RostrumAllergy and asthma in elite summer sport athletes☆,☆☆
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Training environment of elite athletes
Exercise may increase ventilation up to 200 L/min for short periods of time in speed and power athletes and for longer periods in endurance athletes, such as long-distance runners and swimmers. During winter in countries with 4 distinct seasons, athletes train outdoors in cold weather or indoors where air quality may be poor.4 Inhalation of cold air during exercise aggravates exercise-induced asthma in people with asthma.5 Exercise alone increases bronchial responsiveness to methacholine in
Asthma and allergy in Olympic Games
In the 1976 and 1980 Olympic Games, 9.7% and 8.5% of the Australian Olympic athletes reported asthma in a physical examination (Table I).2Most of the athletes with asthma were swimmers. Allergy was reported by 10% of the athletes in both Olympic Games. In 1984, 26 (4.3%) of the 597 US Olympic team athletes had physician-diagnosed asthma, 41 (6.9%) used bronchodilator medication for symptoms compatible with EIB, and 42 (7.0%) had a history of exercise-induced bronchial symptoms.1 These 67
Exercise challenge tests in elite athletes
Although many studies have shown that increased bronchial responsiveness to nonspecific stimuli is common in elite athletes, few studies have investigated the occurrence of EIB. It is a unique or pathognomonic feature of asthma unlike methacholine or histamine hyperreactivity.27 The interpretation of the exercise challenge test (ECT) result in athletes with respect to postexercise lung function is unclear because only a few studies have investigated normal exercise responses in athletes.
The
Airway inflammation
Airway inflammation in athletes has been studied only in swimmers and cross-country skiers. Twenty-nine elite swimmers and 19 healthy, symptom-free control subjects gave induced sputum samples to investigate airway inflammation.38 Of these, 14 (48%) swimmers and 3 (16%) control subjects showed increased bronchial responsiveness to histamine. Sputum from swimmers showed significantly higher differential cell counts of eosinophils and neutrophils compared with control subjects. Sputum
Characteristics of asthma in summer and winter sport athletes
Athletes with summer events are intensively exposed to airborne allergens during training and competitions, whereas winter sport athletes are intensively exposed to cold air. Swimmers are exposed to chlorine compounds. In skiers39, 42, 43 the association between atopy, respiratory allergy, and asthma is not as clear as in summer sport athletes.21, 34 Hay fever and atopy are more common in long-distance runners as compared with control subjects,21 whereas the occurrence of atopy in skiers is
Medical and nonmedical treatment of asthma in elite athletes
Highly trained athletes commonly use antiasthmatic medication to treat their exercise-induced bronchial symptoms. In a recent study, 17% of 253 Finnish elite summer sports athletes used antiasthmatic medication13 (Table II).
Medication Speed and power athletes (N = 106) Long-distance runners (N = 107) Swimmers (N = 42) Asthma medication 11 (10.4%) 23 (21.5%) 9 (21.4%) Inhaled corticosteroid 5 (4.8%) 6 (5.6%) 6 (14.3%) Inhaled β2
Doping aspects
The Medical Commission of the International Olympic Committee has listed the banned drugs (Table III).62Freely allowed to use Disodium cromoglycate Nedocromil sodium Leukotriene antagonists Ipratropium bromide Systemic theophylline Antihistamines Permitted by notification Inhaled salbutamol, terbutaline, salmeterol Declaration required in Olympic and championship games Inhaled corticosteroids Prohibited
Conclusions
EIB affects maximal exercise capacity of the athletes by increasing ventilatory cost and decreasing maximal ventilatory capacity. Increased bronchial responsiveness and airway inflammation may predispose athletes to upper respiratory tract infections. Viral respiratory tract infections increase bronchial responsiveness more in exercising athletes than in sedentary controls.46 The variable nature of asthma symptoms can partly explain the day-to-day variability in performance capacity of some
Acknowledgements
We thank Hannu Salokoski and Tuula Metso, MSc, for help with preparing the color illustrations.
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Supported by the Finnish Sports and Allergy Research Foundation.
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Reprint requests: Ilkka Helenius, MD, PhD, Ohjaajantie 3A 4, 00400 Helsinki, Finland.