratory testing is performed 24 h post TT. This clinical trial evaluates the potential performance-enhancing effects of non-prohibited, not medically indicated inhaled short- and long-acting beta-2 agonists on skeletal muscle gene expression, endocrine regulation, cardiac biomarkers, cardiopulmonary function and acute endurance exercise performance. These data will be used by WADA to adapt the annually published list of prohibited substances (WADA 2021) and will be published in scientific journals.

TRIAL REGISTRATION

The trial is registered at the European Clinical Trials Database (Eudra CT) with the number: 2015-005598-19 as well as at the German register for clinical studies (DRKS number 00010574 ).

Tackling nasal symptoms in athletes: Moving towards personalized medicine

Adequate nasal breathing is indispensable for athletes, and nasal symptoms have been shown to interfere with their subjective feeling of comfortable breathing and quality of life. Nasal symptoms are caused by either structural abnormalities or mucosal pathology. Structural pathologies are managed differently from mucosal disease, and therefore, adequate diagnosis is of utmost importance in athletes in order to choose the correct treatment option for the individual. Literature suggests that nasal symptoms are more prevalent in athletes compared to the general population and certain sports environments might even trigger the development of symptoms. Given the high demands of respiratory function in athletes, insight into triggering factors is of high importance for disease prevention. Also, it has been suggested that athletes are more neglectful to their symptoms and hence remain undertreated, meaning that special attention should be paid to education of athletes and their caregivers. This review aims at giving an overview of nasal physiology in exercise as well as the possible types of nasal pathology. Additionally, diagnostic and treatment options are discussed and we focus on unmet needs for the management and prevention of these symptoms in athletes within the concept of precision medicine.

Features of Neutrophils From Atopic and Non-Atopic Elite Endurance Runners

We collected peripheral blood from thirty-nine elite male endurance runners at rest (24 hours after the last exercise session) and used the Allergy Questionnaire for Athletes score and plasma specific IgE level to separate them into atopic and non-atopic athletes. Neutrophils obtained from atopic and non-atopic athletes were subsequently stimulated in vitro with fMLP (N-formyl-methionyl-leucyl-phenylalanine), LPS (lipopolysaccharide), or PMA (phorbol 12-myristate 13-acetate). Neutrophils from non-atopic runners responded appropriately to LPS, as evidenced by the production of pro (IL-8, TNF-α, and IL-6) and anti-inflammatory (IL-10) cytokines. Neutrophils from atopic elite runners exhibited lower responses to LPS stimulus as indicated by no increase in IL-1β, TNF-α, and IL-6 production. Neutrophils from non-atopic and atopic runners responded similarly to fMLP stimulation, indicating that migration function remained unaltered. Both groups were unresponsive to PMA induced reactive oxygen species (ROS) production. Training hours and training volume were not associated with neutrophil IgE receptor gene expression or any evaluated neutrophil function. Since non-atopic runners normally responded to LPS stimulation, the reduced neutrophil response to the stimuli was most likely due to the atopic state and not exercise training. The findings reported are of clinical relevance because atopic runners exhibit a constant decline in competition performance and are more susceptible to invading microorganisms.

Evaluation of Allergic Diseases, Symptom Control, and Relation to Infections in a Group of Italian Elite Mountain Bikers

OBJECTIVES

This study estimates the prevalence of allergic diseases in a group of Italian elite mountain bikers, compares the prevalence of infectious episodes between allergic and nonallergic athletes, and evaluates asthma and rhinitis symptom control in allergic athletes.

DESIGN

Two hundred twenty-six Italian nonsmoking mountain bikers received by mail the Allergy Questionnaire for Athletes (AQUA) and completed it. The RhinAsthma Patient Perspective (RAPP) questionnaire was sent to the 108 participants with a positive AQUA score and 104 returned the questionnaire.

METHODS

Athletes with an AQUA score ≥5 or <5 were defined AQUA+ (allergic) or AQUA- (nonallergic), respectively. RhinAsthma Patient Perspective questionnaire total score ≥15 was indicative of a poor control of symptoms.

RESULTS

Of the 226 athletes, 47.8% were AQUA+, whereas 52.2% were AQUA-. A higher number of AQUA+ athletes reported frequent upper respiratory tract infections (URTIs) and herpes labialis than AQUA- athletes (P < 0.001), and the prevalence of URTI was greater in the subgroup of AQUA+ athletes who trained ≥3 hours per session. According to RAPP questionnaire score, 21.1% of AQUA+ mountain bikers had a poor control of asthma and rhinitis symptoms.

