Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes

Anderson, Sandra D.; Kippelen, Pascale

doi:10.1016/j.jaci.2008.05.001

Cited by 197 publications

(180 citation statements)

References 157 publications

(174 reference statements)

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“…19 An explanation for the rapid onset of symptoms with EIW lies in the mechanism of airway hyperresponsiveness, with release of bronchoconstrictive mediators from inflammatory cells upon rewarming and rehydration of the airway after exercise. 5 A previous study in children demonstrated that an exercise challenge can increase subsequent airway hyperresponsiveness to allergens. 20 Although we did not determine whether exercise was the trigger for the exacerbations leading to the urgent medical visits, our findings combined with those revealing susceptibility to allergen challenge after exercise 20 suggest that a report of EIW may be an indicator of a rapidonset phenotype that could be aggravated by other extrinsic exposures.…”

Section: Discussionmentioning

confidence: 99%

Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence

et al. 2013

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OBJECTIVE: Exercise-induced wheeze (EIW) may identify a distinct population among asthmatics and give insight into asthma morbidity etiology. The prevalence of pediatric asthma and associated urgent medical visits varies greatly by neighborhood in New York City and is highest in low-income neighborhoods. Although increased asthma severity might contribute to the disparities in urgent medical visits, when controlling for health insurance coverage, we previously observed no differences in clinical measures of severity between asthmatic children living in neighborhoods with lower (3%–9%) versus higher (11%–19%) asthma prevalence. Among these asthmatics, we hypothesized that EIW would be associated with urgent medical visits and a child’s neighborhood asthma prevalence. METHODS: Families of 7- to 8-year-old children were recruited into a case-control study of asthma through an employer-based health insurance provider. Among the asthmatics (n = 195), prevalence ratios (PRs) for EIW were estimated. Final models included children with valid measures of lung function, seroatopy, and waist circumference (n = 140). RESULTS: EIW was associated with urgent medical visits for asthma (PR, 2.29; P = .021), independent of frequent wheeze symptoms. In contrast to frequent wheeze, EIW was not associated with seroatopy or exhaled NO, suggesting a distinct mechanism. EIW prevalence among asthmatics increased with increasing neighborhood asthma prevalence (PR, 1.09; P = .012), after adjustment for race, ethnicity, maternal asthma, environmental tobacco smoke, household income, and neighborhood income. CONCLUSIONS: EIW may contribute to the disparities in urgent medical visits for asthma between high- and low-income neighborhoods. Physicians caring for asthmatics should consider EIW an indicator of risk for urgent medical visits.

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Section: Discussionmentioning

confidence: 99%

Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence

et al. 2013

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“…(12) The hyperosmolar stimulus induced by EVH and the subsequent airway injury induced by the high ventilation rate are considered to reflect what occurs during strenuous exercise. (13,14) The EVH test was developed in order to simulate the effects that ventilation at high flow rates has on the airway surface liquid, creating a drying and osmotic effect. (15) Objective documentation of asthma or EIB as a prerequisite for an athlete to be allowed to use inhaled β 2 agonists was first introduced at the 2002 Winter Olympic Games.…”

Section: Introductionmentioning

confidence: 99%

Broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite

Teixeira

Costa

et al. 2012

J. bras. pneumol.

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Objective: To determine the prevalence of exercise-induced bronchoconstriction among elite long-distance runners in Brazil and whether there is a difference in the training loads among athletes with and without exercise-induced bronchoconstriction. Methods: This was a cross-sectional study involving elite long-distance runners with neither current asthma symptoms nor a diagnosis of exercise-induced bronchoconstriction. All of the participants underwent eucapnic voluntary hyperpnea challenge and maximal cardiopulmonary exercise tests, as well as completing questionnaires regarding asthma symptoms and physical activity, in order to monitor their weekly training load. Results: Among the 86 male athletes recruited, participation in the study was agreed to by 20, of whom 5 (25%) were subsequently diagnosed with exercise-induced bronchoconstriction. There were no differences between the athletes with and without exercise-induced bronchoconstriction regarding anthropometric characteristics, peak oxygen consumption, baseline pulmonary function values, or reported asthma symptoms. The weekly training load was significantly lower among those with exercise-induced bronchoconstriction than among those without. Conclusions: In this sample of long-distance runners in Brazil, the prevalence of exerciseinduced bronchoconstriction was high.Keywords: Athletes; Asthma, exercise-induced; Exercise test. ResumoObjetivo: Determinar a prevalência de broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite e se há uma diferença na carga de treinamento entre atletas com e sem broncoespasmo induzido por exercício. Métodos: Estudo transversal com corredores de longa distância de elite sem sintomas atuais de asma e sem diagnóstico de broncoespasmo induzido por exercício. Todos os participantes foram submetidos ao teste de hiperventilação voluntária eucápnica e ao teste cardiopulmonar de esforço máximo e responderam a questionários sobre sintomas de asma e atividade física para monitorizar sua carga de treinamento semanal. Resultados: Dos 86 atletas do sexo masculino recrutados, 20 concordaram em participar do estudo, dos quais 5 (25%) foram diagnosticados com broncoespasmo induzido por exercício. Não foram evidenciadas diferenças entre os atletas com e sem broncoespasmo induzido por exercício em relação a características antropométricas, consumo de oxigênio de pico, valores basais de função pulmonar ou sintomas de asma relatados. A carga de treinamento semanal foi significativamente menor nos atletas com broncoespasmo induzido por exercício do que naqueles sem esse diagnóstico. Conclusões: Nesta amostra de corredores de longa distância brasileiros, a prevalência de broncoespasmo induzido por exercício foi alta. predictors of EIB and, therefore, should not be the sole basis for prescribing medications. (4,15) Interestingly, the International Olympic Committee has reported that the notification of β 2 agonist use by athletes correlates with the prevalence of asthma symptoms in all countries except Bra...

