Jaeger Eva, Maurer Debbie J, Wallimann Alexandra, Kistler Walter, Villiger Beat, Agache Ioana, Jutel Marek, Nadeau Kari, Rukhadze Maia, Bonini Matteo, Price Oliver J, Akdis Cezmi A, Villiger Michael
Swiss Research Institute for Sports Medicine (SRISM), Davos, Switzerland.
Department of Sports Medicine, Hospital Davos, Davos, Switzerland.
Scand J Med Sci Sports. 2025 Apr;35(4):e70046. doi: 10.1111/sms.70046.
Strenuous exercise in elite sports impacts the immune system, leading to high rates of upper respiratory tract infections and airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB). Cross-country (XC) skiers and ice hockey (IH) players are particularly affected due to their training environments and sports disciplines. This systematic review (SR) evaluates immune and inflammatory responses and the risk of developing airway dysfunction in these athletes. Original articles focusing on immune response, systemic inflammation, and airway dysfunction in competitive XC skiers and IH players were retrieved from MEDLINE/Ovid, EMBASE, and the Cochrane Library. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Of 3582 studies screened, 50 met the inclusion criteria. Both elite XC skiers and IH players exhibit increased cortisol levels and altered systemic immune cell compositions in response to training and competition. Both groups show neutrophilic or mixed neutrophilic/eosinophilic airway inflammation, in contrast to the primarily eosinophilic inflammation associated with allergic asthma. Both XC skiers (27%) and IH players (14%) had a high prevalence of physician-diagnosed asthma. This SR highlights the notable burden of airway dysfunction in elite winter athletes, with elevated rates of asthma and EIB. The observed inflammatory patterns support the concept of a "sport asthma" endotype, which may be a result of chronic exposure to cold, dry air. Effective management may benefit from refined diagnostic criteria, the identification of specific biomarkers, and tailored prevention and treatment strategies for asthma and EIB.
精英运动中的高强度训练会影响免疫系统，导致上呼吸道感染和气道功能障碍的发生率较高，如哮喘和运动诱发的支气管收缩（EIB）。越野滑雪运动员和冰球运动员因其训练环境和运动项目而受到特别影响。本系统评价（SR）评估了这些运动员的免疫和炎症反应以及发生气道功能障碍的风险。从MEDLINE/Ovid、EMBASE和Cochrane图书馆检索了关注竞技越野滑雪运动员和冰球运动员免疫反应、全身炎症和气道功能障碍的原始文章。使用Cochrane偏倚风险工具评估偏倚风险。在筛选的3582项研究中，50项符合纳入标准。精英越野滑雪运动员和冰球运动员在训练和比赛时均表现出皮质醇水平升高和全身免疫细胞组成改变。与主要与过敏性哮喘相关的嗜酸性炎症不同，两组均表现为嗜中性或嗜中性/嗜酸性混合气道炎症。越野滑雪运动员（27%）和冰球运动员（14%）中医生诊断哮喘的患病率均较高。本系统评价强调了精英冬季运动员气道功能障碍的显著负担，哮喘和EIB的发生率升高。观察到的炎症模式支持“运动性哮喘”亚型的概念，这可能是长期暴露于寒冷、干燥空气中的结果。有效的管理可能受益于完善的诊断标准、特定生物标志物的识别以及针对哮喘和EIB的量身定制的预防和治疗策略。
