Exercise-induced asthma: why is it so frequent in Olympic athletes?

Moreira, André; Delgado, Luís; Carlsen, Kai‐Håkon

doi:10.1586/ers.10.88

Cited by 32 publications

(33 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding has been previously reported in studies performed before 2000 in other national Olympic delegations [3,[5][6][7][8]. However, the use of the same study protocol and methodology in different cross-sectional surveys allows us to more accurately evaluate the increasing trend of this morbid condition, as well as to provide updated information in a large population of athletes.…”

Section: Discussionsupporting

confidence: 79%

“…However, independently from the above potential confounders, studies performed in Olympic teams before 2000 show that the prevalence of asthma in elite athletes is high and increasing, from 9.7% in 1976 to 21.9% in 1996 in the Australian Olympic delegation [4,5], and from 11.2% in 1984 to 16.7% in 1996 in the US Olympic delegation [6,7]. Asthma in elite athletes appears to be a distinct phenotype [8][9][10][11][12] which needs adequate attention and management considering that 23.1% of the 263 sudden deaths in athletes reported by Becker et al [13] occurred in asthmatic athletes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Asthma, allergy and the Olympics

Bonini

Gramiccioni

Fioretti

et al. 2015

Current Opinion in Allergy &Amp; Clinical Immunology

View full text Add to dashboard Cite

OBJECTIVE: There are no comprehensive surveys relating the reported high prevalence of asthma and allergic diseases in athletes to comorbidities and immune changes associated with intense chronic exercise. This 12-year survey aims to evaluate several clinical, functional and immunological parameters in order to assess features, trend and burden of asthma, allergy, infections and autoimmune diseases, in a large homogeneous population of Olympic athletes. METHODS: Six hundred and fiftynine Italian Olympic athletes were studied through four cross-sectional surveys performed between 2000 and 2012 before the Summer and Winter Olympics. Clinical diagnosis of allergic, autoimmune and infectious diseases was complemented by: skin-prick tests (n = 569); pulmonary function tests (n = 415); total (n = 158) and specific (n = 72) serum IgE; serum autoantibodies (n = 30), cytokines and growth factors (n = 92); flow cytometry (n = 135). RESULTS: The prevalence of asthma and/or exerciseinduced bronchoconstriction was 14.7%, with a significant increase (P = 0.04) from 2000 (11.3%) to 2008 (17.2%). The prevalence of rhinitis, conjunctivitis, skin allergic diseases and anaphylaxis was 26.2%, 20.0%, 14.8% and 1.1%, respectively. Sensitization to inhalant allergens was documented in 49.0% of athletes, being 32.7% in 2000 and 56.5% in 2008 (P < 0.0001). Food, drug and venom allergy was present in 7.1%, 5.0% and 2.1% of athletes, respectively. The high prevalence of asthma and allergy was associated with recurrent upper respiratory tract (10.3%) and herpes (18.2%) infections, an abnormal T cell subset profile and a general down-regulation of serum cytokines with a significantly lower IFN-/IL-4 ratio. CONCLUSION: A chronic and intense physical exercise may cause a transient immunodepression with a preferential shift to a Th2 response, associated with abnormalities of the respiratory tract. ObjectiveThere are no comprehensive surveys relating the reported high prevalence of asthma and allergic diseases in athletes to comorbidities and immune changes associated with intense chronic exercise. This 12-year survey aims to evaluate several clinical, functional and immunological parameters in order to assess features, trend and burden of asthma, allergy, infections and autoimmune diseases, in a large homogeneous population of Olympic athletes. MethodsSix hundred and fifty-nine Italian Olympic athletes were studied through four cross-sectional surveys performed between 2000 and 2012 before the Summer and Winter Olympics. Clinical diagnosis of allergic, autoimmune and infectious diseases was complemented by: skin-prick tests (n ¼ 569); pulmonary function tests (n ¼ 415); total (n ¼ 158) and specific (n ¼ 72) serum IgE; serum autoantibodies (n ¼ 30), cytokines and growth factors (n ¼ 92); flow cytometry (n ¼ 135). ResultsThe prevalence of asthma and/or exercise-induced bronchoconstriction was 14.7%, with a significant increase (P ¼ 0.04) from 2000 (11.3%) to 2008 (17.2%). The prevalence of rhinitis, conjunctivitis, skin allergic dise...

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Asthma, allergy and the Olympics

Bonini

Gramiccioni

Fioretti

et al. 2015

Current Opinion in Allergy &Amp; Clinical Immunology

View full text Add to dashboard Cite

show abstract

“…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).…”

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

View full text Add to dashboard Cite

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...

show abstract

“…Reorganization of the contractile apparatus of the airway smooth muscle may take place with habitual endurance exercise, thus enabling the smooth muscle fibers to adapt to changes in cell shape. Although we favour the mechanical explanation, other mechanisms, such as changes in the neural and/or biochemical control of the airways induced by physical training, may also contribute (Moreira et al, 2011a). In this scenario, development of asthma in atopic individuals could be in part secondary to lack of exercise and a sedentary lifestyle.…”

Section: Do Acute Exercise and Training Decrease Bronchial Reactivity?mentioning

confidence: 79%

“…The resulting picture is very complex, and the potential clinical consequences are often contradictory, suggesting the opportunity to define different phenotypes of exercise-associated airway changes (Lee & Anderson, 1985;Haahtela et al, 2008;Moreira et al, 2011a). Studies in asthmatic athletes in the 90' had began to explore the possibility that airway inflammation might be involved in exercise-associated respiratory symptoms.…”

Section: Introductionmentioning

confidence: 99%