Increased bronchial parasympathetic tone in elite cross-country and biathlon skiers: a randomised crossover study

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.

Exhaled nitric oxide concentration upon acute exposure to moderate altitude

The purpose of this study was to assess immediate changes in the partial pressure of nitric oxide (NO) in exhaled gas (PE NO ) in healthy trained subjects who were acutely exposed to moderate altitude. One group of nine and another group of 20 healthy subjects were exposed to an ambient pressure of 728 hPa (546 mmHg) corresponding to an altitude of 2800 m for 5 and 90 min, respectively, in an altitude chamber. PE NO was measured offline by sampling exhaled gas in tight metal foil bags at 5, 30, 60, and 90 min. A correction for increased expiratory flow rate due to gas density effects at altitude was performed (PE NO corr). PE NO was significantly decreased by 13-16%, while the fraction of NO in exhaled gas (FE NO) was increased by 16-19% compared to sea level. There was no significant change in PE NO corr after exposure to altitude for 5, 30, 60, and 90 min. We conclude that there was no change in PENO upon arrival at altitude after correcting for gas density effects on expiratory flow rate. Corrections for altitude effects must be done before comparing measurements performed at different altitudes when using measurements of FENO to monitor athletes who have asthma during training at altitude.

Can one single test protocol for provoking exercise-induced bronchoconstriction also be used for assessing aerobic capacity?

INTRODUCTION

Several different exercise protocols are used to assess exercise-induced bronchoconstriction (EIB), and to measure peak oxygen uptake (VO(2 peak)) and peak minute ventilation (VE(peak)).

OBJECTIVE

The aim of this study was to evaluate if one single test protocol for assessing EIB can also be used to determine aerobic capacity measured by VO(2 peak) and VE(peak).

METHODS

In a randomised cross-over design, 40 healthy subjects (female symbol/male symbol = 17/23) aged 14-40 years performed two exercise tests on a treadmill. Twenty subjects (female symbol/male symbol = 7/13) performed the two exercise tests at a treadmill inclination of 10.5%; the remaining 20 subjects (female symbol/male symbol = 10/10) performed at an inclination of 5.3%. A common stepwise protocol with 20 min of warming up was compared to an EIB test protocol of an 8-min treadmill run without warming up, with a workload corresponding to 95% of maximum heart rate during the last 4 min.

RESULTS

VO(2 peak) did not differ significantly between the two test protocols at 10.5% inclination: 63.3 mL/kg min(-1)(59.3, 67.4) [mean (95% confidence intervals)] and 63.9 mL/kg min(-1) (60.0, 68.0), respectively, or at 5.3% inclination: 56.0 mL/kg min(-1) (52.1, 60.0) and 56.1 mL/kg min(-1) (51.9, 60.2), respectively. Also, VE(peak) did not differ between the protocols 158 (144, 173) vs 161 L/min (145, 176) at 10.5% inclination and 123 (114, 132) vs 127 L/min (116, 138) at 5.3% inclination, with the EIB protocol and the stepwise protocol, respectively.

CONCLUSION

VO(2 peak) and VE(peak) did not differ between the two test protocols, and one single standardised EIB test may thus be used both for both provoking EIB and assessing VO(2 peak).

Exercise capacity and exercise-induced bronchoconstriction (EIB) in a cold environment

INTRODUCTION

Exercise in a cold environment has been reported to increase exercise-induced bronchoconstriction (EIB). However, the effect of a cold environment upon exercise capacity in subjects with EIB has, to our knowledge, not been previously reported.

PURPOSE

Primary: To examine the influence of changing environmental temperature upon exercise capacity measured by peak oxygen uptake (VO(2 peak)), peak ventilation (VE(peak)) and peak running speed in subjects with diagnosed EIB. Secondary: To assess the influence of changing environmental temperature upon EIB.

