Rostrum
Allergy and asthma in elite summer sport athletes,☆☆

https://doi.org/10.1067/mai.2000.107749Get rights and content

Abstract

Exercise may increase ventilation up to 200 L/min for short periods of time in speed and power athletes, and for longer periods in endurance athletes, such as long-distance runners and swimmers. Therefore highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many pollen allergens in spring and summer. Competitive swimmers inhale and microaspirate large amounts of air that floats above the water surface, which means exposure to chlorine derivatives from swimming pool disinfectants. In the summer Olympic Games, 4% to 15% of the athletes showed evidence of asthma or used antiasthmatic medication. Asthma is most commonly found in endurance events, such as cycling, swimming, or long-distance running. The risk of asthma is especially increased among competitive swimmers, of which 36% to 79% show bronchial hyperresponsiveness to methacholine or histamine. The risk of asthma is closely associated with atopy and its severity among athletes. A few studies have investigated occurrence of exercise-induced bronchospasm among highly trained athletes. The occurrences of exercise-induced bronchospasm vary from 3% to 35% and depend on testing environment, type of exercise used, and athlete population tested. Mild eosinophilic airway inflammation has been shown to affect elite swimmers and cross-country skiers. This eosinophilic inflammation correlates with clinical parameters (ie, exercise-induced bronchial symptoms and bronchial hyperresponsiveness). Athletes commonly use antiasthmatic medication to treat their exercise-induced bronchial symptoms. However, controlled studies on their long-term effects on bronchial hyperresponsiveness and airway inflammation in the athletes are lacking. Follow-up studies on asthma in athletes are also lacking. What will happen to bronchial hyperresponsiveness and airway inflammation after discontinuation of competitional career is unclear. In the future, follow-up studies on bronchial responsiveness and airway inflammation, as well as controlled studies on both short- and long-term effects of antiasthmatic drugs in the athletes are needed. (J Allergy Clin Immunol 2000;106:444-52.)

Section snippets

Training environment of elite athletes

Exercise may increase ventilation up to 200 L/min for short periods of time in speed and power athletes and for longer periods in endurance athletes, such as long-distance runners and swimmers. During winter in countries with 4 distinct seasons, athletes train outdoors in cold weather or indoors where air quality may be poor.4 Inhalation of cold air during exercise aggravates exercise-induced asthma in people with asthma.5 Exercise alone increases bronchial responsiveness to methacholine in

Asthma and allergy in Olympic Games

In the 1976 and 1980 Olympic Games, 9.7% and 8.5% of the Australian Olympic athletes reported asthma in a physical examination (Table I).2Most of the athletes with asthma were swimmers. Allergy was reported by 10% of the athletes in both Olympic Games. In 1984, 26 (4.3%) of the 597 US Olympic team athletes had physician-diagnosed asthma, 41 (6.9%) used bronchodilator medication for symptoms compatible with EIB, and 42 (7.0%) had a history of exercise-induced bronchial symptoms.1 These 67

Exercise challenge tests in elite athletes

Although many studies have shown that increased bronchial responsiveness to nonspecific stimuli is common in elite athletes, few studies have investigated the occurrence of EIB. It is a unique or pathognomonic feature of asthma unlike methacholine or histamine hyperreactivity.27 The interpretation of the exercise challenge test (ECT) result in athletes with respect to postexercise lung function is unclear because only a few studies have investigated normal exercise responses in athletes.

The

Airway inflammation

Airway inflammation in athletes has been studied only in swimmers and cross-country skiers. Twenty-nine elite swimmers and 19 healthy, symptom-free control subjects gave induced sputum samples to investigate airway inflammation.38 Of these, 14 (48%) swimmers and 3 (16%) control subjects showed increased bronchial responsiveness to histamine. Sputum from swimmers showed significantly higher differential cell counts of eosinophils and neutrophils compared with control subjects. Sputum

Characteristics of asthma in summer and winter sport athletes

Athletes with summer events are intensively exposed to airborne allergens during training and competitions, whereas winter sport athletes are intensively exposed to cold air. Swimmers are exposed to chlorine compounds. In skiers39, 42, 43 the association between atopy, respiratory allergy, and asthma is not as clear as in summer sport athletes.21, 34 Hay fever and atopy are more common in long-distance runners as compared with control subjects,21 whereas the occurrence of atopy in skiers is

Medical and nonmedical treatment of asthma in elite athletes

Highly trained athletes commonly use antiasthmatic medication to treat their exercise-induced bronchial symptoms. In a recent study, 17% of 253 Finnish elite summer sports athletes used antiasthmatic medication13 (Table II).

. Use of allergy and asthma medication among Finnish summer sports elite athletes*

MedicationSpeed and power athletes (N = 106)Long-distance runners (N = 107)Swimmers (N = 42)
Asthma medication11 (10.4%)23 (21.5%)9 (21.4%)
 Inhaled corticosteroid5 (4.8%)6 (5.6%)6 (14.3%)
 Inhaled β2

Doping aspects

The Medical Commission of the International Olympic Committee has listed the banned drugs (Table III).62

. International Olympic Committee list of permitted and prohibited asthma and allergy medications, 1999

Freely allowed to use
 Disodium cromoglycate
 Nedocromil sodium
 Leukotriene antagonists
 Ipratropium bromide
 Systemic theophylline
 Antihistamines
Permitted by notification
 Inhaled salbutamol, terbutaline, salmeterol
Declaration required in Olympic and championship games
 Inhaled corticosteroids
Prohibited
 

Conclusions

EIB affects maximal exercise capacity of the athletes by increasing ventilatory cost and decreasing maximal ventilatory capacity. Increased bronchial responsiveness and airway inflammation may predispose athletes to upper respiratory tract infections. Viral respiratory tract infections increase bronchial responsiveness more in exercising athletes than in sedentary controls.46 The variable nature of asthma symptoms can partly explain the day-to-day variability in performance capacity of some

Acknowledgements

We thank Hannu Salokoski and Tuula Metso, MSc, for help with preparing the color illustrations.

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  • Cited by (0)

    Supported by the Finnish Sports and Allergy Research Foundation.

    ☆☆

    Reprint requests: Ilkka Helenius, MD, PhD, Ohjaajantie 3A 4, 00400 Helsinki, Finland.

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