Airway dysfunction in elite athletes – an occupational lung disease?

Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete's respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.

[1]  D. Hewitt Reactive Airways Dysfunction Syndrome (RADS) , 2015 .

[2]  C. Meyer,et al.  Occupational Lung Disease , 2009, Journal of thoracic imaging.

[3]  Fern M. Cheek,et al.  American Thoracic Society Documents An Official American Thoracic Society Clinical Practice Guideline : Exercise-induced Bronchoconstriction , 2013 .

[4]  S. Pakhalé,et al.  Effect of physical training on airway inflammation in animal models of asthma: a systematic review , 2013, BMC Pulmonary Medicine.

[5]  G. Canonica,et al.  Microarray evaluation of specific IgE to allergen components in elite athletes , 2012, Allergy.

[6]  I. Pavord,et al.  Airway dysfunction and inflammation in pool- and non-pool-based elite athletes. , 2012, Medicine and science in sports and exercise.

[7]  G. Howatson,et al.  Prevalence of allergy and upper respiratory tract symptoms in runners of the London marathon. , 2012, Medicine and science in sports and exercise.

[8]  S. Anderson,et al.  Respiratory health of elite athletes – preventing airway injury: a critical review , 2012, British Journal of Sports Medicine.

[9]  L. Ansley,et al.  Misdiagnosis of exercise‐induced bronchoconstriction in professional soccer players , 2012, Allergy.

[10]  L. Boulet,et al.  Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools. , 2012, The Journal of allergy and clinical immunology.

[11]  K. Rundell Effect of air pollution on athlete health and performance , 2012, British Journal of Sports Medicine.

[12]  M. Sue-Chu Winter sports athletes: long-term effects of cold air exposure , 2012, British Journal of Sports Medicine.

[13]  S. Anderson,et al.  Assessment and prevention of exercise-induced bronchoconstriction , 2012, British Journal of Sports Medicine.

[14]  L. Boulet,et al.  Airway dysfunction in swimmers , 2012, British Journal of Sports Medicine.

[15]  S. Anderson,et al.  Airway injury during high-level exercise , 2012, British Journal of Sports Medicine.

[16]  K. Fitch An overview of asthma and airway hyper-responsiveness in Olympic athletes , 2012, British Journal of Sports Medicine.

[17]  F. Esposito,et al.  Effect of training on airways inflammatory response and remodeling in a rat model , 2011, Respiratory Physiology & Neurobiology.

[18]  S. Anderson,et al.  Effect of inspired air conditions on exercise-induced bronchoconstriction and urinary CC16 levels in athletes. , 2011, Journal of applied physiology.

[19]  C. Bolger,et al.  Hyperpnea-induced bronchoconstriction and urinary CC16 levels in athletes. , 2011, Medicine and science in sports and exercise.

[20]  L. Boulet,et al.  Airway hyperresponsiveness in elite swimmers: is it a transient phenomenon? , 2011, The Journal of allergy and clinical immunology.

[21]  S. Salvi,et al.  Bronchoconstriction and airway remodeling. , 2011, The New England journal of medicine.

[22]  G. Whyte,et al.  Diagnosis of exercise-induced bronchoconstriction: eucapnic voluntary hyperpnoea challenges identify previously undiagnosed elite athletes with exercise-induced bronchoconstriction , 2010, British Journal of Sports Medicine.

[23]  L. Boulet,et al.  Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes , 2009, European Respiratory Journal.

[24]  Angus Stevenson,et al.  Concise Oxford English Dictionary , 2009 .

[25]  L. Boulet,et al.  The Respiratory Health of Swimmers , 2009, Sports medicine.

[26]  P. Burge,et al.  Exercise‐induced asthma, respiratory and allergic disorders in elite athletes , 2008, Allergy.

[27]  J. Weiler,et al.  Exercise‐induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy) , 2008, Allergy.

[28]  V. Backer,et al.  Airway responsiveness and inflammation in adolescent elite swimmers. , 2008, The Journal of allergy and clinical immunology.

[29]  M. Francaux,et al.  Fractional exhaled NO and serum pneumoproteins after swimming in a chlorinated pool. , 2008, Medicine and science in sports and exercise.

[30]  S. Anderson,et al.  Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes. , 2008, The Journal of allergy and clinical immunology.

[31]  Michael Goodman,et al.  Asthma and Swimming: A Meta-Analysis , 2008, The Journal of asthma : official journal of the Association for the Care of Asthma.

[32]  R. Garrod,et al.  Exercise-induced bronchoconstriction in athletes-should we screen? , 2007, Medicine and science in sports and exercise.

[33]  K. Carlsen,et al.  Bronchial hyperresponsiveness in skiers: field test versus methacholine provocation? , 2007, Medicine and science in sports and exercise.

[34]  P. Cullinan,et al.  Standards of care for occupational asthma , 2007, Thorax.