METHODS

Twenty subjects (10-45 years old, male/female: 13/7) with EIB underwent exercise testing by running on a treadmill in a climate chamber under standardised, regular conditions, 20.2 degrees C (+/-1.1) and 40.0% (+/-3.3) relative humidity [mean(+/-SD)], and in a standardised cold environment, -18.0 degrees C (+/-1.4) and 39.2% (+/-3.8) relative humidity in random order on separate days. Oxygen uptake (VO(2)), minute ventilation (V E), respiratory exchange ratio (RER), heart rate (HR) and running speed were measured during exercise. Lung function (flow volume loops) was measured before and 1, 3, 6, 10 and 15 min after exercise and 15 min after inhalation of salbutamol.

RESULTS

VO(2 peak) decreased 6.5%, from 47.9 (45.0, 50.8) to 44.8 ml kg(-1)min(-1) (41.2, 48.4) [mean (95% confidence intervals)] (p=0.004) in the cold environment. Also running speed was significantly lower in the cold environment (p=0.02). No differences were found for VE(peak), RER(peak) or HR(peak). The post-exercise reduction in forced expiratory volume in 1s (FEV(1)) (DeltaFEV(1)) increased significantly from 24% (19,29) to 31% (24,38), respectively (p=0.04) after exercise in the cold environment. No correlation was found between reduction in VO(2 peak) and the increased maximum fall in FEV(1) in the cold environment.

CONCLUSION

Exercise capacity (VO(2 peak) and peak running speed) was markedly reduced during exercise in a cold environment whereas EIB increased in subjects suffering from EIB.

Humidity influences exercise capacity in subjects with exercise-induced bronchoconstriction (EIB)

RATIONALE

Exercise-induced bronchoconstriction (EIB) increases in cold and dry air and decreases in humid air in subjects with asthma. Few reports have reported on the effect of humid environment upon exercise capacity in subjects with EIB.

OBJECTIVE

The primary aim of the present study was to examine the effect of changing the humidity of the environmental air upon exercise capacity measured by peak oxygen uptake (V O2 peak), peak ventilation (V Epeak) and peak running speed (V peak) and secondarily to assess the influence of environmental humidity upon EIB in subjects suffering from EIB.

METHODS

Twenty subjects (10-45 years old, male/female:13/7) with diagnosed EIB performed exercise testing under standardised, regular environmental conditions, 20.2 degrees C (+/- 1.1) and 40% (+/- 3.3) relative humidity [mean (+/- SD)], and under standardised humid environmental conditions; 19.9 degrees C (+/- 1.0) and 95% (+/- 1.7) relative humidity in random order on separate days. Lung function was measured before and 1, 3, 6, 10 and 15 min after exercise. Heart rate (HR), oxygen uptake (V O2), respiratory gas exchange ratio (RER), breathing frequency (BF) and minute ventilation (V E) were measured during exercise.

RESULTS

V O2 peak and V peak increased significantly from 40% to 95% relative humidity of the environmental air, 4.5% and 5.9%, respectively (P = 0.001). HRpeak increased significantly in the humid environment, while BF(peak) decreased significantly. RERpeak and V Epeak did not change significantly. Post-exercise reduction in FEV1 (DeltaFEV1) and FEF50 (forced expiratory flow at 50% of FVC) (DeltaFEF50) significantly decreased after exercise in a humid environment as compared to regular conditions, DeltaFEV1: 12% (7,17) vs. 24% (19,29) [mean (95% confidence intervals)], respectively, DeltaFEF50: 20% (12,29) vs. 38% (30,46), respectively (P < 0.001).

CONCLUSION

Exercise capacity (V O2 peak and V peak) markedly improved during exercise in humid air in subjects with EIB, whereas EIB was reduced to the half.

Asthma in medium altitude--exercise-induced bronchoconstriction in hypobaric environment in subjects with asthma

BACKGROUND

Hypoxic gas inhalation has been reported to enhance airway responsiveness and results in bronchoconstriction in animal models and in humans with asthma. However, the data have so far been conflicting. The aim of the present study was to examine the effect of reduced barometric pressure on exercise-induced bronchoconstriction (EIB) in subjects with asthma.

