Exercise and asthma: an overview

Abstract

The terms ‘exercise-induced asthma’ (EIA) and ‘exercise-induced bronchoconstriction’ (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.

Mechanisms of exercise‐induced bronchoconstriction in athletes: Current perspectives and future challenges

“…EIB may be modulated by the baseline condition of the subject or by sport‐specific characteristics. The level of exercise load is fundamental, and a kind of “biological gradient” may seem to occur, and can be evaluated by examining exposure time in a sport or cumulative hours of training and how this modifies the risk of airway dysfunction …”

Aerobic exercise training reduces bronchial hyper-responsiveness and serum pro-inflammatory cytokines in patients with asthma

“…Experimental evidence shows that low-to-moderate intensity aerobic exercise reduces inflammation and remodelling 5. The authors correctly state that serum cytokine levels may not necessarily reflect airway inflammation; however, exercise training effects are more detectable in the systemic immune response 6.…”

Specific probiotics in elite athlete injuries: indication for usage

“…Asthma and exercise-induced bronchoconstriction are prevalent conditions in elite athletes, which leads doctors to mostly rely on asthma medication to treat athletes feeling "out of breath" (Couto & Moreira, 2016). The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB, for an acute airflow obstruction without asthma symptoms) are often used interchangeably to describe symptoms of asthma such as coughing, wheezing, or dyspnea provoked by vigorous physical activity (Del Giacco, Firinu, Bjermer, & Carlsen, 2015). Elite athletes also have an increased risk for EIA/EIB, especially those that participate in endurance sports such as swimming, running, and cycling and in winter sports (Moreira, Delgado, & Carlsen, 2011).…”