This paper aims to identify factors that may account for the high values and varied prevalence of exercise-induced bronchospasm (EIB), which occur in the population of athletes. Journal articles, indexed and peer reviewed, published in the MEDLINE and SPORTDiscus database were screened using a computer search. Keywords as “prevalence,” “exercise,” “bronchospasm,” and “athletes” were crossed. The diagnosis of EIB based on the questionnaire or maximal decrease of ventilatory parameters was considered as inclusion criteria and selection of articles. Analysis of selected articles reveals higher values and varied prevalence of EIB (11–55%) compared to those in the general population (4–20%). Evaluation criteria of EIB are those based on the characteristics of sedentary subjects. Criteria sometimes do not seem adapted to specific sports. This paper suggests a differential diagnostic approach which takes account of both the EIB characteristics of sedentary and those of sportsmen. 1. Introduction Asthma and exercise-induced bronchospasm (EIB) are terms used to describe the same phenomenon depending on the path of physiological nature of the subjects and the circumstances highlighted. However, these two terms are not always interchangeable. Indeed, asthma is a multifactorial disease resulting from the combination of factors predisposing congenital (hereditary factors) and environmental factors favoring (allergens, pollen, home and industrial dusts, and air pollution inhalation, etc.). It is defined as a disorder characterized by attacks of breathlessness or chest tightness paroxysmal wheezing, usually exhalation, indicating a sharp decrease of the caliber of the bronchi which combine progressive edema and hypersecretion of mucous tract air breathing (nasal cavity, pharynx, larynx, trachea, bronchi) can lead to inflammation. Clinically, asthma is characterized by attacks of breathing difficulty arising from crises, time varying and is reversible spontaneously or under the effect of treatment. These accesses coincide with episodes of varying degrees of airway obstruction and reversible [1]. As a result, the diagnosis of asthma is very delicate. The diagnosis of asthma is based on the examination, respiratory symptoms, family history, and pulmonary function at rest, during exercise and pharmacodynamic tests. To validate this diagnosis in the resting state, the criteria of the European Respiratory Society [2] and the American Thoracic Society [3] require a ratio of forced expiratory volume in 1 second (FEV) less than 80% of the theoretical value, a ratio of FEV on
References
[1]
I. A. Gilbert and E. R. McFadden, “Airway cooling and rewarming. The second reaction sequence in exercise-induced asthma,” Journal of Clinical Investigation, vol. 90, no. 3, pp. 699–704, 1992.
[2]
ERS, “Standardized lung function testing,” Official Statement of the European Respiratory Journal, vol. 6, pp. 16–53, 1993.
[3]
R. O. Crapo, J. L. Hankinson, C. Irvin et al., “Standardization of spirometry: 1994 Update,” American Journal of Respiratory and Critical Care Medicine, vol. 152, no. 3, pp. 1107–1136, 1995.
[4]
Global Initiative for Asthma. The Global Burden of Asthma Report 2004, http://www.ginasthma.org/pdf/GINABurdenReport.pdf .
[5]
C. Anandan, U. Nurmatov, O. C. P. Van Schayck, and A. Sheikh, “Is the prevalence of asthma declining? Systematic review of epidemiological studies,” Allergy, vol. 65, no. 2, pp. 152–167, 2010.
[6]
K. W. Rundell and D. M. Jenkinson, “Exercise-induced bronchospasm in the elite athlete,” Sports Medicine, vol. 32, no. 9, pp. 583–600, 2002.
[7]
W. Nystad, J. Harris, and J. S. Borgen, “Asthma and wheezing among Norwegian elite athletes,” Medicine and Science in Sports and Exercise, vol. 32, no. 2, pp. 266–270, 2000.
[8]
I. J. Helenius, H. O. Tikkanen, and T. Haahtela, “Association between type of training and risk of asthma in elite athletes,” Thorax, vol. 52, no. 2, pp. 157–160, 1997.
[9]
J. Medelli, J. Lounana, F. Messan, J. J. Menuet, and M. Petitjean, “Testing of pulmonary function in a professional cycling team,” Journal of Sports Medicine and Physical Fitness, vol. 46, no. 2, pp. 298–306, 2006.
[10]
J. Elers, L. Pedersen, and V. Backer, “Asthma in elite athletes,” Expert Review of Respiratory Medicine, vol. 5, no. 3, pp. 343–351, 2011.
[11]
K. W. Rundell, B. A. Spiering, T. M. Evans, and J. M. Baumann, “Baseline lung function, exercise-induced bronchoconstriction, and asthma-like symptoms in elite women ice hockey players,” Medicine and Science in Sports and Exercise, vol. 36, no. 3, pp. 405–410, 2004.