METHODS

Twenty subjects (10-45 years old, male symbol/female symbol = 13/7) with asthma (at least 10% reduction in forced expiratory volume in 1-second postexercise) participated in exercise testing in barometric pressure corresponding to altitudes of 200 (normobaric) and 2500 (hypobaric) m above sea level in random order on separate days. Lung function was measured before and after exercise, as well as after inhalation of salbutamol. Heart rate, oxygen uptake (), arterial oxygen saturation (S(p)O(2)), respiratory gas exchange ratio (RER) and minute ventilation () were measured during exercise.

RESULTS

There was no difference in lung function after exercise. The and HR(peak) during exercise did not differ. The RER(peak) was higher (P = 0.04) in hypobaric environment. The decreased 10.1% (7.2-13.0) [mean (95% confidence intervals)] (P < 0.001) from normobaric to hypobaric environment. At the same time, S(p)O(2) at decreased from 94.4 (92.2-96.6) to 85.6% (82.8-88.4) (P < 0.001).

CONCLUSIONS

A barometric pressure corresponding to altitude of 2500 m did not increase EIB in subjects with asthma. The reduction in is most probably due to the lower S(p)O(2) in hypobaric environment.

Feasibility of measuring lung function in preschool children

BACKGROUND

There have been difficulties in applying spirometric tests to children of preschool age.

METHODS

The feasibility of measuring lung function was examined in 652 children aged 3-6 years using dynamic spirometry with an animation programme and the guidelines approved by the European Respiratory Society.

RESULTS

Data from 603 (92%) children with at least two acceptable forced expiratory manoeuvres were analysed; 408 (68%) achieved at least three acceptable manoeuvres. Children with only two acceptable manoeuvres were younger, shorter, and weighed less (p<0.001). The lower levels of lung function in this group were partly explained by body size. 63% of those with three acceptable manoeuvres had a difference of </=5% between the highest and second highest forced expiratory volume in 1 second (FEV(1)); when a difference of </=10% was applied, 91% of the children were included. A similar trend was seen for forced vital capacity (FVC). The acceptability and reproducibility increased with increasing age, and levels of lung function increased linearly with age. The linear regression model showed that standing height was a satisfactory predictor of lung function; the explained fraction of variance (R(2)) was 59% for FEV(1). Most FVC manoeuvres in children older than 3 years were acceptable and reproducible.

CONCLUSIONS

Spirometric testing is feasible in preschool children and may be useful for both clinical practice and research. This study may fill the deficiency in reference values for European preschool children.

Can asthma treatment in sports be doping? The effect of the rapid onset, long-acting inhaled beta2-agonist formoterol upon endurance performance in healthy well-trained athletes

Inhaled beta2-agonists have been subject to restrictions in relationship to sports due to fear of possible improvement in endurance performance. According to the international doping regulations only inhaled salbutamol, terbutaline and salmeterol are allowed for use in sports. Formoterol is a recently introduced rapid onset-long-acting inhaled beta2-agonist. The main aim of the present randomized, double-blind placebo-controlled study was to investigate possible improvement in endurance performance of inhaled formoterol in 24 healthy well-trained competitive male athletes, 21-29 years old. Lung function (flow-volume loops) was measured before, 15 min after each inhaled study drug and before and repeatedly after exercise. On day 1, maximum oxygen uptake (VO2max), peak ventilation (VEpeak) and running time till exhaustion were measured and used to determine the exercise load on days 2 and 3. On days 2 and 3 the subjects inhaled the study drugs, rested for 1 h, then exercised, and VO2max, VEpeak and running time until exhaustion were determined. Inhaled formoterol did not improve any parameter of endurance performance. On the other hand a statistically significant, although not clinically significant (0.05 ml(-1) min kg(-1)), change was found in estimated difference of VO2max between formoterol and placebo in favour of placebo. Lung function increased significantly after inhaled formoterol, and after exercise also for placebo, but without differences between the beta2-agonist and placebo after exercise. In conclusion, inhaled formoterol did not improve endurance performance compared to placebo.