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“…Although thermal and osmotic consequences of water loss play prominent roles in the emergence of EIB (2), more studies are needed to elucidate the underlying mechanism. Circulating epinephrine (EPI), produced by adrenal medulla chromaffin cells (AMCC), is believed to bind the adrenergic receptors of airway smooth muscles to achieve adrenergic bronchodilation, and a loss of this function could directly influence the severity of the obstruction.…”

mentioning

confidence: 99%

High-intensity training induces EIB in rats through neuron transdifferentiation of adrenal medulla chromaffin cells

Feng

Xun

et al. 2013

American Journal of Physiology-Lung Cellular and Molecular Phys

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He R, Feng J, Xun Q, Qin Q, Hu C. High-intensity training induces EIB in rats through neuron transdifferentiation of adrenal medulla chromaffin cells. Am J Physiol Lung Cell Mol Physiol 304: L602-L612, 2013. First published February 15, 2013 doi:10.1152/ajplung.00406.2012.-A high prevalence of exercise-induced bronchoconstriction (EIB) can be found in elite athletes, but the underlying mechanisms remain elusive. Airway responsiveness, NGF and epinephrine (EPI) levels, and chromaffin cell structure in high-(HiTr) and moderate-intensity training (MoTr) rats with or without ovalbumin (OVA) sensitization were measured in a total of 120 male Sprague-Dawley rats. The expression of NGF-associated genes in rat adrenal medulla was tested. Both HiTr and OVA intervention significantly increased airway resistance to aerosolized methacholine measured by whole body plethysmography. HiTr significantly increased inflammatory reaction in the lung with a major increase in peribronchial lymphocyte infiltration, whereas OVA significantly increased the infiltration of various inflammatory cells with an over 10-fold increase in eosinophil level in bronchoalveolar lavage. Both HiTr and OVA intervention upregulated circulating NGF level and peripherin level in adrenal medulla, but downregulated phenylethanolamine N-methyl transferase level in adrenal medulla and circulating EPI level. HiTr ϩ OVA and HiTr ϩ ExhEx (exhaustive exercise) interventions significantly enhanced most of the HiTr effects. The elevated NGF level was significantly associated with neuronal conversion of adrenal medulla chromaffin cells (AMCC). The levels of p-Erk1/2, JMJD3, and Mash1 were significantly increased, but the levels of p-p38 and p-JNK were significantly decreased in adrenal medulla in HiTr and OVA rats. Injection of NGF antiserum and moderate-intensity training reversed these changes observed in HiTr and/or OVA rats. Our study suggests that NGF may play a vital role in the pathogenesis of EIB by inducing neuron transdifferentiation of AMCC via MAPK pathways and subsequently decreasing circulating EPI. exercise; asthma; lung; inflammation; NGF; neuron conversion; adrenal medulla EXERCISE-INDUCED BRONCHOCONSTRICTION (EIB) is the increase in airway obstruction with symptoms of coughing, wheezing, or dyspnea as a result of exercise (23). EIB occurs in ϳ11% of the general population without asthma (13). Inhalation of cold air and sudden changes in humidity or temperature have been associated with EIB (20). High prevalence of EIB is usually observed among endurance athletes (7), implicating that intensity of exercise may be associated with EIB.Although thermal and osmotic consequences of water loss play prominent roles in the emergence of EIB (2), more studies are needed to elucidate the underlying mechanism. Circulating epinephrine (EPI), produced by adrenal medulla chromaffin cells (AMCC), is believed to bind the adrenergic receptors of airway smooth muscles to achieve adrenergic bronchodilation, and a loss of this function could directly influence the sev...

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Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes

Cited by 197 publications

References 157 publications

Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence

Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence

Broncoespasmo induzido por exercício em corredores brasileiros de longa distância de elite

High-intensity training induces EIB in rats through neuron transdifferentiation of adrenal medulla chromaffin cells

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