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International audience; An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.

Background In 2000, the Liaison Committee on Medical Education required that all medical schools provide experiential training in end-of-life care. To adhere to this mandate and advance the professional development of medical students, experiential training in communication skills at the end-of-life was introduced into the third-year surgical clerkship curriculum at Wright State University Boonshoft School of Medicine. Materials and methods In the 2007–08 academic year, 97 third-year medical students completed six standardized end-of-life care patient scenarios commonly encountered during the third-year surgical clerkship. Goals and objectives were outlined for each scenario, and attending surgeons graded student performances and provided formative feedback. Results All 97 students, 57.7% female and average age 25.6 ± 2.04 y, had passing scores on the scenarios: (1) Adult Hospice, (2) Pediatric Hospice, (3) Do Not Resuscitate, (4) Dyspnea Management/Informed Consent, (5) Treatment Goals and Prognosis, and (6) Family Conference. Scenario scores did not differ by gender or age, but students completing the clerkship in the first half of the year scored higher on total score for the six scenarios (92.8% ± 4.8% versus 90.5% ± 5.0%, P = 0.024). Conclusions Early training in end-of-life communication is feasible during the surgical clerkship in the third-year of medical school. Of all the scenarios, “Conducting a Family Conference” proved to be the most challenging.

A higher prevalence of airway hyperresponsiveness, airway remodeling, and asthma has been identified among athletes who compete and train in environmental conditions of cold dry air and/or high air pollution. Repeated long-duration exposure to cold/dry air at high minute ventilation rates can cause airway damage. Competition or training at venues close to busy roadways, or in indoor ice arenas or chlorinated swimming pools, harbors a risk for acute and chronic airway disorders from high pollutant exposure. This article discusses the effects of these harsh environments on the airways, and summarizes potential mechanisms and prevalence of airway disorders in elite athletes.

Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma.To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB and to develop evidence-based guidelines for the diagnosis and treatment of EIB. The evidence was appraised and recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach.Recommendations for the treatment of EIB were developed. The quality of evidence supporting the recommendations was variable, ranging from low to high. A strong recommendation was made for using a short-acting β(2)-agonist before exercise in all patients with EIB. For patients who continue to have symptoms of EIB despite the administration of a short-acting β(2)-agonist before exercise, strong recommendations were made for a daily inhaled corticosteroid, a daily leukotriene receptor antagonist, or a mast cell stabilizing agent before exercise.The recommendations in this Guideline reflect the currently available evidence. New clinical research data will necessitate a revision and update in the future.

Exercise in children has important health benefits. However, in elite endurance athletes, there is an increased prevalence of exercise-induced bronchoconstriction and airway inflammation. Particularly at risk are those who practice in cold weather, ice rinks, swimming pools, and air pollution. The inflammation is caused by repetitive episodes of hyperventilation of cold, dry air, allergens, or toxins such as chlorine or air pollution. Children may be particularly at risk for lung injury under these conditions because of the immaturity and ongoing development of their lung. However, studies in pediatric athletes and exercising young children are sparse. Epithelial injury associated with hyperventilation of cold, dry air has not been described in children. However, exercise in the presence of air pollution and chlorine is associated with airway injury and the development of asthma in children; the effect appears to be modulated by both atopy and genetic polymorphisms. While management of exercise-induced bronchoconstriction and asthma is well established, there is little data to guide treatment or prevention of remodeling in athletes or inhalational lung injury in children. Studies underscore the need to maintain high levels of air quality. More investigations should be undertaken to better define the natural history, pathophysiology, and treatment of exercise-induced pulmonary inflammation in both elite athletes and exercising children.