[12]
W. W. Storms, “Review of exercise-induced asthma,” Medicine and Science in Sports and Exercise, vol. 35, no. 9, pp. 1464–1470, 2003.
[13]
C. Fuentes, S. Contreras, O. Padilla, J. A. Castro-Rodriguez, A. Moya, and S. Caussade, “Exercise challenge test: is a 15% fall in FEV1 sufficient for diagnosis?” Journal of Asthma, vol. 48, no. 7, pp. 729–735, 2011.
[14]
E. R. McFadden, K. A. M. Lenner, and K. P. Strohl, “Postexertional airway rewarming and thermally induced asthma. New insights into pathophysiology and possible pathogenesis,” Journal of Clinical Investigation, vol. 78, no. 1, pp. 18–25, 1986.
[15]
S. D. Anderson and K. Holzer, “Exercise-induced asthma: is it the right diagnosis in elite athletes?” Journal of Allergy and Clinical Immunology, vol. 106, no. 3, pp. 419–428, 2000.
[16]
E. R. McFadden, “Hypothesis: exercise-induced asthma as a vascular phenomenon,” The Lancet, vol. 335, no. 8694, pp. 880–882, 1990.
[17]
E. C. Deal, E. R. McFadden, R. H. Ingram, and J. J. Jaeger, “Esophageal temperature during exercise in asthmatic and nonasthmatic subjects,” Journal of Applied Physiology Respiratory Environmental and Exercise Physiology, vol. 46, no. 3, pp. 484–490, 1979.
[18]
J. Solway, “Airway heat and water fluxes and the tracheobronchial circulation,” European Respiratory Journal, vol. 3, no. 12, pp. 608–617, 1990.
[19]
R. T. Thole, R. E. Sallis, A. L. Rubin, and G. N. Smith, “Exercise-induced bronchospasm prevalence in collegiate cross-country runners,” Medicine and Science in Sports and Exercise, vol. 33, no. 10, pp. 1641–1646, 2001.
[20]
Y.-J. Bae, Y. S. Kim, C.-S. Park et al., “Reliability and validity of the St George's Respiratory Questionnaire for asthma,” International Journal of Tuberculosis and Lung Disease, vol. 15, no. 7, pp. 966–971, 2011.
[21]
K. W. Rundell, J. Im, L. B. Mayers, R. L. Wilber, L. Szmedra, and H. R. Schmitz, “Self-reported symptoms and exercise-induced asthma in the elite athlete,” Medicine and Science in Sports and Exercise, vol. 33, no. 2, pp. 208–213, 2001.
[22]
V. Bougault, J. Turmel, and L. P. Boulet, “Bronchial challenges and respiratory symptoms in elite swimmers and winter sport athletes: airway hyperresponsiveness in asthma: its measurement and clinical significance,” Chest, vol. 138, no. 2, 2010.
[23]
S. D. Anderson and J. D. Brannan, “Methods for “indirect” challenge tests including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols,” Clinical Reviews in Allergy and Immunology, vol. 24, no. 1, pp. 27–54, 2003.
[24]
E. M. Wagner and D. B. Jacoby, “Methacholine causes reflex bronchoconstriction,” Journal of Applied Physiology, vol. 86, no. 1, pp. 294–297, 1999.
[25]
G. J. Argyros, J. M. Roach, K. M. Hurwitz, A. H. Eliasson, and Y. Y. Phillips, “The refractory period after eucapnic voluntary hyperventilation challenge and its effect on challenge technique,” Chest, vol. 108, no. 2, pp. 419–424, 1995.
[26]
S. D. Anderson, G. J. Argyros, H. Magnussen, and K. Holzer, “Provocation by eucapnic voluntary hyperpnoea to identify exercise induced bronchoconstriction,” British Journal of Sports Medicine, vol. 35, no. 5, pp. 344–347, 2001.
[27]
M. Sue-Chu, J. D. Brannan, S. D. Anderson, N. Chew, and L. Bjermer, “Airway hyperresponsiveness to methacholine, adenosine 5-monophosphate, mannitol, eucapnic voluntary hyperpnoea and fi eld exercise challenge in elite cross-country skiers,” British Journal of Sports Medicine, vol. 44, no. 11, pp. 827–832, 2010.
[28]
K. Holzer, S. D. Anderson, and J. Douglass, “Exercise in elite summer athletes: challenges for diagnosis,” Journal of Allergy and Clinical Immunology, vol. 110, no. 3, pp. 374–380, 2002.
[29]
IOC Consensus Statement on asthma in elite athletes 2008, http://www.olympic.org/Documents/Reports/EN/en_report_1301.pdf.
[30]
K. W. Rundell, R. L. Wilber, L. Szmedra, D. M. Jenkinson, L. B. Mayers, and J. Im, “Exercise-induced asthma screening of elite athletes: field versus laboratory exercise challenge,” Medicine and Science in Sports and Exercise, vol. 32, no. 2, pp. 309–316, 2000.