[35]  T. Lasserson,et al.  Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction. , 2007, The Cochrane database of systematic reviews.

[36]  J. Weiler,et al.  American Academy of Allergy, Asthma & Immunology Work Group report: exercise-induced asthma. , 2007, The Journal of allergy and clinical immunology.

[37]  S. Spaan,et al.  Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers , 2007, European Respiratory Journal.

[38]  B. Maron,et al.  Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism Endorsed by the American College of Cardi , 2007, Circulation.

[39]  S. V. von Duvillard,et al.  High incidence of exercise-induced bronchoconstriction in triathletes of the Swiss national team , 2007, British Journal of Sports Medicine.

[40]  J. Weiler,et al.  Work Group Report* American Academy of Allergy, Asthma & Immunology Work Group Report: Exercise-induced asthma , 2007 .

[41]  Benjamin D Levine,et al.  Protecting athletes from sudden cardiac death. , 2006, JAMA.

[42]  V. Moore,et al.  FEV1 decline in occupational asthma , 2006, Thorax.

[43]  P. O'Byrne,et al.  Effect of ciclesonide dose and duration of therapy on exercise-induced bronchoconstriction in patients with asthma. , 2006, The Journal of allergy and clinical immunology.

[44]  Richard J Martin,et al.  Efficacy of a heat exchanger mask in cold exercise-induced asthma. , 2006, Chest.

[45]  C. Wren,et al.  Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. , 2005, European heart journal.

[46]  A. Togias,et al.  Reduced airway responsiveness in nonelite runners. , 2005, Medicine and science in sports and exercise.

[47]  Jonathan P. Parsons,et al.  Exercise-induced bronchoconstriction in athletes. , 2005, Chest.

[48]  C. Marsh,et al.  WERNICKE'S ENCEPHALOPATHY IN A PATIENT AFTER GASTRIC BYPASS SURGERY , 2005 .

[49]  C. Prefaut,et al.  Effect of endurance training on lung function: a one year study , 2005, British Journal of Sports Medicine.

[50]  G. Whyte,et al.  Impact of changes in the IOC-MC asthma criteria: a British perspective , 2005, Thorax.

[51]  G. Liss,et al.  Evidence based guidelines for the prevention, identification, and management of occupational asthma , 2005, Occupational and Environmental Medicine.

[52]  S. Anderson,et al.  Exercise-induced bronchoconstriction: Pathogenesis , 2005, Current allergy and asthma reports.

[53]  T. Haahtela,et al.  Asthma, Airway Inflammation and Treatment in Elite Athletes , 2005, Sports medicine.

[54]  Bernard Wuyam,et al.  A 10‐year follow‐up study of pulmonary function in symptomatic elite cross‐country skiers – athletes and bronchial dysfunctions , 2004, Scandinavian journal of medicine & science in sports.

[55]  A. Benigno,et al.  Airway cell composition at rest and after an all-out test in competitive rowers. , 2004, Medicine and science in sports and exercise.

[56]  G. P. Herbison,et al.  Adverse effects of short‐acting beta‐agonists: Potential impact when anti‐inflammatory therapy is inadequate , 2004, Respirology.

[57]  K. Rundell,et al.  Baseline lung function, exercise-induced bronchoconstriction, and asthma-like symptoms in elite women ice hockey players. , 2004, Medicine and science in sports and exercise.

[58]  K. Rundell Pulmonary Function Decay In Women Ice Hockey Players: Is There a Relationship to Ice Rink Air Quality? , 2004, Inhalation toxicology.

[59]  T. Mickleborough,et al.  Fish oil supplementation reduces severity of exercise-induced bronchoconstriction in elite athletes. , 2003, American journal of respiratory and critical care medicine.

[60]  J. Walters,et al.  Adverse Effects of β-Agonists , 2003 .

[61]  M. Bonsignore,et al.  Airway cells after swimming outdoors or in the sea in nonasthmatic athletes. , 2003, Medicine and science in sports and exercise.

[62]  Kenneth Lutchen,et al.  Modeling airflow-related shear stress during heterogeneous constriction and mechanical ventilation. , 2003, Journal of applied physiology.

[63]  P. Gosling DORLAND’S ILLUSTRATED MEDICAL DICTIONARY , 2003, Australasian Chiropractic & Osteopathy.

[64]  Y. Obase,et al.  Airway inflammation, bronchial hyperresponsiveness and asthma in elite ice hockey players. , 2003, The European respiratory journal.

[65]  S. Tarlo Workplace irritant exposures: do they produce true occupational asthma? , 2003, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[66]  B. Schofield,et al.  Repeated peripheral airway hyperpnea causes inflammation and remodeling in dogs. , 2003, Medicine and science in sports and exercise.

[67]  M. Bonsignore,et al.  Increased airway inflammatory cells in endurance athletes: what do they mean? , 2003, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[68]  Judy Pearsall,et al.  The concise Oxford English dictionary , 2016 .