CONCLUSIONS

Our study shows a high prevalence of allergy among Italian elite mountain bikers whose asthma and rhinitis symptoms are poorly controlled in about a fifth of the sample. Allergic athletes, mainly those training more than 3 hours per session, are at higher risk of URTI and herpes labialis. Screening programs to detect allergic diseases and to evaluate symptom control in athletes should be strongly encouraged.

Protective Effect of Aerobic Exercise on the Nasal Mucosa of Rats Against the Histopathologic Changes in Cigarette Smoke Exposure

INTRODUCTION

Smoking is a public health problem that has been proven to have adverse effects on human health. Aerobic exercise has positive effects on the human body, especially on the respiratory system.

OBJECTIVE

The aim of this experimental animal model study was to determine whether regular aerobic exercise has a protective effect against the harmful effects of cigarette smoke on the nasal mucosa of rats.

METHODS

A total of 24 male Wistar albino rats were randomly separated into 3 groups of 8: group 1 (cigarette smoking), group 2 (cigarette smoking and exercise), and group 3 (control group). At the end of the experiment period, histopathological (light and electron microscopy) and immunohistochemical (GSTA 1, CYP1A1, and CYP2E1) evaluations were made of the nasal mucosa of the animals.

RESULTS

Goblet cell loss and basal membrane thickening were significantly lower in group 2 and group 3 compared to group 1. In the electron microscope evaluation, the inflammatory expressions of the goblet cells were observed in a very small area in group 2. In group 1, these were distributed over large areas between the mucosal cells. There was seen to be significant swelling of the mitochondria in group 1 compared to the other groups. No statistically significant difference was determined between the groups with respect to GSTA1, CYP2E1, and CYP1A1 scores (P > .05).

CONCLUSION

The results of this study showed that regular aerobic exercise has a protective effect against the harmful effects of smoking on the nasal mucosa of rats.

Asthma among elite athletes, mechanism of occurrence and impact on respiratory parameters: A review of literature

Introduction: It is generally accepted that physical activity benefits every person but athletes diagnosed with asthma face various challenges during their training to keep the symptoms of the disease under control. Prolonged exposure to agents in the environment in which athletes train favors the development of permanent changes in the airways. Their action leads to permanent hyper-reactivity with development of an inflammatory response and the release of mediators (IL-8, leukotrienes, eicosanoids) that lead to damage epithelial cells with breaking connection between them and consequent dysfunction of the respiratory system. This condition is called exercise-induced asthma (EIA). This fact is especially important for athletes who have long endurance training. The best way to check the condition of breathing system is with a diagnostic method which is the " gold" standard spirometry. Aim: The point of this systematic review is to get closer the mechanism occurrence of EIA/(exercise-induced bronchoconstriction)-EIB, prevalence and incidence of EIA/EIB, changes of pulmonary function and quality of life in elite athletes. We searched papers from PubMed and Cochrane database using keywords: 'exercise-induced asthma', 'athletes', 'spirometry', 'bronchoconstriction', 'bronchospasm', 'physical activity', 'physical training', 'prevalence', 'incidence'. We have studied 48 scientific papers in total. Conclusion: The prevalence of asthma among elite athletes, especially endurance athletes is higher than in general population. The explanation of this phenomenon is related to the whole mechanism of occurrence, it is still insufficiently clarified, but one thing is for sure that with good disease control athletes can play and compete undisturbed for many years.

Nasal disease and quality of life in athletes

Objectives

Nasal disease imposes a significant disease burden upon the individual in the general population, but is relatively under studied in athletes. This study sought to define the frequency of nasal symptoms in the active population, and to quantify the impact of these symptoms on quality of life and on the frequency of upper respiratory tract infections.

Results

A total of 296 participants completed the study (246 athletes and 50 sedentary controls). Nasal symptoms were significantly more frequent in the active group than in the sedentary controls (70 per cent vs 52 per cent). Upper respiratory tract infections were significantly more common in athletes with regular nasal symptoms than in athletes without nasal symptoms. Quality-of-life scores, as measured by the 22-item Sino-Nasal Outcome Test, were significantly worse in athletes with regular nasal symptoms.

Conclusion

This study suggests that regular exercise is associated with a significant increase in the prevalence of troubling nasal symptoms, and nasal symptoms in athletes are associated with increased susceptibility to upper respiratory tract infections. Quality of life was negatively affected, confirming the importance of nasal health to athlete welfare.

