Asthma, Airway Inflammation and Treatment in Elite Athletes

Abstract

Highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many inhalant irritants and allergens all year round. Asthma occurs most commonly in athletes engaging in endurance events such as cross-country skiing, swimming, or long-distance running. As well as the type of training, a major risk factor is atopic disposition. A mixed type of eosinophilic and neutrophilic airway inflammation has been shown to affect elite swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a form of repeated thermal, mechanical, or osmotic airway trauma resulting in a healing or remodelling process. Elite athletes commonly use antiasthma drugs to treat exercise-induced bronchial symptoms. Only a few controlled studies have been conducted on the effects of antiasthma drugs on asthma symptoms, bronchial hyperresponsiveness and airway inflammation in elite athletes. Inhaled beta(2)-adrenoceptor agonists are effective against exercise-induced bronchospasm. In contrast, airway inflammation, bronchial hyperresponsiveness and symptoms have responded poorly to inhaled corticosteroids and leukotriene antagonists. As discontinuing high-level exercise has proved effective in reducing eosinophilic airway inflammation, exercise or training should be restricted in athletes having troublesome symptoms and sputum eosinophilia. Switching training to less irritating environments should be considered whenever possible. It appears to be difficult to change the 'natural course' of asthma in athletes by anti-inflammatory treatment.

Cold air-provoked respiratory symptoms: the mechanisms and management

“…Indeed, a high prevalence of respiratory symptoms and airway hyperresponsiveness has been found in skiers, swimmers and long-distance runners (75). Endobronchial biopsies of elite, competitive skiers demonstrate elevated numbers of clustered lymphocytes, neutrophils and macrophages (76,77).…”

Exercise-Induced Bronchospasm in Soccer Athletes Living in a Tropical Humid Region

“…The prevalence of respiratory symptom among elite athletes is high [22] and exercises of long duration with high loads, requiring high ventilation levels, are those that most often cause EIB [23][24][25]. It is believed that the mechanism responsible for EIB is airway periciliary fluid dehydration due to hyperventilation that leads to mediators release by airway epithelial and mast cells [26].…”

Airways inflammatory and atopy-related responses in athletes

“…endurance, or speed and power) seems to influence the airway symptoms (asthma or AHR) in elite athletes. 17 The prevalence of atopic symptoms is high in endurance sports such as long-distance running (15.5 -23.9%). 17 It is especially high in cold environment sports swimmers training indoors (13.4 -44%).…”

“…17 The prevalence of atopic symptoms is high in endurance sports such as long-distance running (15.5 -23.9%). 17 It is especially high in cold environment sports swimmers training indoors (13.4 -44%). 17 For speed and power sports, including various athletes such as sprinters, football players and basketball players, the prevalence of asthma is slightly lower and usually ranges from 8% to 21%.…”

“…The literature suggests that hyperventilation during exercise, combined with exposure to cold air and/or to a mixture of allergens and pollutants, induces airway inflammatory responses and possibly airway remodelling which may be responsible for the development of asthma or AHR in elite endurance athletes. 17 The majority of the research has reported differences in inflammatory cell recruitment or activation in the airways of elite endurance athletes, at baseline or after exercise intervention, compared with controls. However, only recently have there been reports of the possible underlying mechanisms that explain the regulation of airway inflammatory responses 7 and how these airway inflammatory responses may result in pathological airway remodelling.…”