[69]  M. Sears Adverse effects of -agonists , 2002 .

[70]  J. Pugin,et al.  Role of MAP kinase activation in interleukin-8 production by human BEAS-2B bronchial epithelial cells submitted to cyclic stretch. , 2002, American journal of respiratory cell and molecular biology.

[71]  T. Haahtela,et al.  Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers. , 2002, The Journal of allergy and clinical immunology.

[72]  M. Francaux,et al.  Changes in serum pneumoproteins caused by short-term exposures to nitrogen trichloride in indoor chlorinated swimming pools , 2002, Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals.

[73]  A. Draper,et al.  Occupational Asthma , 2002, The Journal of asthma : official journal of the Association for the Care of Asthma.

[74]  D. Jenkinson,et al.  Exercise-Induced Bronchospasm in the Elite Athlete , 2002, Sports medicine.

[75]  M. Bonsignore,et al.  Airway inflammation in nonasthmatic amateur runners. , 2001, American journal of physiology. Lung cellular and molecular physiology.

[76]  T. Haahtela,et al.  Allergy and asthma in elite summer sport athletes. , 2000, The Journal of allergy and clinical immunology.

[77]  S. Holgate,et al.  Bronchial epithelium as a key regulator of airway allergen sensitization and remodeling in asthma. , 2000, American journal of respiratory and critical care medicine.

[78]  J. Weiler,et al.  Asthma in United States olympic athletes who participated in the 1998 olympic winter games. , 2000, The Journal of allergy and clinical immunology.

[79]  L. Bjermer,et al.  Placebo-Controlled Study of Inhaled Budesonide on Indices of Airway Inflammation in Bronchoalveolar Lavage Fluid and Bronchial Biopsies in Cross-Country Skiers , 2000, Respiration.

[80]  L. Bjermer,et al.  Evidence of airway inflammation and remodeling in ski athletes with and without bronchial hyperresponsiveness to methacholine. , 2000, American journal of respiratory and critical care medicine.

[81]  A. Freed,et al.  Mucosal injury and eicosanoid kinetics during hyperventilation-induced bronchoconstriction. , 1999, Journal of applied physiology.

[82]  L. Bjermer,et al.  Non-invasive evaluation of lower airway inflammation in hyper-responsive elite cross-country skiers and asthmatics. , 1999, Respiratory medicine.

[83]  M. Davis,et al.  Repetitive hyperpnoea causes peripheral airway obstruction and eosinophilia. , 1999, The European respiratory journal.

[84]  S. Rennard,et al.  Bronchoscopy and bronchoalveolar lavage findings in cross-country skiers with and without "ski asthma". , 1999, The European respiratory journal.

[85]  J. Levy,et al.  Determinants of nitrogen dioxide concentrations in indoor ice skating rinks. , 1998, American journal of public health.

[86]  J. Weiler,et al.  Asthma in United States Olympic athletes who participated in the 1996 Summer Games. , 1998, The Journal of allergy and clinical immunology.

[87]  T. Haahtela,et al.  Occurrence of exercise induced bronchospasm in elite runners: dependence on atopy and exposure to cold air and pollen. , 1998, British journal of sports medicine.

[88]  T. Haahtela,et al.  Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors. , 1998, The Journal of allergy and clinical immunology.

[89]  T. Haahtela,et al.  Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers , 1998, Allergy.

[90]  T. Haahtela,et al.  Association between type of training and risk of asthma in elite athletes. , 1997, Thorax.

[91]  P. Howarth,et al.  Effect of natural allergen exposure during the grass pollen season on airways inflammatory cells and asthma symptoms. , 1996, Thorax.

[92]  J. Kaprio,et al.  Asthma and other pulmonary diseases in former elite athletes. , 1996, Thorax.

[93]  P. Casán,et al.  Assessment of chlorine exposure in swimmers during training. , 1996, Medicine and science in sports and exercise.

[94]  T. Heir,et al.  The influence of training intensity, airway infections and environmental conditions on seasonal variations in bronchial responsiveness in cross‐country skiers , 1995, Scandinavian journal of medicine & science in sports.

[95]  J D Spengler,et al.  Nitrogen dioxide exposures inside ice skating rinks. , 1994, American journal of public health.

[96]  J. Henriksen Exercise‐Induced Bronchoconstriction , 1986, Allergy.

[97]  A. Bundgaard,et al.  EXERCISE-INDUCED ASTHMA , 1978 .

[98]  I. Bernstein,et al.  Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. , 1985, Chest.

[99]  K. Katsouyanni,et al.  The association of fat and other macronutrients with breast cancer: a case-control study from Greece. , 1994, British Journal of Cancer.

[100]  R. Shephard,et al.  The switching point from nasal to oronasal breathing. , 1980, Respiration physiology.

[101]  W. A. Newman Dorland,et al.  Dorland's Illustrated Medical Dictionary , 1974 .