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Physical exercise requires proper function of the upper and lower airways in order to meet exertional ventilatory requirements. Athletes performing frequent intensive exercise experience more sino-nasal symptoms and demonstrate objective decreases in sino-nasal function when compared with the general population. Sino-nasal dysfunction is known to interfere with sport performance. Nasal epithelial injury, neutrophilic influx, and decreased mucociliary clearance have been associated with intensive training. In this review, the authors provide a comprehensive overview of the prevalence of sino-nasal disease in athletes, the possible underlying pathophysiologic mechanisms, and a summary of diagnostic and treatment options., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Keywords: AQUA questionnaire; athletes; atopy; FeNO EN AQUA questionnaire athletes atopy FeNO 1 5 5 03/30/23 20230301 NES 230301 Allergic sensitization and allergic diseases have been reported to have a high prevalence in athletes.[[1]] Moreover, atopy has been significantly associated with bronchial hyperreactivity and exercise-induced bronchoconstriction in elite athletes.[[3]] Sensitization to allergens is generally determined by a skin prick test (SPT) and/or allergen-specific serum IgE analysis.[5] Recently, the Allergy Questionnaire for Athletes (AQUA©),[6] a screening tool to predict atopy in elite adult athletes, was validated for screening of atopy in young elite athletes.[7] This screening tool may help with the early identification of atopy, which may burden the physical performances, and is especially helpful in young elite athletes.[5] Increased fractional exhaled NO (FeNO) levels are, considered to be an effective, noninvasive tool to assess the presence of eosinophilic airway inflammation and as tool to diagnose childhood asthma.[[8], [10]] This has also been correlated with allergic sensitization.[11] Therefore, we hypothesize that measuring FeNO levels may also be a useful noninvasive method to predict atopy in this population. The AUC of FeNO increased from 0.765 ( I p i < .0001) to 0.814 ( I p i < .0001) if we considered multiple sensitizations (participants with >=2 positive SPTs; Figure 1C), suggesting that FeNO levels might be a useful indicator for multiple sensitizations within atopic athletes. Can AQUA© questionnaire and FeNO predict atopy in early-career athletes? (C) ROC curve indicating the sensitivity and specificity of AQUA© (left) and FeNO (right) to predict atopy and multiple sensitizations (for FeNO). [Extracted from the article]

Adequate nasal breathing is indispensable for athletes, and nasal symptoms have been shown to interfere with their subjective feeling of comfortable breathing and quality of life. Nasal symptoms are caused by either structural abnormalities or mucosal pathology. Structural pathologies are managed differently from mucosal disease, and therefore, adequate diagnosis is of utmost importance in athletes in order to choose the correct treatment option for the individual. Literature suggests that nasal symptoms are more prevalent in athletes compared to the general population and certain sports environments might even trigger the development of symptoms. Given the high demands of respiratory function in athletes, insight into triggering factors is of high importance for disease prevention. Also, it has been suggested that athletes are more neglectful to their symptoms and hence remain undertreated, meaning that special attention should be paid to education of athletes and their caregivers. This review aims at giving an overview of nasal physiology in exercise as well as the possible types of nasal pathology. Additionally, diagnostic and treatment options are discussed and we focus on unmet needs for the management and prevention of these symptoms in athletes within the concept of precision medicine. [ABSTRACT FROM AUTHOR]