Exercise-Induced Lung Disease: Too Much of a Good Thing?

Abstract

Exercise in children has important health benefits. However, in elite endurance athletes, there is an increased prevalence of exercise-induced bronchoconstriction and airway inflammation. Particularly at risk are those who practice in cold weather, ice rinks, swimming pools, and air pollution. The inflammation is caused by repetitive episodes of hyperventilation of cold, dry air, allergens, or toxins such as chlorine or air pollution. Children may be particularly at risk for lung injury under these conditions because of the immaturity and ongoing development of their lung. However, studies in pediatric athletes and exercising young children are sparse. Epithelial injury associated with hyperventilation of cold, dry air has not been described in children. However, exercise in the presence of air pollution and chlorine is associated with airway injury and the development of asthma in children; the effect appears to be modulated by both atopy and genetic polymorphisms. While management of exerciseinduced bronchoconstriction and asthma is well established, there is little data to guide treatment or prevention of remodeling in athletes or inhalational lung injury in children. Studies underscore the need to maintain high levels of air quality. More investigations should be undertaken to better define the natural history, pathophysiology, and treatment of exercise-induced pulmonary inflammation in both elite athletes and exercising children.

The Impact of Air Pollution on Game Outcome

“…In the field of sport management, it has been recognized that air pollution substantially affects athletes’ physical health (Shah et al, 2015; Weiss & Rundell, 2011; Xing et al, 2016) and mental health (Bos et al, 2014). Short-term air pollution can cause great respiratory and cardiovascular harm to the heart and lungs of strenuous athletes (Watanabe et al, 2019).…”

Managing respiratory problems in athletes

“…1 When athletes do present with respiratory symptoms, it is not uncommon for them to present to the general physician in either the setting of primary care (eg chronic cough), the acute medical take (eg chest pain) or via referral to a non-respiratory specialist (eg referred to cardiology with dyspnoea). Indeed, even in specialist respiratory medicine training, there is no component within the programme dedicated to provide expertise in this area.…”

Exercise-Induced Bronchoconstriction in Children and Adolescents

“…14 The higher activity levels and relatively immature lungs of children may make them more susceptible to inhalational toxicants, such as air pollutants, which worsen EIB. [15][16][17] EIB in children can be effectively treated, and it is, therefore, important to recognize its signs and make an accurate diagnosis. However, in organized sports, children with asthma are often left in the care of coaches or supervising parents that have inadequate knowledge of their disease management.…”