[Show abstract][Hide abstract] ABSTRACT: Introduction Exercise-induced bronchoconstriction (EIB) is a common condition in endurance athletes. Exercise-induced vocal cord dysfunction (EIVCD) is a frequent confounder of EIB. The diagnosis of EIVCD may be challenging and can be missed as the problem is often intermittent and may only occur during intense exercise. Eucapnic voluntary hyperventilation (EVH) is the best test to detect EIB. This pilot study aimed to assess if EVH could be helpful in the diagnosis of EIVCD associated or not to EIB in athletes.
Methods A nasolaryngoscopy was performed during a 6 min EVH test, in 13 female athletes suspected to have VCD, aged 21±7 years. Image analysis was conducted by two Ear Nose and Throat surgeons in random order.
Results During the EVH, three athletes showed incomplete paradoxical vocal cords movement, without inspiratory stridor. However, 12 athletes showed marked supraglottic movement without inspiratory stridor. In two athletes, this supraglottic movement was severe, one showing a marked collapse of the epiglottis with an almost complete obstruction of the larynx by the arytenoid cartilage mucosa. In 3 of the 12 athletes with supraglottic movement, severe vibration of the mucosa covering the arytenoid cartilages was also observed.
Conclusions EVH challenge in athletes can provide information on various types of glottic and supraglottic obstruction in reproducing laryngeal movements during hyperventilation. Our findings make us suggest that exercise induced upper airway obstructions should be named: Exercise-induced laryngeal obstruction (EILO). Then, EILO should be divided in three categories: supraglottic, glottic (EIVCD) and mixed (glottic and supraglottic) obstruction.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate the levels of 8-isoprostane (8-IsoP) in the airways of competitive swimmers at baseline and after a swimming session according to their airway responsiveness.
Twenty-three swimmers and six lifeguards had a baseline spirometry and bronchoprovocative challenges. During a second visit, swimmers performed a usual swimming session while lifeguards stayed in the same pool environment for the same time period. Forced expiratory volume in one second (FEV1) was measured before and 5 min after the end of the session. Exhaled breath condensate (EBC) was sampled before and 10 min after the session and EBC 8-IsoP levels were analysed by enzyme immunoassay. Change in EBC 8-IsoP from baseline to post-swimming session was calculated.
We observed no relationships between airway hyper-responsiveness and 8-IsoP values before or after swimming in swimmers. The levels of 8-IsoP were significantly higher after the training session (mean value 2.9, s = 0.5 pg mL(-1)) than at baseline (mean value 1.9, s = 0.4 pg mL(-1)) in swimmers only (p = .012). EBC 8-IsoP levels after the swimming session significantly correlated with the percent change in FEV1 after swimming.
EBC 8-IsoP levels were increased after training in swimmers but not in lifeguards, suggesting that exercise-induced hyperpnoea in a chlorinated pool environment increases airways oxidative stress.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the changes in airway responsiveness to methacholine inhalation test (MIT) when performed after an eucapnic voluntary hyperpnea challenge (EVH) in athletes.
Two MIT preceded (visit 1) or not (visit 2) by an EVH, were performed in 28 athletes and 24 non-athletes. Twelve athletes and 13 non-athletes had airway hyperresponsiveness (AHR) to methacholine, and 11 athletes and 11 non-athletes had AHR to EVH (EVH+).
The MIT PC20 post-EVH was significantly lower compared to baseline MIT PC20 by 1.3±0.7 doubling-concentrations in EVH+ athletes only (p<0.0001). No significant change was observed in EVH- athletes and EVH+/EVH- non-athletes. A significant correlation between the change in MIT PC20 post-EVH and EVH+/EVH- status and athlete/nonathlete status was found (Adjusted R2=0.26 and p<0.001). Three (11%) athletes and one (4%) non-athlete had a change in the diagnosis of AHR when MIT was performed consecutively to EVH.
The responsiveness to methacholine was increased by a previous indirect challenge in EVH+ athletes only. The mechanisms for such increase remain to be determined. MIT and EVH should ideally be performed on separate occasions as there is a small but possible risk to obtain a false-positive response to methacholine when performed immediately after the EVH.