Internal combustion engines are a major source of particulate matter (PM) which has been shown to result in vasoconstriction, yet no present study to our knowledge has investigated the effect of exhaust emissions on both exercise performance and the vasculature.To examine the effect of freshly generated whole exhaust on exercise performance, pulmonary arterial pressure (PP), and flow-mediated vasodilation (FMD) of the brachial artery.Sixteen male, collegiate athletes (age: 20.8±1.28 years) were randomly assigned to submaximal exercise for 20 min followed by a 6 min maximal work accumulation exercise test in either high PM (HPM) or low PM (LPM) conditions on two consecutive days. After a 7-day washout period, subjects completed identical exercise trials in the alternate condition. HPM conditions were generated from a 4-cycle gasoline engine. The participants' PP and FMD were assessed before and after each exercise trial by tricuspid regurgitant velocity and brachial artery imaging, respectively.Total work (LPM: 108.0±14.8 kJ; HPM: 104.9±15.2 kJ, p=0.019) and FMD (LPM: 8.17±6.41%; HPM: 6.59±2.53%; p=0.034) significantly decreased in HPM while PP was significantly increased (LPM: 16.9±1.13 mmHg; HPM: 17.9±1.70 mmHg; p=0.004). A significant correlation was identified between the change in exercise performance and the change in FMD (r=0.494; p=0.026) after the first HPM trial.Exercise performance declined in HPM conditions in part due to impaired vasodilation in the peripheral vasculature.

Asthma is common in many types of athletes, but its prevalence appears to be particularly high in swimmers. Long-term and acute exposure to swimming pool disinfectants has been shown to increase asthma risk in swimmers through inducing oxidative stress, which results in inflammation of the pulmonary epithelium and subsequent airway remodeling. Individuals with specific genotypes are more likely to develop asthma when exposed to inhaled irritants. Therefore, it is important for physicians to be knowledgeable about the risks associated with asthma in swimmers, as well as the diagnostic techniques and practices to reduce asthma symptoms.

Chief Editors: John M. Weiler, MD, MBA, President, CompleWare Corporation, Professor Emeritus, University of Iowa, Iowa City, Iowa; Sandra D. Anderson, PhD, DSc, Clinical Professor, Sydney Medical School, Royal Prince Alfred Hospital, Department of Respiratory and Sleep Medicine, Camperdown NSW 2050, Australia; Christopher Randolph, MD, Clinical Professor of Pediatrics, Yale Affiliated Programs, Waterbury Hospital, Center for Allergy, Asthma and Immunology, Waterbury, Connecticut

The purpose of this study was to examine the effects of level vs. graded skate skiing on capillary blood lactate (B(La)), heart rate (HR), oxygen consumption (V(O2)), and training intensity prescriptions. Eleven Nordic skiers completed 2 submaximal skate roller skiing treadmill protocols during which intensity was increased either by grade (G(inc)) or by speed (S(inc)). The protocols were compared for prethreshold BLa, HR, and V(O2) at lactate threshold (LT) and the HR/V(O2) relationship. Additionally, double-pole (primarily upper body) and skating (arms and legs combined) protocols were used to measure peak V(O2) and peak HR. Heart rate and V(O2) at LT were lower during G(inc) compared with S(inc) (154.9 +/- 6.8 b.min(-1) vs. 162.0 +/- 9.1 b.min(-1) and 46.3 +/- 2.8 ml.kg(-1).min(-1) vs. 49.1 +/- 1.6 ml.kg(-1).min(-1), respectively, both p < 0.01). Pre-threshold B(La) and the HR/V(O2) relationship were not different between the submaximal protocols. V(O2) and HRpeak were higher in skating compared with double poling (64.6 +/- 1.8 ml.kg(-1).min(-1) vs. 60.3 +/- 2.8 ml.kg(-1).min(-1), 192.6 +/- 5.8 b.min(-1) vs. 187.8 +/- 6.7 b.min(-1), respectively, both p < 0.01). Greater reliance on upper-body musculature during graded skiing and its associated lower aerobic capacity increases B(La) when compared with level skiing. The leftward shift in the B(La) vs. intensity curve during uphill skiing should be recognized to properly prescribe training intensity as well as interpret laboratory results.

