Sports Medicine

, Volume 31, Issue 8, pp 601–616 | Cite as

Prevalence and Mechanisms of Development of Asthma and Airway Hyperresponsiveness in Athletes

  • Jean-Bruno Langdeau
  • Louis-Philippe Boulet
Review Article


A high prevalence of asthma and airway hyperresponsiveness (AHR) has been reported in the athlete population. Factors potentially predisposing athletes to these conditions have not been clearly identified. Although moderate exercise has been shown to be beneficial in patients with asthma, repeated high-intensity exercise could possibly contribute to the development of asthma and AHR. This report provides an overview of the prevalence and possible mechanisms of development of asthma and AHR in the athlete population. The prevalence of asthma and AHR are higher in athletes than in the general population, particularly in swimmers and athletes performing sports in cold air environments. Possible mechanisms involved in the development of asthma in athletes are still uncertain; however, the content and physical characteristics of the inhaled air seem to be important factors, while immune and neurohumoral influences could play a modulatory role. This report stresses the need for further studies to better define the aetiologic factors and mechanisms involved in the development of asthma and AHR in athletes, and proposes relevant preventive and therapeutic measures.


Asthma Airway Inflammation Formoterol Respiratory Sinus Arrhythmia Airway Hyperresponsiveness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to thank Lori Henig Schubert for reviewing the manuscript. This review was supported by local funds.


  1. 1.
    Weiss K, Gergen TA, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med 1992; 326: 862–6PubMedCrossRefGoogle Scholar
  2. 2.
    Beasley R, Crane J, Lai CK, et al. Prevalence and etiology of asthma. J Allergy Clin Immunol 2000; 105: 466–72CrossRefGoogle Scholar
  3. 3.
    Burney PGJ, Chinn S, Rona RJ. Has the prevalence of asthma increased in children? Evidence from the national study of health and growth 1973–86. BMJ 1990; 300: 1306–10PubMedCrossRefGoogle Scholar
  4. 4.
    Gergen PJ, Mullaly DI, Evans R. National survey of prevalence of asthma among children in the United States, 1976 to 1980. Pediatrics 1988; 81: 1–7PubMedGoogle Scholar
  5. 5.
    Helenius IJ, Tikkanen HO, Sarna S, et al. Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors. J Allergy Clin Immunol 1998; 101: 646–52PubMedCrossRefGoogle Scholar
  6. 6.
    Weiler JM, Layton T, Hunt M. Asthma in United States Olympic athletes who participated in the 1996 Summer Games. J Allergy Clin Immunol 1998; 102: 722–6PubMedCrossRefGoogle Scholar
  7. 7.
    Nastasi KJ, Heinly TL, Blaiss MS. Exercise-induced asthma and the athlete. J Asthma 1995; 32: 249–57PubMedCrossRefGoogle Scholar
  8. 8.
    Sandsund M, Faerevik H, Reinertsen RE, et al. Effects of breathing cold and warm air on lung function and physical performance in asthmatic and nonasthmatic athletes during exercise in the cold. Ann N Y Acad Sci 1997; 813: 751–6PubMedCrossRefGoogle Scholar
  9. 9.
    Langdeau J-B, Turcotte H, Bowie DM, et al. Airway hyper-responsiveness in elite athletes. Am J Respir Crit Care Med 2000; 161: 1479–84PubMedGoogle Scholar
  10. 10.
    American Thoracic Society. Standards for the diagnosis of patients with COPD and asthma. Am Rev Respir Dis 1987; 136: 225–44CrossRefGoogle Scholar
  11. 11.
    New National Heart, Lung and Blood Institute (NHLBI) guidelines for the diagnosis and management of asthma. NHLBI. Lippincott Health Promot Lett 1997; 2: 8–9Google Scholar
  12. 12.
    Nadel JA, Busse WW. Asthma. Am J Respir Crit Care Med 1998; 157 (4 Pt 2): S130-S138Google Scholar
  13. 13.
    Juniper EF, Cockcroft DW, Hargreave FE, editors. Histamine and methacholine inhalation tests: tidal breathing method. Laboratory procedure and standardization. Lund: Canadian Thoracic Society, 1991Google Scholar
  14. 14.
    Cockcroft DW. Airway responsiveness. In: Barnes PJ, editor. Asthma. Philadelphia (PA): Lippincott-Raven, 1997: 1253–5Google Scholar
  15. 15.
    Weiss ST. Asthma: epidemiology. In: Fishman AP, Elias JA, Fishman JA. Pulmonary diseases and disorders. 3rd ed. New York (NY): McGraw-Hill, 1998: 735–43Google Scholar
  16. 16.