[31]
S. D. Anderson, N. M. Connolly, and S. Godfrey, “Comparison of bronchoconstriction induced by cycling and running,” Thorax, vol. 26, no. 4, pp. 396–401, 1971.
[32]
C. Omori, B. H. Schofield, W. Mitzner, and A. N. Freed, “Hyperpnea with dry air causes time-dependent alterations in mucosal morphology and bronchovascular permeability,” Journal of Applied Physiology, vol. 78, no. 3, pp. 1043–1051, 1995.
[33]
B. Brunekreef, G. Hoek, O. Breugelmans, and M. Leentvaar, “Respiratory effects of low-level photochemical air pollution in amateur cyclists,” American Journal of Respiratory and Critical Care Medicine, vol. 150, no. 4, pp. 962–966, 1994.
[34]
P. L. Kinney, D. M. Nilsen, M. Lippmann et al., “Biomarkers of lung inflammation in recreational joggers exposed to ozone,” American Journal of Respiratory and Critical Care Medicine, vol. 154, no. 5, pp. 1430–1435, 1996.
[35]
W. C. Hinds, Aerosol Technology. Properties, Behavior, and Measurement of Airborne Particles, John Wiley & Sons, New York, NY, USA, 2nd edition, 1999.
[36]
C. H. Yu, M. T. Morandi, and C. P. Weisel, “Passive dosimeters for nitrogen dioxide in personal/indoor air sampling: a review,” Journal of Exposure Science and Environmental Epidemiology, vol. 18, no. 5, pp. 441–451, 2008.
[37]
K. W. Rundell, B. A. Spiering, D. A. Judelson, and M. H. Wilson, “Bronchoconstriction during cross-country skiing: is there really a refractory period?” Medicine and Science in Sports and Exercise, vol. 35, no. 1, pp. 18–26, 2003.
[38]
J. I. Levy, K. Lee, Y. Yanagisawa, P. Hutchinson, and J. D. Spengler, “Determinants of nitrogen dioxide concentrations in indoor ice skating rinks,” American Journal of Public Health, vol. 88, no. 12, pp. 1781–1786, 1998.
[39]
M. Brauer, K. Lee, J. D. Spengler et al., “Nitrogen dioxide in indoor ice skating facilities: an international survey,” Journal of the Air and Waste Management Association, vol. 47, no. 10, pp. 1095–1102, 1997.
[40]
W. James Gauderman, G. Frank Gilliland, H. Vora et al., “Association between air pollution and lung function growth in Southern California children: results from a second cohort,” American Journal of Respiratory and Critical Care Medicine, vol. 166, no. 1, pp. 76–84, 2002.
[41]
G. Oberdorster, R. M. Gelein, J. Ferin, and B. Weiss, “Association of particulate air pollution and acute mortality: involvement of ultrafine particles?” Inhalation Toxicology, vol. 7, no. 1, pp. 111–124, 1995.
[42]
S. A. Meo, A. M. Al-Drees, S. Rasheed et al., “Effect of duration of exposure to polluted air environment on lung function in subjects exposed to crude oil spill into sea water,” International Journal of Occupational Medicine and Environmental Health, vol. 22, no. 1, pp. 35–41, 2009.
[43]
S. Abe, H. Takizawa, I. Sugawara, and S. Kudoh, “Diesel exhaust (DE)-induced cytokine expression in human bronchial epithelial cells: a study with a new cell exposure system to freshly generated DE in vitro,” American Journal of Respiratory Cell and Molecular Biology, vol. 22, no. 3, pp. 296–303, 2000.
[44]
C. C. Daigle, D. C. Chalupa, F. R. Gibb et al., “Ultrafine particle deposition in humans during rest and exercise,” Inhalation Toxicology, vol. 15, no. 6, pp. 539–552, 2003.
[45]
K. Lee, Y. Yanagisawa, J. D. Spengler, and S. Nakai, “Carbon monoxide and nitrogen dioxide exposures in indoor ice skating rinks,” Journal of Sports Sciences, vol. 12, no. 3, pp. 279–283, 1994.
[46]
L. J. Folinsbee, “Does nitrogen dioxide exposure increase airways responsiveness?” Toxicology and Industrial Health, vol. 8, no. 5, pp. 273–283, 1992.
[47]
R. L. Wilber, K. W. Rundell, L. Szmedra, D. M. Jenkinson, J. Im, and S. D. Drake, “Incidence of exercise-induced bronchospasm in Olympic winter sport athletes,” Medicine and Science in Sports and Exercise, vol. 32, no. 4, pp. 732–737, 2000.
