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Bronchial Hyperresponsiveness, Airway Inflammation, and Airflow Limitation in Endurance Athletes^*

^* From the HP2 Laboratory (Drs. Vergès, Flore, Rossini, Levy, and Wuyam), Department of Medicine, Departments of Respiratory Diseases (Dr. Devouassoux) and Cytology (Dr. Fior-Gozlan), and Exercise and Lung Function Laboratory (Drs. Levy and Wuyam), CHU Grenoble, Joseph Fourier University, Grenoble, France.

Correspondence to: Bernard Wuyam, MD, PhD, Exercise and Lung Function Laboratory, A. Michallon Hospital, BP 217X, 38043 Grenoble Cedex 09, France; e-mail: BWuyam{at}chu-grenoble.fr

Background: Whereas a high prevalence of bronchial abnormalities has been reported in endurance athletes, its underlying mechanisms and consequences during exercise are still unclear.

Study objectives: The purpose of this study was to assess the following: (1) bronchial responsiveness to methacholine and to exercise; (2) airway inflammation; and (3) airflow limitation during intense exercise in endurance athletes with respiratory symptoms.

Design: Cross-sectional observational study.

Setting: Lung function and exercise laboratory at a university hospital.

Patients and measurements: Thirty-nine endurance athletes and 13 sedentary control subjects were explored for the following: (1) self-reported respiratory symptoms; (2) bronchial hyperresponsiveness (BHR) to methacholine and exercise; (3) airflow limitation during intense exercise; and (4) bronchial inflammation using induced sputum and nitric oxide (NO) exhalation.

Results: Fifteen athletes (38%) showed BHR to methacholine and/or exercise in association with bronchial eosinophilia (mean [± SD] eosinophil count, 4.1 ± 8.5% vs 0.3 ± 0.9% vs 0%, respectively), higher NO concentrations (19 ± 10 vs 14 ± 4 vs 13 ± 4 parts per billion, respectively), a higher prevalence of atopy, and more exercise-induced symptoms compared with nonhyperresponsive athletes and control subjects (p < 0.05). Furthermore, airflow limitation during intense exercise was observed in eight athletes, among whom five had BHR. Athletes with airflow limitation reported more symptoms and had FEV₁, FEV₁/FVC ratio, and forced expiratory flow at midexpiratory phase values of 14%, 9%, and 29%, respectively, lower compared with those of nonlimited athletes (p < 0.05).

Conclusion: BHR in endurance athletes was associated with the criteria of eosinophilic airway inflammation and atopy, whereas airflow limitation during exercise was primarily a consequence of decreased resting spirometric values. Both BHR and bronchial obstruction at rest with subsequent expiratory flow limitation during exercise may promote respiratory symptoms during exercise in athletes.

Key Words: airflow limitation • airway inflammation • athlete • bronchial • eosinophil • exercise • hyperresponsiveness • nitric oxide

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				Evidence based journal watch Br. J. Sports Med., March 1, 2006; 40(3): 281 - 282. [Full Text] [PDF]