    Barnes PJ. New concepts in the pathogenesis of bronchial hyper-responsiveness and asthma. J Allergy Clin Immunol 1989; 83: 1013–5PubMedCrossRefGoogle Scholar
  17. 17.
    Rennard SI. Repair mechanisms in asthma. J Allergy Clin Immunol 1996; 98 (6 Pt 2): S278-S286CrossRefGoogle Scholar
  18. 18.
    Sheils IA, Bowler SD, Taylor SM. Airway smooth muscle proliferation in asthma: the potential of vascular leakage to contribute to pathogenesis. Med Hypotheses 1995; 45: 37–40CrossRefGoogle Scholar
  19. 19.
    Shimura S, Andoh Y, Haraguchi M, et al. Continuity of airway goblet cells and intraluminal mucus in the airways of patients with bronchial asthma. Eur Respir J 1996; 9: 1395–401PubMedCrossRefGoogle Scholar
  20. 20.
    Dubé J, Boulet L-P. Rôles de l’inflammation et des modifications des structures bronchiques dans l’asthme allergique. Med Sci 1996; 12: 351–7Google Scholar
  21. 21.
    Li X, Wilson JW. Increased vascularity of the bronchial mucosa in mild asthma. AmJ Respir Crit Care Med 1997; 156: 229–33Google Scholar
  22. 22.
    Tremblay GM, Chakir J, Boulet L-P, et al. Bronchial myofibroblasts and tissue remodelling in asthma. Can Respir J 1998; 5: 59–61PubMedGoogle Scholar
  23. 23.
    Bousquet J, Jeffery PK, Busse WW, et al. Asthma. From bronchoconstriction to airways inflammation and remodelling. Am J Respir Crit Care Med 2000; 161: 1720–45PubMedGoogle Scholar
  24. 24.
    Mahler DA. Exercise-induced asthma. Med Sci Sports Exerc 1993; 25: 554–61PubMedGoogle Scholar
  25. 25.
    Spector SL. Update on exercise-induced asthma. Ann Allergy 1993; 71: 571–7PubMedGoogle Scholar
  26. 26.
    Weiler JM. Exercise-induced asthma: a practical guide to definitions, diagnosis, prevalence, and treatment. Allergy Asthma Proc 1996; 17: 315–25PubMedCrossRefGoogle Scholar
  27. 27.
    Freed AN. Models and mechanisms of exercise-induced asthma. Eur Respir J 1995; 8: 1770–85PubMedCrossRefGoogle Scholar
  28. 28.
    Boulet L-P, Becker A, Bérubé D, et al. Canadian Asthma Consensus Report. Can Med Assoc 1999; 161 Suppl. 11: S1-S62Google Scholar
  29. 29.
    Chen WY, Horton DJ. Heat and water loss from the airways and exercise-induced asthma. Respiration 1977; 34: 305–13PubMedCrossRefGoogle Scholar
  30. 30.
    Makker HK, Holgate ST. Mechanisms of exercise-induced asthma. Eur J Clin Invest 1994; 24: 571–85PubMedCrossRefGoogle Scholar
  31. 31.
    Varray A, Préfaut C. Les bases physiopathologiques du réentraînement à l’effort des asthmatiques. Rev Mal Respir 1992; 9: 355–66PubMedGoogle Scholar
  32. 32.
    Cypcar D, Lemanske Jr RF. Asthma and exercise. Chest Med 1994; 15: 351–68Google Scholar
  33. 33.
    Anderson SD. Is there a unifying hypothesis for exercise-induced asthma? J Allergy Clin Immunol 1984; 73: 660–5PubMedCrossRefGoogle Scholar
  34. 34.
    Eggleston PA, Kagey-Sobotka A, Schleimer RP. Interaction between hyperosmolar and IgE-induced histamine release from basophils and mast cells. Am Rev Respir Dis 1984; 130: 86–91PubMedGoogle Scholar
  35. 35.
    Deal EC, Wasserman SI, Soter NA, et al. Evaluation of role played by mediators of immediate hypersensitivity in exercise-induced asthma. J Clin Invest 1980; 65: 659–65PubMedCrossRefGoogle Scholar
  36. 36.
    Tan RA, Spector SL. Exercise-induced asthma. Sports Med 1998; 25: 1–6PubMedCrossRefGoogle Scholar
  37. 37.
    Venge P, Henriksen J, Dahl R, et al. Exercise-induced asthma and the generation of neutrophil chemotactic activity. J Allergy Clin Immunol 1990; 85: 498–504PubMedCrossRefGoogle Scholar
  38. 38.
    Smith CM, Anderson SD. Hyperosmolarity as the stimulus to asthma induced by hyperventilation. J Allergy Clin Immunol 1986; 77: 729–36PubMedCrossRefGoogle Scholar
  39. 39.