[Show abstract][Hide abstract] ABSTRACT: Exercise-induced cough (EIC) is frequently reported by winter athletes, but this symptom is not always associated with exercise-induced bronchoconstriction (EIB). The aims of this study were to determine if EIC can be inhibited or reduced with the inhalation of ipratropium, and if EIC in winter athletes is associated with EIB.
On 2 visits, 24 cross-country skiers (10 males and 12 females, mean age 17 ± 3 years) performed an outdoor exercise in the winter (30-minute warm-up, followed by a 3-minute sprint), randomly preceded by the inhalation of ipratropium or a placebo. A spirometry was done at baseline and 20 minutes after inhalation of ipratropium or placebo. Exercise was then performed, followed by the measurement of forced expiratory volume in 1 second and the recording of the number of coughs until 60 minutes after exercise. Before and after exercise, the perception of cough intensity was evaluated using a modified Borg scale.
Twelve of 16 athletes who completed the study (75%) were symptomatic following exercise with placebo (number of coughs ≥ 5), but none developed EIB. For these athletes, the number of coughs after exercise (mean number of coughs ± standard deviation: placebo, 26 ± 14; ipratropium, 25 ± 23; P value, nonsignificant) and the maximal perception score for cough intensity (mean Borg score ± standard deviation: placebo, 1.9 ± 1.2; ipratropium, 2.0 ± 1.1; P value, nonsignificant) were not significantly different between ipratropium and placebo. A decrease in the number of coughs was observed in 6 of the symptomatic athletes and an increase was observed in the other 6, resulting in a nonsignificant mean effect.
Ipratropium does not appear to significantly influence the number and the perception of cough following exercise. Moreover, these results suggest that EIC is not mainly associated with EIB. However, a subgroup of athletes seems to show a beneficial response to ipratropium, suggesting different cough responses in this population.
No preview · Article · Nov 2014 · The Physician and sportsmedicine
[Show abstract][Hide abstract] ABSTRACT: Self-reported respiratory symptoms are poor predictors of exercise-induced bronchoconstriction in athletes.
Determine if athletes have an inadequate perception of bronchoconstriction.
130 athletes and 32 non-athletes completed a standardized questionnaire, underwent eucapnic voluntary hyperpnea and methacholine inhalation test. Perception scores were quoted on a modified Borg scale before each spirometry for cough, breathlessness, chest tightness, and wheezing. Perception slope values were also obtained by plotting the variation of perception scores before and after the challenges against the fall in forced expiratory volume in one second, expressed as a percentage of the initial value (Perception scores after - before)/forced expiratory volume in one second fall).
Up to 76% of athletes and 68% of non-athletes had a perception score of 0.5 or less at 20 % fall in forced expiratory volume in one second following methacholine. Athletes with exercise-induced bronchoconstriction/airway hyperresponsiveness had lower perception slopes to methacholine than asthmatic non-athletes for breathlessness only (p=0.02). Among athletes, those with exercise-induced bronchoconstriction/airway hyperresponsiveness had greater perception slope to eucapnic voluntary hyperpnea for breathlessness and wheezing (p=0.02). Women athletes had a higher perception slope for breathlessness after eucapnic voluntary hyperpnea and cough after methacholine compared with men (p<0.05). The age of athletes correlated significantly to the perception slope to eucapnic voluntary hyperpnea for each symptom (p<0.05).
Minimal differences in bronchoconstriction-related symptoms' perception between athletes and non-athletes were observed. Among athletes, the presence of an exercise-induced bronchoconstriction/airway hyperresponsiveness, an older age and female gender were associated with slightly higher perception scores.
[Show abstract][Hide abstract] ABSTRACT: Background:
Cardiorespiratory disorders are common in athletes. However, these conditions are often underdiagnosed, which potentially results in impaired performance and increased health risks. The aim of this study was to evaluate, in a research setting, the prevalence of cardiorespiratory disorders in athletes in order to determine the potential value of a screening program.
One hundred thirty-three athletes were studied. Each subject underwent a physical examination. A eucapnic voluntary hyperventilation (EVH) test and a methacholine inhalation test were performed to confirm the diagnosis of asthma. A cardiovascular evaluation was also performed, including maximal exercise test with electrocardiogram, 24-hour ambulatory blood pressure monitoring, 24-hour Holter monitoring, and blood sampling.