The purpose of this study was to investigate effects of PM1 (particulate matter with aerodynamic diameter 0.02-2 microm) inhalation on exercise performance in healthy subjects. Inhalation of internal combustion-derived PM is associated with adverse effects to the pulmonary and muscle microcirculation. No data are available concerning air pollution and exercise performance. Fifteen healthy college-aged males performed 4 maximal effort 6-min cycle ergometer trials while breathing low or high PM1 to achieve maximal work accumulation (kJ). Low PM1 inhalation trials 1 and 2 were separated by 3 days; then after a 7 day washout, trials 3 and 4 (separated by 3 days) were done while breathing high PM1 generated from a gasoline engine; CO was kept below 10 ppm. Lung function was done after trial 1 to verify nonasthmatic status. Lung function was normal before and after low PM1 exercise. PM1 number counts were not different between high PM1 trials (336,730 +/- 149,206 and 396,200 +/- 82,564 for trial 3 and 4, respectively) and were different from low PM1 trial number counts (2,260 +/- 500) (P < 0.0001). Mean heart rate was not different between trials (189 +/- 6.0, 188 +/- 7.6, 188 +/- 7.6, 187 +/- 7.4, for low and high PM1 trials; respectively). Work accumulated was not different between low PM1 trials (96.1 +/- 9.38 versus 96.6 +/- 10.83 kJ) and the first high PM1 trial (trial 3, 96.8 +/- 10.65 kJ). Work accumulated in the second high PM1 trial 4, 91.3 +/- 10.04 kJ) was less than in low PM1 trials 1 and 2, and high PM1 trial 3 (P = 0.004, P = 0.003, P = 0.0008; respectively). Acute inhalation of high (PM1) typical of many urban environments could impair exercise performance.

Purpose: The prevalence of allergy and asthma symptoms and asthma medication use, which has been extensively studied in elite athletes, has received little attention in recreational roadrunners. Methods: A validated questionnaire was used to determine the prevalence of allergy and asthma symptoms, the use of medication, and allergy specialty attention among recreational roadrunners. Comparison with the published prevalence of allergy and asthma symptoms in Olympic athletes was made. Results: The prevalence of allergy and asthma symptoms were similar in two consecutive yearly surveys (2003, 2004). The response from 2004 was 11% (484 of 4398 runners). The study population was 60% male, 56% Caucasian, 10% non-Caucasian, and 34% undesignated. Subjects competed for 13.2 ± 10.5 yr. Prevalence was 44% for symptoms of allergy, 31% for asthma, and 21% for both. Of those reporting allergy symptoms alone, 0.5% had prescription medications or medication before the race. Those with asthma and allergy or asthma alone were more likely to have prescription medication (allergy and asthma, 32%, P = 0.0001; asthma, 6%, P = 0.001), to take medication before the race (asthma and allergy, 27%, P = 0.0001; asthma, 5%, P = 0.007), or to seek specialty attention and medication (asthma and allergy, 39%, P = 0.0001; asthma, 7%, P = 0.004) than those with allergy symptoms alone. The comparison with results from a survey of Olympic athletes indicates that symptoms of allergy and asthma were more prevalent in recreational athletes (P = 0.0001 to 0.007), but roadrunners were less likely to be taking prescription medication (P = 0.025). Conclusion: These results suggest that the recreational roadrunner is more likely to report symptoms of allergy and/or asthma but less likely to have prescription medication than the Olympic athlete.

Airway responses were compared following 6-minute eucapnic voluntary hyperventilation and 6-minute exercise challenges by examining resting and post-challenge impulse oscillometry and spirometry variables. Twenty-two physically active individuals with probable exercise-induced bronchoconstriction took part in this study. Impulse oscillometry and spirometry were performed at baseline and for 20 minutes post-challenge at 5-minute intervals. High correlation was found between the two measures of change in airway function for both methods of challenge. Impulse oscillometry detected a difference in degree of response to the challenges, whereas spirometry indicated no difference, suggesting that impulse oscillometry is a more sensitive measure of change in airway function.

Study objective The efficacy of using impulse oscillometry (IOS) as an indirect measure of airflow obstruction compared to spirometry after exercise challenges in the evaluation of exercise-induced bronchoconstriction (EIB) has not been fully appreciated. The objective was to compare airway responses following room temperature and cold temperature exercise challenges, and to compare whether IOS variables relate to spirometry variables. Design Spirometry and IOS were performed at baseline and for 20 min after challenge at 5-min intervals. Setting Two 6-min exercise challenges, inhaling either room temperature (22.0°C) or cold temperature (− 1°C) dry medical-grade bottled air. At least 48 h was observed between these randomly assigned challenges. Participants Twenty-two physically active individuals (12 women and 10 men) with probable EIB. Interventions Subjects performed 6 min of stationary cycle ergometry while breathing either cold or room temperature medical-grade dry bottled air. Subjects were instructed to exercise at the highest intensity sustainable for the duration of the challenge. Heart rate and kilojoules of work performed were documented to verify exercise intensity. Measurements and results Strong correlations were observed within testing modalities for post-room temperature and post-cold temperature exercise spirometry and IOS values. Spirometry revealed no differences in postexercise peak falls in lung function between conditions; however, IOS identified significant differences in respiratory resistance (p Conclusions Correlations were found between spirometric and IOS measures of change in airway function for both exercise challenges, indicating close equivalency of the methods. The challenges appeared to elicit the EIB response by a similar mechanism of water loss, and cold temperature did not have an additive effect. IOS detected a difference in degree of response between the temperatures, whereas spirometry indicated no difference, suggesting that IOS is a more sensitive measure of change in airway function.