Wheezing in school children is not always asthma

Our objective was to study whether children with reported asthma differed from children with wheeze but without asthma, and from children with neither asthma nor wheeze, regarding lung function, bronchial hyper-responsiveness (BHR) using methacholine inhalation, exercise-induced bronchoconstriction (EIB), and skin prick test (SPT) reactivity. School children (n=2188), enrolled in a survey of asthma, were classified into three mutually exclusive groups by parental report of: asthma, wheeze, and no asthma/no wheeze. A random sample of 80 children in each group was tested (n=240). Among asthmatics, 68% (95% confidence interval (CI), 57-79) had a BHR (measured as PD20 forced expiratory volume in 1 s (FEV1) < or = 8.16 micromol using methacholine) compared to 31% (CI 20-42%) and 30% (CI 19-40%) in the wheeze and no asthma/no wheeze groups. The dose-response slope (DRS) confirmed the PD20 data and distinguished equally between groups. EIB (> or =10% fall in FEV1) was more frequent (40%, CI 29-52%) among asthmatics than among children with wheeze (12%, CI 4-19%) and no asthma/no wheeze (7%, CI 1-13%). The prevalence of at least one positive SPT was twice as high in the asthma group (58%, CI 47-69%) than in the wheeze (27%, CI 16-37%) and the no asthma/no wheeze (25%, CI 15-35%) groups. These results indicate that children with asthma differ from children with wheeze and children with no asthma/no wheeze regarding lung function, BHR, EIB, and SPT reactivity. Children with wheeze are more similar to children with no asthma/no wheeze with respect to these parameters.

L-tryptophan supplementation does not improve running performance

In 1988 Segura and Ventura (14) reported that 1.2 g of L-Tryptophan (L-TRY) supplementation increased total exercise time by 49.4% when the subjects were running at 80% of maximal oxygen uptake (VO2max). In human performance research, acute improvements of that category are rather uncommon. Both for this reason and because ingestion of purified L-TRY may have adverse effects, it seemed pertinent to repeat the investigation of Segura and Ventura. Forty-nine well-trained male runners, aged 18-44, with an average maximal aerobic power of 66 (57-78) ml.kg-1.min-1, participated in a randomized double blind placebo (P) study. Each subject underwent four trials on the treadmill. The first two served as learning experience, including measurement of VO2max and anaerobic threshold. During the last two trials the subjects ran until exhaustion at a speed corresponding to 100% of their VO2max-first an initial trial and then after receiving a total of 1.2 g L-TRY or P over a 24 hour period prior to the run. No significant difference between the improvements in the L-TRY and P group could be demonstrated. It is concluded that oral L-TRY supplementation does not enhance running performance.

A double-blind placebo controlled study of healthy volunteers given a subcutaneous disulfiram implantation

A study was carried out to elicit information of the pharmacological effect of implanted disulfiram (DS). Healthy volunteers were randomized to either of two groups; six were given 1 g DS implant and six subjects placebo (PL) implants. Each participant was subjected to one intravenous ethanol challenge before, and six intravenous ethanol challenges as well as one oral ethanol challenge after the implantation. No clinical signs of disulfiram-ethanol reactions (DER) were observed. The intravenous challenges did not result in any significant differences between pre- and post-implantation values for blood acetaldehyde concentrations in the DS group, and these values were not significantly different from the corresponding values in the PL group. However, somewhat higher blood acetaldehyde concentrations were recorded after an oral ethanol dose (0.8 g/kg) in the DS group. In a longitudinal study with oral ethanol challenges after implanted DS, one of three healthy volunteers had a significant higher blood acetaldehyde concentration three weeks after the implantation, while no such tendency was found in any subject tested earlier or later in the post-implantation period. The blood acetaldehyde levels after oral challenges were, however, far too low to produce a DER.