    McFadden Jr ER, Lenner KA, Strohl KP. Postexertional airway rewarming and thermally induced asthma. New insights into pathophysiology and possible pathogenesis. J Clin Invest 1986; 78: 18–25PubMedCrossRefGoogle Scholar
  40. 40.
    McFadden Jr ER. Exercise-induced asthma. Assessment of current etiologic concepts. Chest 1987; 91 Suppl.: 151S-7SCrossRefGoogle Scholar
  41. 41.
    Cochrane LM, Clark CJ. Benefits and problems of a physical training programme for asthmatic patients. Thorax 1990; 45: 345–51PubMedCrossRefGoogle Scholar
  42. 42.
    Bundgaard A, Ingemann Hansen T, Schmidt A, et al. Effect of physical training on peak oxygen consumption rate and exercise- induced asthma in adult asthmatics. Scand J Clin Lab Invest 1982; 42: 9–13PubMedCrossRefGoogle Scholar
  43. 43.
    Rasmussen F, Lambrechtsen J, Siersted HC, et al. Is low physical fitness a risk factor for the development of asthma? [abstract]. Am J Respir Crit Care Med 1999; 159: A416Google Scholar
  44. 44.
    Freeman W, Williams C, Nute MG. Endurance running performance in athletes with asthma. J Sports Sci 1990; 8: 103–17PubMedCrossRefGoogle Scholar
  45. 45.
    Freeman W, Nute MG, Brooks S, et al. Responses of asthmatic and non-asthmatic athletes to prolonged treadmill running. Br J Sports Med 1990; 24: 183–90PubMedCrossRefGoogle Scholar
  46. 46.
    Emtner M, Finne M, St Alenheim G. High-intensity physical training in adults with asthma: a comparison between training on land and in water. Scand J Rehabil Med 1998; 30: 201–9PubMedCrossRefGoogle Scholar
  47. 47.
    Weiler JM, Ryan III EJ. Asthma in United States Olympic athletes who participated in the 1998 Olympic Winter Games. J Allergy Clin Immunol 2000; 106: 267–71PubMedCrossRefGoogle Scholar
  48. 48.
    Pierson W, Voy RO. Exercise-induced bronchospasm in the XXIII Summer Olympic Games. N Engl Reg Allergy Proc 1988; 9: 209PubMedCrossRefGoogle Scholar
  49. 49.
    Voy RO. The U.S. Olympic Committee experience with exercise-induced bronchospasm, 1984. Med Sci Sports Exerc 1986; 18: 328–30Google Scholar
  50. 50.
    Kukafka DS, Lang DM, Porter S, et al. Exercise-induced bronchospasm in high school athletes via a free running test: incidence and epidemiology. Chest 1998; 114: 1613–22PubMedCrossRefGoogle Scholar
  51. 51.
    Hier T, Oseid S. Self-reported asthma and exercise-induced asthma symptoms in high-level competitive cross-country skiers. Scand J Med Sci Sports 1994; 4: 128–33CrossRefGoogle Scholar
  52. 52.
    Wilber RL, Kenneth WR, Szmedra L, et al. Incidence of exercise- induced bronchospam in Olympic winter sport athletes. Med Sci Sports Exerc 2000; 32: 732–7PubMedCrossRefGoogle Scholar
  53. 53.
    Mannix ET, Manfredi F, Farber MO. A comparison of two challenge tests for identifying exercise-induced bronchospasm in figure skaters. Chest 1999; 115: 649–53PubMedCrossRefGoogle Scholar
  54. 54.
    Mannix ET, Farber MO, Palange P, et al. Exercise-induced asthma in figure skaters. Chest 1996; 109: 312–5PubMedCrossRefGoogle Scholar
  55. 55.
    Provost-Craig MA, Arbour KS, Sestili DC, et al. The incidence of exercise-induced bronchospasmin competitive figure skaters. J Asthma 1996; 33: 67–71PubMedCrossRefGoogle Scholar
  56. 56.
    Leuppi JD, Kuhn M, Comminot C, et al. High prevalence of bronchial hyperresponsiveness and asthma in ice hockey players. Eur Respir J 1998; 12: 13–6PubMedCrossRefGoogle Scholar
  57. 57.
    Sue-Chu M, Larsson L, Bjermer L. Prevalence of asthma in young cross-country skiers in central Scandinavia: differences between Norway and Sweden. Respir Med 1996; 90: 99–105PubMedCrossRefGoogle Scholar
  58. 58.
    Helenius IJ, Rytilä P, Metso T, et al. Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers. Allergy 1998; 53: 346–52PubMedCrossRefGoogle Scholar
  59. 59.