Ten intercollegiate football players were tested within 3 days prior to (T1) and the day following the end (T2) of football preseason training camp and during weeks 7 (T3) and 11 (T4) of the competitive season. During each testing session, subjects performed a 30-second Wingate anaerobic power test. Near-infrared continuous wave spectroscopy was used to measure muscle deoxygenation during exercise. No changes in any power performance measures were seen during the competitive football season. A significant (p < 0.05) decrease in the extent of deoxygenation during exercise was observed between T2 (72.6 +/- 19.4%) and T4 (50.2 +/- 14.2%). A 30 and 29% difference (p < 0.05) in the onset of reoxygenation was observed between T1 and T3 and T4, respectively. A 51% decrease (p < 0.05) in halftime recovery was observed between T2 and T3. Results indicate that the extent of muscle deoxygenation is reduced during high-intensity exercise and that muscle oxygen recovery kinetics improves over the duration of a competitive season of football.

The present study was conducted to examine (a) whether there is an association between maximal oxygen uptake (Vo(2)max) and reduction in postexercise heart rate (HR) and blood lactate concentrations ([La]) following resistance exercise and (b) how intensity and Volume of resistance exercise affect postexercise Vo(2). Eleven regularly weight-trained males (20.8 +/- 1.3 years; 96.2 +/- 14.4 kg, 182.4 +/- 7.3 cm) underwent 4 sets of squat exercise on 3 separate occasions that differed in both exercise intensity and volume. During each testing session, subjects performed either 15 repetitions.set(-1) at 60% of 1 repetition maximum (1RM) (L), 10 repetitions.set(-1) at 75% of 1RM (M), or 4 repetitions.set(-1) at 90% of 1RM (H). During each exercise, Vo(2) and HR were measured before (PRE), immediately post (IP), and at 10 (10P), 20 (20P) 30 (30P), and 40 (40P) minutes postexercise. The [La] was measured at PRE, IP, 20P, and 40P. Decrease in HR (DeltaHR) was determined by subtracting HR at 10P from that at IP, whereas decrease in [La] (Delta[La]) was computed by subtracting [La] at 20P from that at IP. A significant correlation (p < 0.05) was found between Vo(2)max and DeltaHR in all exercise conditions. A significant correlation (p < 0.05) was also found between Vo(2)max and Delta[La] in L and M but not in H. The Vo(2) was higher (p < 0.05) during M than H at IP and 10P, while no difference was seen between L and M and between L and H. These results indicate that those with greater aerobic capacity tend to have a greater reduction in HR and [La] during recovery from resistance exercise. In addition, an exercise routine performed at low to moderate intensity coupled with a moderate to high exercise volume is most effective in maximizing caloric expenditure following resistance exercise.

Cold Air Inhalation Does Not Affect the Severity of EIB after Exercise or Eucapnic Voluntary Hyperventilation. Med. Sci. Sports Exerc., Vol. 37, No. 4, pp. 544-549, 2005. Introduction: Exercise-induced bronchoconstriction (EIB) is thought to result from osmotic and thermal events of air conditioning during exercise at high ventilation rates. The purpose of this study was to evaluate lung function after exercise and eucapnic voluntary hyperventilation (EVH) while breathing both room-temperature and cold-temperature dry bottled air. Methods: Twenty-two subjects were identified as EIB probable by a fall of ≥7% in forced expiratory volume in the first second of exhalation (FEV 1 ) using a 6-min room-temperature EVH challenge (RTEVH; 22.0°C). Subjects then randomly performed three 6-min challenges: cold-temperature EVH (CTEVH; -1°C), room-temperature exercise (RTEX; 22.0°C), and cold-temperature exercise (CTEX; -1°C), with a period of at least 48 h observed between challenges. Spirometry was performed at baseline and at 5, 10, 15, and 20 min postchallenge. Results: Reasonable agreement was found between challenge modes and room-temperature and cold-temperature challenges. Postchallenge percent falls in FEV 1 were -15.21, -13.80, -13.12, and -10.69 for RTEVH, CTEVH, RTEX, and CTEX, respectively. RTEVH resulted in a significantly greater percent fall in FEV 1 than CTEX (P = 0.048); no other differences in FEV 1 were observed. Conclusion: Similar postchallenge percent falls in FEV 1 for room- and cold-temperature EVH and exercise suggest that dryness is essential to test conditions, as cold temperature did not have an additive effect to the EIB response.

