Respiratory inflammation and infections in high‐performance athletes

Abstract

Upper respiratory illness is the most common reason for non-injury-related presentation to a sports medicine clinic, accounting for 35-65% of illness presentations. Recurrent or persistent respiratory illness can have a negative impact on health and performance of athletes undertaking high levels of strenuous exercise. The cause of upper respiratory symptoms (URS) in athletes can be uncertain but the majority of cases are related to common respiratory viruses, viral reactivation, allergic responses to aeroallergens and exercise-related trauma to the integrity of respiratory epithelial membranes. Bacterial respiratory infections are uncommon in athletes. Undiagnosed or inappropriately treated asthma and/or allergy are common findings in clinical assessments of elite athletes experiencing recurrent URS. High-performance athletes with recurrent episodes of URS should undergo a thorough clinical assessment to exclude underlying treatable conditions of respiratory inflammation. Identifying athletes at risk of recurrent URS is important in order to prescribe preventative clinical, training and lifestyle strategies. Monitoring secretion rates and falling concentrations of salivary IgA can identify athletes at risk of URS. Therapeutic interventions are limited by the uncertainty of the underlying cause of inflammation. Topical anti-inflammatory sprays can be beneficial for some athletes. Dietary supplementation with bovine colostrum, probiotics and selected antioxidants can reduce the incidence or severity of URS in some athletes. Preliminary studies on athletes prone to URS indicate a genetic predisposition to a pro-inflammatory response and a dysregulated anti-inflammatory cytokine response to intense exercise as a possible mechanism of respiratory inflammation. This review focuses on respiratory infections and inflammation in elite/professional athletes.

A prospective cohort study of 7031 distance runners shows that 1 in 13 report systemic symptoms of an acute illness in the 8–12 day period before a race, increasing their risk of not finishing the race 1.9 times for those runners who started the race: SAFER study IV

“…It has also been documented that during periods of high-intensity, prolonged training or increased competition ‘load’, there is an amplified risk of subclinical immunological changes that may increase the risk of symptomatology or specific diagnosis of acute illness 13 14. Similarly, a single high intensity and prolonged duration exercise session is associated with decreased immunity, which can last from 3 to 72 hours, and this period is referred to as the ‘open window’ period where an athlete is particularly vulnerable to contract an acute illness 15–19…”

Evaluation of ColdZyme Mouth Spray for the Protection against Common Cold in Elite Athletes to Reduce Unwanted Absence from Training and Competition

“…According to the International Olympic Committee consensus statement on load in sport and risk of illness it is estimated that about 50% of all acute illness in athletes during competitions and tournaments affect the respiratory tract [1]. In conclusion, the specific conditions for elite athletes, such as hard exercise and travelling, are conducive for being infected by common cold viruses [3] [8].…”

“…Repeated periods of infection are linked to recurrent physical injuries that can be detrimental for the athlete and the team [1]. A few studies suggest that elite athletes suffer from more upper respiratory tract infections than recreational athletes [2] [3]. Data on the relationship between training and competition load and the risk of illness are limited to a few selected sports and athlete populations and high loads have been reported to have either posi- tive or negative influences on risk of illness in athletes [1] [4].…”

User Experience of ColdZyme Mouth Spray against Common Cold in Competitive Athletes

“…According to the International Olympic Committee Consensus Statement on Load in Sport and Risk of Illness it is estimated that about 50% of all acute illness in athletes during competitions and tournaments affect the respiratory tract [6]. In conclusion, the specific conditions for elite athletes, such as hard exercise and travelling, increase susceptibility for infection by common cold viruses [2] [8].…”

“…Studies show that elite athletes suffer from more common colds and upper respiratory tract infections than recreational athletes [1] [2]. There is a well-established association between prolonged hard exercise and suppressed immune function [3].…”