Seventy-four (56%) athletes had airway hyperresponsiveness to EVH or the methacholine inhalation test. Among those with airway hyperresponsiveness, 45 (61%) athletes were only hyperresponsive to EVH, and 10 (14%) were only hyperresponsive to the methacholine inhalation test (using the criteria of a PC20 ≤ 4 mg/mL). Thirty-two (24%) athletes had a known diagnosis of asthma, while 34 (26%) athletes received a new asthma diagnosis. Ninety-seven (73%) athletes were sensitized to common airborne allergens. Forty-seven (35%) athletes completed the cardiovascular evaluation. Three (6%) and 7 (15%) athletes had a previous or new diagnosis of cardiovascular disease, respectively. Resting systemic hypertension was documented in 2 (4%) athletes and exaggerated blood pressure response to exercise was found in 12 (26%) athletes.
This cardiorespiratory screening data set in athletes showed a high prevalence of exercise-induced asthma and exercise hypertension, which in many cases were not previously diagnosed.
No preview · Article · Sep 2012 · The Physician and sportsmedicine
[Show abstract][Hide abstract] ABSTRACT: The importance of exercise-induced exaggerated blood pressure (BP) response in endurance athletes is not known.
To assess the hemodynamic parameters and metabolic profile in athletes with an exaggerated BP response to exercise.
Forty-four endurance athletes underwent a maximal exercise test, a 24-h ambulatory blood pressure monitoring, a 24-h Holter assessment, and sampling of blood on two occasions: (a) during intense training and (b) following 3 weeks without training.
During the training period, 11 athletes showed an exaggerated BP response to exercise, whereas seven of these 11 athletes also showed an exaggerated BP response during the resting period. Elevation in systolic BP was greater in athletes with an exaggerated BP response than athletes with a normal BP response to exercise (resting: 84±22 vs. 60±18 mmHg, P=0.02; training: 100±21 vs. 70±18 mmHg, P=0.004). During the training period, athletes with an exaggerated BP response to exercise showed higher systolic BP values on 24-h ambulatory blood pressure monitoring (136±15 vs. 118±8 mmHg, P=0.02). During the resting period, athletes with an exaggerated BP response to exercise had lower apolipoprotein-A1 (1.3±0.1 vs. 1.5±0.2 g/l, P=0.009), and higher SDNN (259±47 vs. 209±52 ms, P=0.03) and pNN50 (0.4±0.1 vs. 0.3±0.1%, P=0.05).
These observations may represent the first sign of a slight metabolic disturbance associated with vascular wall abnormalities, although the parameters remain within normal values.
[Show abstract][Hide abstract] ABSTRACT: Exercise-induced cough is common among athletes. Athletes training in cold air often report an increasingly troublesome cough during the winter season. Chronic airway irritation or inflammation may increase the sensory response of cough receptors. The aim of this study was to evaluate the seasonal variability of cough reflex sensitivity to capsaicin in elite athletes.
Fifty-three elite winter athletes and 33 sedentary subjects completed a respiratory questionnaire and a capsaicin provocation test during the summer, fall, and winter. Allergy skin prick tests, spirometry, eucapnic voluntary hyperpnea test (EVH), methacholine inhalation test (MIT), and induced sputum analysis were also performed.
In athletes, the prevalence of cough immediately after exercise was high, particularly during winter. Athletes often showed a late occurrence of cough between 2-8 h after exercise. The cough reflex sensitivity to capsaicin was unchanged through the seasons in both athletes and non-athlete subjects. No significant correlations were found in groups between cough reflex sensitivity to capsaicin and the number of years in sport training, the number of hours of training per week, EVH response (% fall in FEV1), airway responsiveness to methacholine (PC20), airway inflammation or atopy.
The prevalence of cough immediately and a few hours after exercise is high in athletes and more frequently reported during winter. However, cough does not seem to be associated with cough reflex hypersensitivity to capsaicin, bronchoconstriction, or airway inflammation in the majority of athletes.
[Show abstract][Hide abstract] ABSTRACT: Airway disorders are common in regular chlorinated swimming pool attendees, particularly competitive athletes, but the impact of intense swimming training on airway function and structure remains unclear.