Background: Exercise induced bronchoconstriction (EIB) is common in elite athletes. Eucapnic voluntary hyperventilation (EVH) is a laboratory test recommended for the identification of EIB in athletes, secondary to a field exercise challenge. Montelukast attenuates EIB, but its protective effect against airway narrowing from EVH has not been investigated. Objective: To examine the effectiveness of montelukast after exercise and after EVH. Methods: A randomised, placebo controlled, double blind, crossover study was performed with 11 physically active EIB positive subjects (eight men, three women; mean (SD) age 22.8 (6.8) years). Six hours before each of the following challenges 10 mg montelukast or placebo was ingested: (a) a six minute, cold air (–3°C) maximal effort work accumulation cycle ergometer exercise; (b) EVH, breathing 5% CO2 compressed air at 85% maximal voluntary ventilation for six minutes. Spirometry was performed before and 5, 10, and 15 minutes after the challenge. At least 48 hours was observed between challenges. Results: No differences in forced expiratory volume in one second (FEV1) were found after the two challenges. Exercise and EVH resulted in falls in FEV1 of 22.4 (18.0) and 25.6 (16.8) respectively. Falls in FEV1 after montelukast were less than after placebo (10.6 (10.6) and 14.3 (11.3) after exercise and EVH respectively; p

Airborne ultrafine and fine particulate matter (PM1 from fossil-fueled internal combustion engines may cause abnormal airway narrowing. Because of high PM1 exposure from ice resurfacing machines, the ice-rink athlete is especially vulnerable to PM1 toxicity. The purpose of this study was to evaluate protection by a single dose of montelukast in college ice hockey players following PM1 exposure exercise. Nine male ice hockey players (age 19.3+/-1.22 yr) performed 4 randomized, double-blinded, high-intensity, 6-min cycle ergometer trials in low [PM1] (2260+/-500 particles/cm3) and high [PM1] (348,600+/-121,600 particles/cm3) after placebo or montelukast. Pre- and postspirometry showed similar peak FEV1 (forced expiratory volume in 1 s) falls between placebo and montelukast after low [PM1] trials (14.5+/-18.06 vs. 9.5+/-11.75% of baseline, respectively). Peak FEV1 falls after high [PM1] trials were greater for placebo than for montelukast (17.3+/-9.79% vs. 1.7+/-5.77% of baseline; p.0001). High [PM1] FEV1 fall after exercise following montelukast ingestion was less than after exercise following placebo ingestion under high and low [PM1] conditions and after exercise following montelukast ingestion under low [PM1] conditions at 5, 10, and 15 min postchallenge (p.004, .0006, .009, respectively). Montelukast provided greater protection against bronchoconstriction after exercise during high [PM1] than low [PM1] exposure (approximately 90% vs. approximately 35%), suggesting that bronchoconstriction from PM1 exposure is predominately leukotriene mediated. The precise mechanism of airborne PM1-induced leukotriene-mediated airway narrowing remains unclear.