    Potts J. Factors associated with respiratory problems in swimmers. Sports Med 1996; 21: 256–61PubMedCrossRefGoogle Scholar
  60. 60.
    Zwick H, Popp W, Budik G, et al. Increased sensitization to aeroallergens in competitive swimmers. Lung 1990; 168: 111–5PubMedCrossRefGoogle Scholar
  61. 61.
    Helenius IJ, Tikkanen HO, Haahtela T. Association between type of training and risk of asthma in elite athletes. Thorax 1997; 52: 157–60PubMedCrossRefGoogle Scholar
  62. 62.
    Fitch KD. Management of allergic Olympic athletes. J Allergy Clin Immunol 1984; 73: 722–7PubMedCrossRefGoogle Scholar
  63. 63.
    Kujala UM, Sarna S, Kaprio J, et al. Asthma and other pulmonary diseases in former elite athletes. Thorax 1996; 51: 288–92PubMedCrossRefGoogle Scholar
  64. 64.
    Schoene RB, Giboney K, Schimmel C, et al. Spirometry and airway reactivity in elite track and field athletes. Clin J Sport Med 1997; 7: 257–61PubMedCrossRefGoogle Scholar
  65. 65.
    Feinstein RA, LaRussa J, Wang-Dohlman A, et al. Screening adolescent athletes for exercise-induced asthma. Clin J Sport Med 1996; 6: 119–23PubMedCrossRefGoogle Scholar
  66. 66.
    Seaton A, Godden D, Brown K. Increase in asthma: amore toxic environment or a more susceptible population? Thorax 1994; 49: 171–4PubMedCrossRefGoogle Scholar
  67. 67.
    Burrow B, Martinez F, Halonen M, et al. Association of asthma with serum IgE levels and skin test reactivity to allergens. N Engl J Med 1995; 320: 271–7CrossRefGoogle Scholar
  68. 68.
    Bleecker ER, Postma DS, Meyers DA. Genetic susceptibility to asthma in changing environment. Ciba Found Symp 1997; 206: 90–9PubMedGoogle Scholar
  69. 69.
    Bleecker ER, Postma DS, Meyers DA. Evidence for multiple genetic susceptibility loci for asthma. Am J Respir Crit Care Med 1997; 156 (4 Pt 2): S113-S116Google Scholar
  70. 70.
    Laprise C, Boulet L-P. Airway responsiveness and atopy in families of patients with asthma. Clin Invest Med 1996; 19: 461–9PubMedGoogle Scholar
  71. 71.
    D’amato G. Outdoor air pollution in urban areas and allergic respiratory diseases. Monaldi Arch Chest Dis 1999; 54: 470–4PubMedGoogle Scholar
  72. 72.
    Nicolai T, von Mutius E. Pollution and the development of allergy: the East and West Germany story. Arch Toxicol 1997; 19 Suppl.: 201–6CrossRefGoogle Scholar
  73. 73.
    Glovsky MM, Miguel AG, Cass GR. Particulate air pollution: possible relevance in asthma. Allergy Asthma Proc 1997; 18: 163–6PubMedCrossRefGoogle Scholar
  74. 74.
    Pauli G, Bessot JC, Quoix E. Effect of the environment on the development of respiratory allergies. Rev Pneumol Clin 1989; 45: 231–6PubMedGoogle Scholar
  75. 75.
    Slutsky AS. Lung injury caused by mechanical ventilation. Chest 1999; 116: 9S-15SCrossRefGoogle Scholar
  76. 76.
    Chiumello D, Pristine G, Slutsky AS. Mechanical ventilation affects local and systemic cytokines in an animal model of acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 160: 109–16PubMedGoogle Scholar
  77. 77.
    Larsson K, Tornling G, Gavhed D, et al. Inhalation of cold air increases the number of inflammatory cells in the lungs in healthy subjects. Eur Respir J 1998; 12: 825–30PubMedCrossRefGoogle Scholar
  78. 78.
    Sue-Chu M, Karjalainen E-M, Altraja A, et al. Lymphoid aggregates in endobronchial biopsies from young elite cross-country skiers. Am J Respir Crit Care Med 1998; 158: 597–601PubMedGoogle Scholar
  79. 79.
    Sue-Chu M, Larsson L, Moen T, et al. Bronchoscopy and bronchoalveolar lavage findings in cross-country skiers with and without ‘ski asthma’. Eur Respir J 1999; 13: 626–32PubMedCrossRefGoogle Scholar
  80. 80.
    Karjalainen EM, Laitinen A, Sue-Chu M, et al. Evidence of airway inflammation and remodeling in ski athletes with and without bronchial hyperresponsiveness to methacholine. Am J Respir Crit Care Med 2000; 161: 2086–91PubMedGoogle Scholar
  81. 81.