This study aimed to evaluate airway inflammation and remodeling in elite swimmers.
Twenty-three elite swimmers were tested during off-training season. All had exhaled nitric oxide measurement, methacholine test, eucapnic voluntary hyperpnea challenge, allergy skin prick tests, and bronchoscopy with bronchial biopsies. Clinical data and tissues from 10 age-matched mild-asthmatic and 10 healthy nonallergic subjects were used for comparison.
Swimmers had increased airway mucosa eosinophil and mast cell counts than did controls (P < .05). They had more goblet cell hyperplasia and higher mucin expression than did healthy or asthmatic subjects (P < .05). A greater submucosal type I and III collagen expression and tenascin deposition was also observed in swimmers than in controls (P < .05). Neither exhaled nitric oxide nor airway responsiveness to methacholine or eucapnic voluntary hyperpnea challenge correlated with these inflammatory and remodeling changes.
Intense, long-term swimming training in indoor chlorinated swimming pools is associated with airway changes similar to those seen in mild asthma, but with higher mucin expression. These changes were independent from airway hyperresponsiveness. The long-term physiological and clinical consequences of these changes remain to be clarified.
No preview · Article · Dec 2011 · The Journal of allergy and clinical immunology
[Show abstract][Hide abstract] ABSTRACT: Background Inappropriate high blood pressure response to exercise in non athletes is known to be a predictor for future resting systemic hypertension. However, the relevance of exercise hypertension in endurance athletes is not known. Objective Assess the differences in heart rate variability (HRV), 24-h ambulatory blood pressure monitoring (ABPM) and lipid profile in athletes with an hypertensive response to exercise, and athletes with normal response to exercise. Design This study was a prospective cross-sectional study. 47 provincial and national athletes without previous diagnosis of systemic hypertension or other cardiovascular disease, training at least 10 h/week were consecutively recruited. 38 athletes completed the study. INTERVENTION: Athletes underwent an ABPM, a 24-h HRV assessment (Holter), a maximal exercise test and blood samples. Hypertensive response to exercise was defined as systolic blood pressure (SBP) ≥220 mm Hg or diastolic blood pressure (DBP) > 100 mm Hg. Results Two athletes had systemic hypertension (SBP: 139 ± 3, DBP: 81 ± 8 mm Hg) on 24 h-ABPM and 14 athletes showed hypertensive response to exercise (SBP: 243 ± 20, DBP: 77 ± 13 mm Hg). Lower values of high density lipoprotein (HDL) (1.27 ± 0.19 vs 1.51 ± 0.23 g/L, p=0.04) and Apo-A1 (1.31 ± 0.14 vs 1.56 ± 0.15 g/L, p=0.003) were observed in athletes with hypertensive responses to exercise. The latter also had higher values of night time SBP on ABPM compared to athletes with a normal response to exercise (116 ± 6 vs 106 ± 8 mm Hg, p=0.02). No difference was found between both groups regarding HRV indices. Conclusion Higher values of night time SBP on ABPM and lower values of HDL and Apo-A1 were observed in athletes with hypertensive response to exercise. These observations may be the first sign of minor metabolic disturbance in endurance athletes, although parameters remain within de normal values.
No preview · Article · Apr 2011 · British Journal of Sports Medicine
[Show abstract][Hide abstract] ABSTRACT: Airway hyperresponsiveness is highly prevalent in competitive swimmers, but it is unknown whether this is transient or persistent.
To document changes in airway responsiveness and airway inflammation in elite swimmers during intense training and rest.
Nineteen swimmers and 16 healthy controls completed a standardized questionnaire, allergy skin prick tests, exhaled nitric oxide measurement, eucapnic voluntary hyperpnea testing, methacholine challenge, and induced sputum analysis. Testing was performed during intense swimming and after at least 2 weeks of rest.