Impaired sports performance of athletes suffering from pollen-induced allergic rhinitis: a cross-sectional, observational survey in German athletes

BACKGROUND

Allergic rhinitis has major impacts on sports performance of athletes. The present study aimed at determining the frequency of seasonal pollen allergy and analyzing the impacts of pollen allergy, the choice of allergy treatments and their benefits for sports performance in a group of professional and recreational athletes.

METHODS

The study was conducted as a self-reported questionnaire survey. Subjects were recruited from the German Sport University and the Cologne Marathon 2014 during the peak pollen season of 2014.

RESULTS

Athletes returned 636 completed questionnaires, 42.6% of participants reported suffering from a pollen allergy and 30.2% also suffered from asthma. Performance impairments were reported in more than 80% of allergic subjects. In all, 82.2% of subjects used symptomatic medications, 32.3% alternative therapies, and 47.6% allergen immunotherapy. Subjects who used immunotherapy had fewer impaired training bouts than those who used symptomatic and alternative therapies. The majority of subjects had concerns about allergy treatment such as side effects, negative impacts on sports performance and lack of long-term effects.

CONCLUSIONS

This study confirmed a high prevalence of pollen allergy among German athletes. The majority of allergic rhinitis athletes were undertreated, and the reason could be their reservations about allergy treatments. Pollen allergy tremendously reduced sports performance of athletes during the pollen season. This impact can be lessened with proper treatment such as immunotherapy. Better understanding of available treatment modalities should be provided to patients and physicians to improve sports performance of athletes suffering from pollen allergy.

Atopy in Elite Endurance Athletes

OBJECTIVE

To assess the frequency of atopy (specific IgE levels), to evaluate the allergic symptoms using the Allergy Questionnaire for Athletes (AQUA), and to determine whether atopy is associated with allergic symptoms in elite endurance athletes.

DESIGN

Cross-sectional study.

SETTING

Assessments were performed at Hospital das Clinicas-São Paulo University Medical School.

PARTICIPANTS

Fifty-nine elite endurance athletes (triathletes and runners).

MAIN OUTCOME MEASURES

Allergic symptoms were assessed by a validated self-report AQUA questionnaire and atopy by specific IgE level.

RESULTS

The frequency of atopy (specific IgE to at least one inhalant allergen) and allergic symptoms was 57.6% and 54.2%, respectively. In addition, no association was observed between atopy and allergic symptoms.

CONCLUSIONS

A possible implication from our results is that atopy screening in elite athletes should be performed using AQUA questionnaire and measuring specific IgE simultaneously.

Prevalence of Rhinitis in Athletes: Systematic Review

Background

Prevalence of rhinitis in athletes has frequently been studied and varies widely from 27% to 74%. The aim of this systematic review was to examine the prevalence of rhinitis in athletes, to specifically compare the evidence of rhinitis in land-based and aquatic athletes.

Methods

Systematic search of MEDLINE, EMBASE, and the non-MEDLINE subset of PubMed was performed from inception to March 8, 2016, to identify studies on rhinitis in athletes.

Results

Of the 373 identified unique articles, a total of 13 studies satisfied the criteria for this review. The final group contained 9 cohort and 4 case-control studies. We found 10 studies that reported the prevalence of allergic rhinitis (21%–56.5%). In contrast, nonallergic rhinitis was identified by only 1 author (6%). We have also evaluated the prevalence of rhinitis in the separate subgroups (land, water, and cold air) where swimmers seem to be the most affected (40%–74%), followed by cross-country skiers (46%) and track and field athletes (21 to 49%).

Conclusion

We did not reveal any convincing trend of a higher prevalence in land-based athletes compared to general population. By contrast, aquatic and cold air athletes demonstrate increased prevalence reflecting the irritant effects of their environment on the nasal mucosa.

Nasal function and dysfunction in exercise

BACKGROUND

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.

METHODS

The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.

RESULTS

There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.

CONCLUSION

Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

Asthma prevalence in German Olympic athletes: A comparison of winter and summer sport disciplines

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.

Asthma prevalence in Olympic summer athletes and the general population: An analysis of three European countries

BACKGROUND

Some studies have shown a higher prevalence of asthma in elite athletes as compared to the general population. It is inconclusive to what extent certain sport categories are especially affected. The present study offered a unique opportunity to assess these differences in asthma prevalence in the general population and elite summer athletes from a wide range of sport disciplines across various geographical areas.

