Ora Josuel, De Marco Patrizia, Gabriele Mariachiara, Cazzola Mario, Rogliani Paola
Division of Respiratory Medicine, University Hospital "Tor Vergata", 00133 Rome, Italy.
Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.
J Funct Morphol Kinesiol. 2024 Jan 3;9(1):15. doi: 10.3390/jfmk9010015.
Asthma is a complex respiratory condition characterized by chronic airway inflammation and variable expiratory airflow limitation, affecting millions globally. Among athletes, particularly those competing at elite levels, the prevalence of respiratory conditions is notably heightened, varying between 20% and 70% across specific sports. Exercise-induced bronchoconstriction (EIB) is a common issue among athletes, impacting their performance and well-being. The prevalence rates vary based on the sport, training environment, and genetics. Exercise is a known trigger for asthma, but paradoxically, it can also improve pulmonary function and alleviate EIB severity. However, athletes' asthma phenotypes differ, leading to varied responses to medications and challenges in management. The unique aspects in athletes include heightened airway sensitivity, allergen, pollutant exposure, and temperature variations. This review addresses EIB in athletes, focusing on pathogenesis, diagnosis, and treatment. The pathogenesis of EIB involves complex interactions between physiological and environmental factors. Airway dehydration and cooling are key mechanisms, leading to osmotic and thermal theories. Airway inflammation and hyper-responsiveness are common factors. Elite athletes often exhibit distinct inflammatory responses and heightened airway sensitivity, influenced by sport type, training, and environment. Swimming and certain sports pose higher EIB risks, with chlorine exposure in pools being a notable factor. Immune responses, lung function changes, and individual variations contribute to EIB in athletes. Diagnosing EIB in athletes requires objective testing, as baseline lung function tests can yield normal results. Both EIB with asthma (EIBA) and without asthma (EIBwA) must be considered. Exercise and indirect bronchoprovocation tests provide reliable diagnoses. In athletes, exercise tests offer effectiveness in diagnosing EIB. Spirometry and bronchodilation tests are standard approaches, but the diagnostic emphasis is shifting toward provocation tests. Despite its challenges, achieving an optimal diagnosis of EIA constitutes the cornerstone for effective management, leading to improved performance, reduced risk of complications, and enhanced quality of life. The management of EIB in athletes aligns with the general principles for symptom control, prevention, and reducing complications. Non-pharmacological approaches, including trigger avoidance and warming up, are essential. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy in athletes. Short-acting beta agonists (SABA) are discouraged as sole treatments. Leukotriene receptor antagonists (LTRA) and mast cell stabilizing agents (MCSA) are potential options. Optimal management improves the athletes' quality of life and allows them to pursue competitive sports effectively.
哮喘是一种复杂的呼吸系统疾病,其特征为慢性气道炎症和可变的呼气气流受限,全球有数百万人受其影响。在运动员中,尤其是那些参加精英级比赛的运动员,呼吸系统疾病的患病率显著升高,在特定运动项目中的患病率在20%至70%之间不等。运动诱发的支气管收缩(EIB)是运动员中常见的问题,会影响他们的表现和健康。患病率因运动项目、训练环境和遗传因素而异。运动是已知的哮喘触发因素,但矛盾的是,它也可以改善肺功能并减轻EIB的严重程度。然而,运动员的哮喘表型不同,导致对药物的反应各异,管理也面临挑战。运动员的独特之处包括气道敏感性增加、接触过敏原、污染物以及温度变化。本综述探讨运动员中的EIB,重点关注发病机制、诊断和治疗。EIB的发病机制涉及生理和环境因素之间的复杂相互作用。气道脱水和冷却为关键机制,由此产生渗透和热理论。气道炎症和高反应性是常见因素。精英运动员常表现出独特的炎症反应和更高的气道敏感性,这受到运动类型、训练和环境的影响。游泳和某些运动项目EIB风险更高,泳池中的氯暴露是一个显著因素。免疫反应、肺功能变化和个体差异都对运动员的EIB有影响。诊断运动员的EIB需要客观测试,因为基线肺功能测试可能得出正常结果。必须同时考虑伴有哮喘的EIB(EIBA)和不伴有哮喘的EIB(EIBwA)。运动和间接支气管激发试验可提供可靠诊断。在运动员中,运动试验对诊断EIB有效。肺活量测定和支气管扩张试验是标准方法,但诊断重点正转向激发试验。尽管存在挑战,但实现对运动性哮喘(EIA)的最佳诊断是有效管理的基石,可提高表现、降低并发症风险并改善生活质量。运动员EIB的管理符合症状控制、预防和减少并发症的一般原则。非药物方法,包括避免触发因素和热身,至关重要。吸入性糖皮质激素(ICS)是运动员哮喘治疗的基石。不鼓励将短效β受体激动剂(SABA)作为单一治疗方法。白三烯受体拮抗剂(LTRA)和肥大细胞稳定剂(MCSA)是潜在选择。最佳管理可改善运动员的生活质量,使他们能够有效地从事竞技运动。