International SportMed Journal - Volume 3, Issue 2, 2002
Volume 3, Issue 2, 2002
Source: International SportMed Journal 3, pp 1 –9 (2002)More Less
Exercise-induced bronchoconstriction (EIB) is the transient narrowing of the airways that follows strenuous exercise. The prevalence of EIB varies from 4-20% in the general population, to 40-90% in otherwise asthmatic subjects. The initial mechanism inducing EIB is not completely understood but evidence supports an inflammatory process. Although a suspected diagnosis of EIB can be based on self-reported symptoms, an exercise challenge test is recommended to assess a positive functional response to exercise (a fall in FEV1). The primary aim of therapy for EIB is prophylactic. EIB may be prevented in the majority of patients by administering a short-acting β2-adrenergic agonist (salbutamol or terbutaline) or a cromone, either singly or in combination, immediately before exercise. Because the main limitation of these drugs is the short duration of their protective effect, extended periods of exercise require additional doses, or a long acting beta2-agonist (salmeterol or formoterol). Inhaled corticosteroids and antileukotriene drugs have demonstrated their effectiveness in preventing EIB and can be used for that purpose, especially in cases of patients exhibiting symptoms more than twice a week. Since individual variations in the response to these drugs are reported, tests with either modality of treatment could be useful before a definitive long-term therapy is chosen for each patient.
Source: International SportMed Journal 3, pp 1 –9 (2002)More Less
Exercise-induced asthma or exercise-induced bronchoconstriction (EIB) are synonymous terms used to describe a reversible airway disease and refer to the post-exercise decrement in airway function, characterised by airway narrowing and increased airway resistance, which can lead to symptoms of cough, wheezing and/or chest tightness after exercise. Epidemiological evidence with limited experimental data has linked high dietary salt consumption to increasing severity of asthma. Recently, a series of interventional studies have demonstrated that a high salt diet (HSD) worsens and a low salt diet (LSD) improves post-exercise pulmonary function in subjects with EIB. Furthermore, it is possible that both the sodium and chloride ions in salt contribute to the worsening of EIB symptoms after consuming a normal salt diet or HSD. These studies have demonstrated that a LSD reduces the severity of EIB to below the diagnostic limit of a 10% post-exercise fall in FEV1. Athletes can employ a LSD as a potential beneficial therapy for reducing the severity of their EIB. It is not known if a LSD will reduce reliance on pharmacological intervention, thus decreasing reliance on the medications on the IOC banned list, but it is one potential benefit.
Author Unnur S. BjornsdottirSource: International SportMed Journal 3, pp 1 –4 (2002)More Less
Exercise-induced laryngeal prolapse (EILP) is an important differential in the diagnosis of exercise-induced asthma (EIA). This phenomenon has been found in otherwise healthy athletes, where extreme exertion and inspiratory forces cause the aryepiglottic folds to billow into the endolarynx, resulting in subtotal glottic obstruction. Evidence of variable extra-thoracic obstruction is seen on flow-volume loop spirometry. On fibre-optic rhinolaryngoscopy during exercise, oedema with collapse and prolapse of the aryepiglottic folds is noted. These changes coincide with the onset of symptoms and resolve when the degree of exercise is decreased. Patients referred with resistant EIA should undergo specialized laryngeal examinations. EILP can be treated successfully with laser laryngoplasty.
Source: International SportMed Journal 3, pp 1 –10 (2002)More Less
The prevalence of exercise-induced bronchospasm among non-asthmatic individuals is around 10-15%. Although most asthmatics are at risk of suffering exercise-induced bronchospasm, depending on the degree of control of their disease and the amount of exercise they perform, there seems to be an independent clinical entity, namely, exercise-induced asthma, in individuals with otherwise normal lung function. Exercise-induced bronchospasm occurs with the release of cell mediators in response to a hyperosmolar environment, secondary to the loss of water produced on the surface of the bronchii, brought about by the need for humidifying the inspired air. Long-acting beta2-agonists are probably the drugs of choice when exercising sporadically. Antileukotrienes are probably a better option for children and athletes exercising several times daily.
Source: International SportMed Journal 3, pp 1 –8 (2002)More Less
Physical allergy encompasses a spectrum of illness ranging from simple urticaria to exercise-induced anaphylaxis (EIA), which can include vascular and respiratory collapse. A temporal relationship of exercise to allergic triggers, including certain foods and medications, has been demonstrated with EIA. Pathophysiologic evidence demonstrates commonalities with other forms of allergy. While specific diagnostic tests exist to assist in diagnosing EIA, a thorough history often proves most useful. Treatment options include various pharmacologic agents, although interventions aimed at prevention will likely prove to be more beneficial.
Author Constance H. KatelarisSource: International SportMed Journal 3, pp 1 –5 (2002)More Less
Allergic skin conditions are very common, and their presence in athletes may pose particular challenges in management. Some of these conditions may be worsened by factors accompanying exercise, such as increased body heat and sweating, whereas others may only be triggered in the performance of exercise. Physical urticaria is an example of the latter category. Physical urticarias share the common feature of being induced by environmental factors, such as change in temperature, or by direct stimulation of the skin, through pressure, vibration, light and stroking. Atopic dermatitis is a common condition, increasing in prevalence and typically affecting children and adolescents. For the athlete with atopic dermatitis there are special considerations. The disease itself, when moderate to severe, can have a significant impact on performance because of its impact on psychological well-being and the frequency of sleep deprivation caused by pronounced itching and scratching at night. By the nature of many sporting activities there is the increased likelihood of sweating, water loss and raised skin temperature, all of which can lead to the exacerbation of the underlying condition.
Allergic contact dermatitis is a common skin problem caused by a delayed type, hypersensitivity response to a relevant substance, usually a chemical that acts as a hapten. The individual with allergic contact dermatitis will present with a dermatitis localised to the site of contact. Common contactants of particular relevance to the athlete include nickel and rubber accelerators.
Management of the athlete with chronic allergic skin disease requires a sound approach to diagnosis, clear education regarding the problem, sensible advice regarding simple avoidance strategies, maintenance of optimal control of the underlying condition, and the judicious use of non-sedating antihistamines.