METHODS

Cross-sectional data for 1568 general population participants from the European Community Respiratory Health Survey II and 546 elite athletes from the Global Allergy and Asthma European Network Olympic study from three European countries were analyzed. Using logistic regression, the asthma risks associated with athlete sport practice, endurance level and aquatic sport practice, respectively, were investigated.

RESULTS

Athletes in the highest endurance category had increased risk of doctor-diagnosed asthma (OR 3.5; 95% CI 1.7-7.5), asthma symptoms (OR 3.0; CI 1.5-6.0) and asthma symptoms or medication use (OR 3.5; CI 1.8-6.7) compared to the general population. Aquatic athletes were at increased risk of doctor-diagnosed asthma (OR 2.0; CI 1.1-3.9), asthma symptoms (OR 2.6; CI 1.3-5.0) and asthma symptoms or medication use (OR 2.3; CI 1.2-4.4) when compared to individuals not involved in aquatic sports. Regarding the entire athlete population, no increase in asthma was found when compared to the general population.

CONCLUSIONS

Practice of very high endurance and aquatic sports may be associated with increased asthma risks. Athlete participation as such showed no association with asthma risk.

The effect of vitamin C on bronchoconstriction and respiratory symptoms caused by exercise: a review and statistical analysis

Physical activity increases oxidative stress and therefore the antioxidant effects of vitamin C administration might become evident in people undertaking vigorous exercise. Vitamin C is involved in the metabolism of histamine, prostaglandins, and cysteinyl leukotrienes, all of which appear to be mediators in the pathogenesis of exercise-induced bronchoconstriction (EIB). Three studies assessing the effect of vitamin C on patients with EIB were subjected to a meta-analysis and revealed that vitamin C reduced postexercise FEV1 decline by 48% (95% CI: 33% to 64%). The correlation between postexercise FEV1 decline and respiratory symptoms associated with exercise is poor, yet symptoms are the most relevant to patients. Five other studies examined subjects who were under short-term, heavy physical stress and revealed that vitamin C reduced the incidence of respiratory symptoms by 52% (95% CI: 36% to 65%). Another trial reported that vitamin C halved the duration of the respiratory symptoms in male adolescent competitive swimmers. Although FEV1 is the standard outcome for assessing EIB, other outcomes may provide additional information. In particular, the mean postexercise decline of FEF50 is twice the decline of FEV1. Schachter and Schlesinger (1982) reported the effect of vitamin C on exercise-induced FEF60 levels in 12 patients suffering from EIB and their data are analyzed in this paper. The postexercise FEF60 decline was greater than 60% for five participants and such a dramatic decline indicates that the absolute postexercise FEF60 level becomes an important outcome in its own right. Vitamin C increased postexercise FEF60 levels by 50% to 150% in those five participants, but had no significant effect in the other seven participants. Thus, future research on the effects of vitamin C on EIB should not be restricted to measuring only FEV1. Vitamin C is inexpensive and safe, and further study on those people who have EIB or respiratory symptoms associated with exercise is warranted.

Exercise-induced respiratory symptoms and allergy in elite athletes: Allergy and Asthma in Polish Olympic Athletes (A(2)POLO) project within GA(2)LEN initiative

INTRODUCTION

Exercise-induced respiratory symptoms are often reported by professional athletes, but asthma and allergy are underdiagnosed. Few studies used standardized questionnaires combined with clinical assessment to investigate asthma and allergy among athletes.

OBJECTIVES

Assessment of the prevalence of allergy and asthma symptoms among Polish professional athletes and confronting it with clinical data.

METHODS

Two hundred twenty-two Olympic athletes participated in the project being part of the Global Allergy and Asthma European Network (GA(2) LEN) Olympic study. Allergy and asthma status was determined using Allergy Questionnaire for Athletes (AQUA), spirometry, reversibility test, methacholine challenge and skin prick testing. Final diagnosis was established by an allergist.

RESULTS

At least one exercise-induced asthma (EIA) symptom was reported by 28.4% athletes, and finally asthma diagnosis was established in 11.3% while only 5.9% of athletes had history of asthma. Reversibility test was positive in 36% of athletes finally diagnosed with asthma. Allergic rhinitis (AR) symptoms were reported by 27%, and the diagnosis was confirmed in 21% of athletes while only 9% had previously diagnosed AR. No significant differences in frequency of asthma and AR were observed between endurance and non-endurance athletes.

CONCLUSIONS

High prevalence of exercise-induced respiratory symptoms among top athletes is not reflected by asthma diagnosis. As it was expected, our data confirm that - in diagnosis of EIA - lung function testing alone is not useful, whereas reversibility tests are of limited value.