    Laprise C, Laviolette M, Boutet M, et al. Asymptomatic airway hyperresponsiveness: relationships with airway inflammation and remodeling. Eur Respir J 1999; 14: 63–73PubMedCrossRefGoogle Scholar
  82. 82.
    Omori CB, Schofield BH, Witzner W, et al. Hyperpnea with dry air causes time-dependent alterations in mucosal morphology and bronchovascular permeability. J Applied Physiol 1995; 78: 1043–51Google Scholar
  83. 83.
    Boulet L-P, Turcotte H, Laprise C, et al. Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin Exp Allergy 1997; 27: 52–9PubMedCrossRefGoogle Scholar
  84. 84.
    Warner JO. Bronchial hyperresponsiveness, atopy, airway inflammation, and asthma. Pediatr Allergy Immunol 1998; 9: 56–60PubMedCrossRefGoogle Scholar
  85. 85.
    Nelson HS. The atopic diseases. Ann Allergy 1985; 55: 441–7PubMedGoogle Scholar
  86. 86.
    Kaelin M, Brändli O. Exertional asthma in Swiss top-ranking athletes. Schweiz Med Wochenschr 1993; 123: 174–82PubMedGoogle Scholar
  87. 87.
    Lee TH. Precipitating factors of asthma. Br Med Bull 1992; 48: 169–78PubMedGoogle Scholar
  88. 88.
    Pribyl CR, Racca J. Toxic gas exposures in ice arenas. Clin J Sport Med 1996; 6: 232–6PubMedCrossRefGoogle Scholar
  89. 89.
    Stand V, Rak S, Svartengren M, et al. Nitrogen dioxide exposure enhances asthmatic reaction to inhaled allergen in subjects with asthma. Am J Respir Crit Care Med 1997; 155: 881–7Google Scholar
  90. 90.
    Holmén A, Blomqvist J, Frindberg H, et al. Frequency of patients with acute asthma in relation to ozone, nitrogen dioxide, other pollutants of ambient air and meteorological observations. Int Arch Occup Environ Health 1997; 69: 317–22PubMedCrossRefGoogle Scholar
  91. 91.
    Peden DB. Mechanisms of pollution-induced airway disease: in vivo studies. Allergy 1997; 52: 37–44PubMedCrossRefGoogle Scholar
  92. 92.
    Folinsbee LJ, Bedi JF, Horvath SM. Pulmonary function changes after 1 hour continuous heavy exercise in 0.21 ppm ozone. J Appl Physiol 1984; 57: 984–8PubMedGoogle Scholar
  93. 93.
    Linn WS, Venet TG, Shamoo DA, et al. Respiratory effects of sulphur dioxide in heavily exercising asthmatics. Am Rev Respir Dis 1983; 127: 278–83PubMedGoogle Scholar
  94. 94.
    Ball BA, Folinsbee LJ, Peden DB, et al. Allergen bronchoprovocation of patients with mild allergic asthma after ozone exposure. J Allergy Clin Immunol 1996; 98: 563–72PubMedCrossRefGoogle Scholar
  95. 95.
    Gong Jr H, McManus MS, Linn WS. Attenuated response to repeated daily ozone exposures in asthmatic subjects. Arch Environ Health 1997; 52: 34–41PubMedCrossRefGoogle Scholar
  96. 96.
    Barnes PJ. Air pollution and asthma. Postgrad Med 1994; 70: 319–25CrossRefGoogle Scholar
  97. 97.
    Molfino NA, Slutsky AS, Zamel N. The effects of air pollution on allergic bronchial responsiveness. Clin Exp Allergy 1992; 22: 667–72PubMedCrossRefGoogle Scholar
  98. 98.
    Pennanen AS, Salonen RO, Alm S, et al. Characterization of air quality problems in five Finnish indoor ice arenas. J Air Waste Manag Assoc 1997; 47: 1079–86PubMedCrossRefGoogle Scholar
  99. 99.
    Hedberg K, Hedberg CW, Iber C, et al. An outbreak of nitrogen dioxide-induced respiratory illness among ice hockey players. JAMA 1989; 262: 3014–7PubMedCrossRefGoogle Scholar
  100. 100.
    Bundgaard A, Ingemann Hansen T, Schmidt A, et al. Influence of temperature and relative humidity of inhaled gas on exercise- induced asthma. Eur J Respir Dis 1982; 63: 239–44PubMedGoogle Scholar
  101. 101.
    Drobnic F, Freixa A, Casan P, et al. Assessment of chlorine exposure in swimmers during training. Med Sci Sports Exerc 1996; 28: 271–4PubMedCrossRefGoogle Scholar
  102. 102.