Sixteen swimmers and 13 controls were atopic. Airway responsiveness to methacholine and eucapnic voluntary hyperpnea was significantly higher in swimmers than in controls (P < .0001). A significant decrease in airway responsiveness was observed from training to rest in swimmers only (P < .005). This occurred with both methacholine challenge--with PC(20) values of 6.0 mg/mL and 12.8 mg/mL, respectively--and eucapnic voluntary hyperpnea testing--with a maximum fall in FEV(1) after voluntary testing of 14.1 L and 10.1 L, respectively. Eight of 12 swimmers with airway hyperresponsiveness during intense training had normal airway responsiveness during rest. No airway inflammation occurred, and no significant change in this parameter was observed from training to rest.
Training may contribute to the development of airway hyperresponsiveness in elite swimmers, but this seems reversible in many athletes after training cessation for at least 2 weeks.
No preview · Article · Dec 2010 · The Journal of allergy and clinical immunology
[Show abstract][Hide abstract] ABSTRACT: Rhinitis is commonly reported by swimmers. Seasonal allergic rhinitis may impair athletes' performance and quality of life (QOL). No data are currently available on the changes of nasal symptoms during and after a swimming season. We aimed to determine in competitive swimmers: (1) the prevalence of rhinitis and its impact on their QOL during an intense training programme, (2) the changes in nasal symptoms and QOL after a resting period and (3) the relationship between rhinitis and airway hyperresponsiveness (AHR).
Thirty-nine swimmers and 30 healthy controls answered the Rhinitis Quality of Life Questionnaire (RQLQ) and scored nasal symptoms on a seven-point Likert scale during the week preceding their visit. Subjects had allergy skin prick tests and a methacholine challenge. Peak nasal inspiratory flows were also measured. The athletes performed these tests during an intense training period (V1), outside the pollen season and after at least 2 weeks without swimming (V2).
At V1, rhinitis symptoms were reported by 74% of swimmers and 40% of controls (P<0.01). Eighty-four percent of swimmers and 72% of controls were atopic (NS). RQLQ score was higher in swimmers compared with controls at V1 (27.3+/-28.5 vs. 9.5+/-12.7, respectively, P<0.005). The presence of AHR during training did not correlate with the presence of rhinitis symptoms. At V2, the nasal symptoms and RQLQ scores were similar in swimmers and controls.
Intense swimming training is associated with an increase in nasal symptoms and impairment in QOL in most competitive swimmers. Such an increase is not related to seasonal allergen exposure in atopic athletes and probably results from chlorine derivative exposure.
No preview · Article · Aug 2010 · Clinical & Experimental Allergy
[Show abstract][Hide abstract] ABSTRACT: This study was aimed at the following: (1) the prevalence of airway hyperresponsiveness (AHR) and exercise-induced bronchoconstriction (EIB) in swimmers and winter sport athletes according to the previously recommended regulatory sport agencies criteria, (2) the relationship between respiratory symptoms and AHR/EIB, (3) the impact of the chosen cutoff value for AHR on its prevalence, and (4) the effect on the prevalence of the positive eucapnic voluntary hyperpnea (EVH) test of using the highest vs the lowest spirometric post-EVH values to calculate the magnitude of the airway response. We compared the prevalence of respiratory symptoms with responses to methacholine challenge and EVH in 45 swimmers, 45 winter sport athletes, and 30 controls. Two methacholine challenge cutoffs for AHR were analyzed: <or= 4 mg/mL (the sport agencies' criteria for AHR) and <or= 16 mg/mL. Sixty percent of swimmers, 29% of winter sport athletes, and 17% of controls had evidence of EIB or AHR (with the <or= 4 mg/mL criteria). Among athletes with a methacholine provocative concentration inducing a 20% decrease in the FEV(1) between 4 and 16 mg/mL, 43% of swimmers and 100% of winter sport athletes were symptomatic (P < .05). Prevalence of positive EVH tests were 39% in swimmers, 24% in winter sport athletes, and 13% in controls when the highest FEV(1) value measured at each time point post-EVH was used to identify maximal response for calculation of airway response, although these prevalences were higher if we used the lowest value. This study suggests that AHR/EIB is frequent in swimmers, whereas the frequently reported respiratory symptoms in winter sport athletes are often not related to AHR/EIB. Furthermore, the choice of methods for assessing methacholine challenge and EVH responses influences the prevalences of AHR and EIB. Trial registration: clinicaltrials.gov; Identifier NCT 00686491 and NCT 00686452.