AQUA© as predictor of allergy in elite marathon runners

Background

The prevalence of allergy in athletes is increasing, and its risk varies across sports. The risk is dependent mainly on the ventilation rate and environmental factors; however, the prevalence of allergy in elite runners remains unknown. Therefore, the aim of this study was to screen allergy symptoms in elite marathon runners by using a validated questionnaire for screening allergy in athletes.

Methods

Two hundred and one elite marathoners, who participated in the most competitive Brazilian marathons and half-marathons during 2011, were invited to complete a validated self-report Allergy Questionnaire for Athletes (AQUA^©), with additional questions pertaining to training history, such as running experience, running distance per week and their best race time in marathon or half-marathon events.

Results

Sixty percent of the assessed athletes reported allergy symptoms as defined by a positive AQUA outcome (score [greater than or equal to] 5). No significant differences (p > 0.05) between groups (AQUA + and AQUA-) were observed for gender, age, running experience, weekly training volume and best performance time in the half-marathon and marathon. The most frequently reported symptoms were related to the respiratory tract and physical effort.

Conclusions

This study demonstrates that AQUA^© can be used to predict allergy in elite marathon runners. In addition, these athletes have a higher prevalence of allergy symptoms to elite athletes from other sports.

Physician-prescribed medication use by the Finnish Paralympic and Olympic athletes

OBJECTIVE

Data about medication use by Paralympic athletes (PAs) are limited and no data concerning medication use outside Paralympics exist. The objective of the current study was to compare the use of physician-prescribed medication in PAs and Olympic athletes (OAs).

DESIGN

A cross-sectional comparative study.

SETTING

Finnish PAs and OAs receiving financial support from the Finnish Olympic and Paralympic committee in 2006 and 2009, respectively.

PARTICIPANTS

A total of 92 PAs (response rate, 75.0%; 92 of 123) and 372 OAs (response rate, 91.9%; 372 of 405) participated.

ASSESSMENT OF RISK FACTORS

Age, sex, and type of athlete (PA vs OA) were included as independent covariates in the logistic regression model analysis.

MAIN OUTCOME MEASURES

The use of physician-prescribed medication among athletes during the previous 7 days and 12 months.

RESULTS

Among the PAs, the use of physician-prescribed medicines (48.9% vs 33.3%; adjusted odds ratio, 1.99; 95% confidence interval, 1.13-3.51), painkillers (2.61; 1.18-5.78), oral antibiotics (4.10; 1.30-12.87), and anti-epileptic medicines (37.09; 5.92-232.31) were more common than among the OAs during the previous 7 days. Paralympic athletes had used significantly less asthma medicines than the OAs during the previous 7 days (4.3% vs 11.0%; adjusted odds ratio, 0.30; 95% confidence interval, 0.10-0.96).

CONCLUSIONS

The use of any physician-prescribed medicines, especially those to treat chronic diseases, seems to be more common among the PAs than the OAs. Paralympic athletes use significantly less asthma medicines than OAs.

Asthma medication is increasingly prescribed for finnish olympic athletes--for a reason?

BACKGROUND

Use of asthma medication is common among athletes. In 2009, the World Anti-Doping Committee (WADA) and the International Olympic Committee removed the need to document asthma by lung function tests before the use of inhaled β2-agonists.

METHODS

We assessed the changes in asthma medication use in Finnish Olympic athletes 8 years apart in 2002 (N = 446) and 2009 (N = 372). The athletes filled out a questionnaire on asthma symptoms, diagnosis, and medication.

RESULTS

The use of asthma medication increased from 9.4% in 2002 to 12.6% in 2009 (adjusted odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.69). Fixed combinations of inhaled long-acting β2-agonists (LABAs) and inhaled corticosteroids (ICSs) were used three times more in 2009 vs. 2002 (OR = 3.38, 95% CI 1.26-9.12). At the same time, no significant changes were observed in the occurrences of physician-diagnosed asthma (13.9% vs. 15.9%) or wheezing (10.3% vs. 10.2%). In 2002, all athletes on asthma medication also had a physician-diagnosed disease, but in 2009, 11.8% of the athletes on medication were lacking it.

CONCLUSIONS

Especially, the use of combination therapy of LABAs and ICSs is increasing among Finnish Olympic athletes. This trend is worrying as it is not based on increasing occurrence of symptoms, asthma diagnoses, or objective lung function measurements. More data, also from other countries, are needed to change recommendations or WADA rules.