    Georgitis JW. The 1997 Asthma Management Guidelines and therapeutic issues relating to the treatment of asthma. National Heart, Lung, and Blood Institute. Chest 1999; 115: 210–7PubMedCrossRefGoogle Scholar
  103. 103.
    Nieman DC. Upper respiratory tract infections and exercise. Thorax 1995; 50: 1229–31PubMedCrossRefGoogle Scholar
  104. 104.
    Shephard RJ, Rhind S, Shek PN. Exercise and the immune system. Sports Med 1994; 18: 340–69PubMedCrossRefGoogle Scholar
  105. 105.
    Camus G, Dupont-Deby G, Duchateau J, et al. Are similar inflammatory factors involved in strenuous exercise and sepsis? Int Care Med 1994; 20: 602–10CrossRefGoogle Scholar
  106. 106.
    Smith JA. Exercise immunology and neutrophils. Int J Sports Med 1997; 18 Suppl. 1: S46-S55CrossRefGoogle Scholar
  107. 107.
    Shepard RJ, Shek PN. Impact of physical activity and sport on the immune system. Rev Environ Health 1996; 11: 133–47PubMedGoogle Scholar
  108. 108.
    Tvede N, Kappel M, Halkjoer-Kristensen J, et al. The effect of light, moderate and severe bicycle exercise on lymphocyte subsets, natural and lymphokine activated killers cells, lymphocyte proliferative response and interleukin 2 production. Int J Sports Med 1993; 14: 275–82PubMedCrossRefGoogle Scholar
  109. 109.
    Kohut ML, Davis JM, Jackson DA, et al. The role of stress hormones in exercise-induced suppression of alveolar macrophage antiviral function. J Neuroimmunol 1998; 81: 193–200PubMedCrossRefGoogle Scholar
  110. 110.
    Pedersen BK, Rohde T, ZachoM. Immunity in athletes. J Sports Med Phys Fitness 1996; 36: 236–45PubMedGoogle Scholar
  111. 111.
    Mackinnon LT. Immunity in athletes. Int J Sports Med 1997; 18 Suppl. 1: S62-S68CrossRefGoogle Scholar
  112. 112.
    Nieman DC. Immune response to heavy exertion. J Appl Physiol 1997; 82: 1385–94PubMedGoogle Scholar
  113. 113.
    Davis JM, Kohut ML, Colbert LH, et al. Exercise, alveolar macrophage function, and susceptibility to respiratory infection. J Appl Physiol 1997; 83: 1461–6PubMedGoogle Scholar
  114. 114.
    Mackinnon LT, Hopper S. Mucosal (secretory) immune system responses to exercise of varying intensity and during overtraining. Int J Sports Med 1994; 15 Suppl. 3: S179-S183CrossRefGoogle Scholar
  115. 115.
    Heir T, Aanestad G, Carlsen KH, et al. Respiratory tract infection and bronchial responsiveness in elite athletes and sedentary control subjects. Scand J Med Sci Sports 1995; 5: 94–9PubMedCrossRefGoogle Scholar
  116. 116.
    Barnes PJ. Cholinergic control of airway smooth muscle. Am Rev Respir Dis 1987; 136 (4 Pt 2): S42-S45Google Scholar
  117. 117.
    Laitinen LA, Laitinen A. Innervation of airway smooth muscle. Am Rev Respir Dis 1987; 136 (4 Pt 2): S38-S42Google Scholar
  118. 118.
    Barnes PJ. Neural control of human airway in health and disease. Am Rev Respir Dis 1986; 134: 1289–314PubMedGoogle Scholar
  119. 119.
    Kallenbach JM, Webster T, Dowdeswell R, et al. Reflex heart rate control in asthma: evidence of parasympathetic activity. Chest 1985; 5: 644–8CrossRefGoogle Scholar
  120. 120.
    Finnerty JP, Holgate ST. The contribution of histamine release and vagal reflexes, alone and in combination, to exercise-induced asthma. Eur Respir J 1993; 6: 1132–7PubMedGoogle Scholar
  121. 121.
    Eckberg DL. Human sinus arrhythmia as an index of vagal cardiac outflow. J Appl Physiol 1983; 54: 961–6PubMedGoogle Scholar
  122. 122.
    Goldsmith RL, Bigger Jr JT, Steinman RC, et al. Comparison of 24-hour parasympathetic activity in endurance-trained and untrained young men. J Am Coll Cardiol 1992; 20: 552–8PubMedCrossRefGoogle Scholar
  123. 123.
    De Meersman RE. Respiratory sinus arrhythmia alteration following training in endurance athletes. Eur J Appl Physiol 1992; 64: 434–6CrossRefGoogle Scholar
  124. 124.
    McDonald DM. Neurogenic inflammation in the respiratory tract: action of sensory nerve mediators on blood vessels and epithelium of the airway mucosa. Am Rev Respir Dis 1987; 136 (6 Pt 2): S65-S72Google Scholar
  125. 125.
    Shi X, Stevens GH, Foresman BH, et al. Autonomic nervous system control of the heart: endurance exercise training. Med Sci Sports Exerc 1995; 10: 1406–13Google Scholar
  126. 126.
    Nolan J, Flapan AD, Reid J, et al. Cardiac parasympathetic activity in severe uncomplicated coronary artery disease. Br Heart J 1994; 71: 515–20PubMedCrossRefGoogle Scholar
  127. 127.
    Stearns DR, McFadden Jr ER, Breslin FJ, et al. Reanalysis of the refractory period in exertional dyspnea. J Appl Physiol 1981; 50: 503–8PubMedGoogle Scholar
  128. 128.
    Zaagsma J, Van Aalderen WMC, Brouwer F, et al. Adrenergic control of airway function. Am Rev Respir Dis 1987; 136 (4 Pt 2): S45-S50Google Scholar
  129. 129.
    Berkin KG, Inglis GC, Ball SG, et al. Airway responses to low concentrations of adrenaline in normal subjects. QJ Exp Physiol 1985; 70: 203–9Google Scholar
  130. 130.
    Cryer PE. Physiology and pathophysiology of the human sympathoadrenal neuroendocrine system. N Engl J Med 1980; 303: 436–44PubMedCrossRefGoogle Scholar
  131. 131.
    Warren JB, Dalton N. A comparison of the bronchodilator and vasopressor effects of exercise levels of adrenaline in man. Clin Sci 1983; 64: 475–9PubMedGoogle Scholar
  132. 132.
    Lehmann M, Dickhuth HH, Gendrisch F, et al. Training Overtraining: a prospective, experimental study with experienced middle- and long-distance runners. Int J Sports Med 1991; 12: 444–52PubMedCrossRefGoogle Scholar
  133. 133.
    Barnes PJ, FitzGerald GA, Dollery CT. Circadian variation in adrenergic responses in asthmatic subjects. Clin Sci 1982; 62: 349–54PubMedGoogle Scholar
  134. 134.
    Dela F, Mikines KJ, Von Linstow M, et al. Heart rate and plasma catecholamines during 24h of everyday life in trained and untrained men. J Appl Physiol 1992; 73: 2389–95PubMedGoogle Scholar
  135. 135.
    Pestell RG, Hurley DM, Vandongen R. Biochemical and hormonal changes during a 1000 km ultramarathon. Clin Exp Pharmacol Physiol 1989; 16: 353–61PubMedCrossRefGoogle Scholar
  136. 136.
    Dosani R, Van Loon GR, Burki NK. The relationship between exercise-induced asthma and plasma catecholamines. Am Rev Respir Dis 1987; 136: 973–8PubMedCrossRefGoogle Scholar
  137. 137.
    Larsson K, Bevegard S, Mossberg B. Posture-induced airflow limitation in asthma: relationship to plasma catecholamines and an inhaled anticholinergic agent. Eur Respir J 1988; 1: 458–63PubMedGoogle Scholar
  138. 138.
    Larsson K, Carlens P, Bevegard S, et al. Sympathoadrenal responses to bronchoconstriction in asthma: an invasive and kinetic study of plasma catecholamines. Clin Sci 1995; 88: 439–46PubMedGoogle Scholar
  139. 139.
    Kyle JM, Walker RB, Hanshaw SL, et al. Exercise-induced bronchospasm in the young athlete: guidelines for routine screening and initial management. Med Sci Sports Exerc 1992; 24: 856–9PubMedGoogle Scholar
  140. 140.
    Enright T. Exercise-induced asthma and the asthmatic athlete. Wis Med J 1996; 95: 375–8PubMedGoogle Scholar
  141. 141.
    McKenzie DC, McLuckie SL, Stirling DR. The protective effects of continuous and interval exercise in athletes with exercise-induced asthma. Med Sci Sports Exerc 1994; 26: 951–6PubMedGoogle Scholar
  142. 142.
    Todaro A. Exercise-induced bronchodilatation in asthmatic athletes. J Sports Med Phys Fitness 1996; 36: 60–6PubMedGoogle Scholar
  143. 143.
    Kemp JP, Dockhorn RJ, Busse WW, et al. Prolonged effect of inhaled salmeterol against exercise-induced bronchospasm. Am J Respir Crit Care Med 1994; 150: 1612–5PubMedGoogle Scholar
  144. 144.
    Nelson JA, Strauss L, Skowrondki M, et al. Effect of long-term salmeterol treatment on exercise-induced asthma. N Engl J Med 1998; 339: 141–6PubMedCrossRefGoogle Scholar
  145. 145.
    Ramage L, Lipworth BJ, Ingram CG, et al. Reduced protection against exercise induced bronchoconstriction after chronic dosing with salmeterol. Respir Med 1994; 8: 363–8CrossRefGoogle Scholar
  146. 146.
    Simons FE, Gerstner TV, Cheang MS. Tolerance to the bronchoprotective effect of salmeterol in adolescents with exercise-induced asthma using concurrent inhaled glucocorticoid treatment. Pediatrics 1997; 99: 655–9PubMedCrossRefGoogle Scholar
  147. 147.
    Henriksen JM, Dahl R. Effects of inhaled budesonide alone and in combination with low-dose terbutaline in children with exercise-induced asthma. Am Rev Respir Dis 1983; 128: 993–7PubMedGoogle Scholar
  148. 148.
    Waalkens HJ, van Essen Zandvliet EE, Gerritsen J, et al. The effect of an inhaled corticosteroid (budesonide) on exercise-induced asthma in children. Dutch CNSLD Study Group. Eur Respir J 1993; 6: 652–6PubMedGoogle Scholar
  149. 149.
    Larsson K, Gavhed D, Larsson L, et al. Influence of a beta-2- agonist on physical performance at low temperature in elite athletes. Med Sci Sports Exerc 1997; 29: 1631–6PubMedCrossRefGoogle Scholar
  150. 150.
    Ienna TM, McKenzie DC. The asthmatic athlete: metabolic and ventilatory responses to exercise with and without pre-exercise medication. Int J Sports Med 1997; 18: 142–8PubMedCrossRefGoogle Scholar
  151. 151.
    Heir T, Stemshaug H. Salbutamol and high-intensity treadmill running in nonasthmatic highly conditioned athletes. Scand J Med Sci Sports 1995; 5: 231–6PubMedCrossRefGoogle Scholar
  152. 152.
    Carlsen KH, Ingjer F, Kirkegaard H, et al. The effect of inhaled salbutamol and salmeterol on lung function and endurance performance in healthy well-trained athletes. Scand J Med Sci Sports 1997; 7: 160–5PubMedCrossRefGoogle Scholar
  153. 153.
    Fleck SJ, Lucia A, Storms WW, et al. Effects of acute inhalation of albuterol on submaximal and maximal VȮ2 and blood lactate. Int J Sports Med 1993; 14: 239–43PubMedCrossRefGoogle Scholar
  154. 154.
    McDowell SL, Fleck SJ, Storms WW. The effects of salmeterol on power output in nonasthmatic athletes. J Allergy Clin Immunol 1997; 99: 443–9PubMedCrossRefGoogle Scholar
  155. 155.
    Freeman W, Javaid A, Cayton RM. The effect of ipratropium bromide on maximal exercise capacity in asthmatic and nonasthmatic men. Respir Med 1992; 86: 151–5PubMedCrossRefGoogle Scholar
  156. 156.
    Laitinen LA, Altraja A, Karjalainen E-M, et al. Early interventions in asthma with inhaled corticosteroids. J Allergy Clin Immunol 2000; 105 (2 Pt 2): S582-S585CrossRefGoogle Scholar
  157. 157.
    Nathan RA. Anti-leukotriene agents: a new direction in asthma therapy. J Asthma 1996; 33: 353–66PubMedCrossRefGoogle Scholar
  158. 158.
    Diamant Z, Bel EH, Dekhuijzen PN. Anti-leukotriene therapy in asthma. Neth J Med 1998; 53: 176–89PubMedCrossRefGoogle Scholar
  159. 159.
    Edelman JM, Turpin JA, Bronsky EA, et al. Oral Montelukast comparedwith inhaled salmeterol to prevent exercise-induced bronchoconstriction. Ann Intern Med 2000; 132: 97–104PubMedGoogle Scholar
  160. 160.
    Leff JA, Busse WW, Pearlman DS, et al. Montelukast, a leukotriene-receptor antagonist, for the treatment of mild asthma and exercise-induced bronchoconstriction. N Engl J Med 1998; 339: 147–52PubMedCrossRefGoogle Scholar
  161. 161.
    Dessanges JF, Préfaut C, Taytard A, et al. The effect of zafirlukast on repetitive exercise-induced bronchoconstriction: the possible role of leukotrienes in exercise-induced refractoriness. J Allergy Clin Immunol 1999; 104: 1155–61PubMedCrossRefGoogle Scholar
  162. 162.
    Busse WW. Asthma. N Engl J Med 2001; 344: 350–62PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • Jean-Bruno Langdeau
    • 1
  • Louis-Philippe Boulet
    • 1
  1. 1.Hôpital LavalLaval University Cardiothoracic InstituteSainte-FoyCanada

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