The leukotriene receptor antagonist montelukast (ML) attenuates exercise-induced bronchoconstriction (EIB) and its symptoms; however, little is known regarding the acute influence of ML on exercise performance. Purpose: To examine the effects of a single 10-mg dose of ML on physical performance in EIB- and EIB+ athletes. Methods: Twenty-four male college ice hockey players performed two 6-min maximal work accumulation bouts on an electronically braked cycle ergometer in subfreezing conditions (-2.5 ± 0.4°C) 6-8 h after either ML or placebo (PL) to obtain total work accumulated (kJ); subjects were evaluated for EIB after each exercise trial. Results: Eight (33%) subjects were identified as EIB+ (23.5 ± 13.35% fall in FEV 1 ); 16 were EIB- (1.8 ± 3.03% fall in FEV 1 ). ML provided a ∼50% protection against postexercise fall in FEV 1 . No significant differences in kJ were found between PL and ML trials for pooled subjects (95.3 ± 13.69 and 94.8 ± 13.27 kJ, respectively), EIB - subjects (99.6 ± 13.26 and 99.0 ± 11.81 kJ, respectively), or EIB+ subjects (86.8 ± 10.67 and 86.5 ± 12.72 kJ, respectively). Total work accumulated for EIB- subjects was significantly greater than for EIB+ subjects for both PL and ML (P < 0.05). Conclusion: A single 10-mg dose of ML had no ergogenic effect for EIB - and EIB + subjects performing short-duration high-intensity exercise in subfreezing temperature, supporting the use of ML as EIB prophylaxis during international sport competition.

Study objective: For the 2002 Winter Olympic Games, athletes were required to submit objective evidence of asthma or exercise-induced bronchoconstriction (EIB) for approval to inhale a 2-agonist. Eucapnic voluntary hyperventilation (EVH) was recommended as a laboratory challenge that would identify airway hyperresponsiveness (AHR) consistent with EIB. The objective was to compare the change in FEV1 provoked by EVH with that provoked by exercise in cold weather athletes. Design: Spirometry was measured before and for 15 min after challenges. The two challenges were performed in random order at least 24 h apart. Setting: EVH was performed in the laboratory at 19°C, and exercise took place in the field in the cold (2°C, 45% relative humidity). Participants: Thirty-eight athletes (25 female subjects; median age, 16 years). Interventions: For the EVH, athletes inhaled dry air containing 5% carbon dioxide for 6 min at a target ventilation equivalent to 30 times baseline FEV1. Exercise was performed by cross-country skiing, ice skating, or running for 6 to 8 min. Measurements and results: AHR consistent with EIB was defined as > 10% fall in FEV1 from baseline after challenge. Eleven athletes were exercise positive (EX) [FEV1 fall, 20.5 7.3%], and 17 athletes were EVH positive (FEV1 fall, 14.5 4.5%) [mean SD]. Of 19 subjects with AHR, 58% were identified by exercise and 89% were identified by EVH. EVH identified 9 of 11 subjects who were EX and a further 8 subjects with potential for EIB. The average ventilation during EVH was 28 times FEV1. Conclusion: Performing EVH for 6 min in the laboratory had a greater chance of identifying AHR in these athletes compared with 6 to 8 min of field exercise in the cold. The EVH test will be useful to evaluate elite summer sports athletes whose widely different forms of exercise provide an “equipment” challenge to any laboratory.

Purpose: In practice, tests of maximal oxygen uptake (VO 2max ) are often preceded by a lactate profile, a highly intense but submaximal exercise bout. The VO 2max response to preceding high-intensity submaximal exercise, with or without a rest period, has not been determined. If VO 2max is limited after a lactate profile, exercise-induced hypoxemia (EIH) may explain the deficit. The purposes of this study were to: 1) examine the effects of high-intensity submaximal exercise, with or without rest, on subsequent VO 2max ; and 2) evaluate the role of EIH in causing any observed changes. Methods: Ten healthy, well-trained, male cross-country skiers (age = 20.5 ± 4.7 yr, height = 181.6 ± 6.0 cm, mass = 72.1 ± 5.7 kg) completed three exercise trials: an incremental run to fatigue (MAX), MAX preceded by a high-intensity submaximal run (lactate profile) and a 20-min rest period (discontinuous protocol [DC]), and MAX preceded by a high-intensity submaximal exercise run with no rest (continuous protocol [C]). VO 2 , minute ventilation, and arterial oxygen saturation were measured throughout, and diffusion capacity was evaluated 2 min postexercise. Results: No significant between trial differences were observed, although the difference between VO 2 determined during the MAX trial (62.7 ± 6.7 mL.kg -1 .min 1 ) and during the DC trial (58.3 ± 4.4 mL.kg -1 .min 1 ) approached significance (P = 0.059). DC VO 2max responses could be separated into two groups: five responders whose VO 2max suffered during the DC trial (decreased >7.5% from MAX) and five nonresponders, whose VO 2max was unaffected by preceding submaximal exercise and a rest period. Responders showed greater aerobic capacity during the MAX trial. Conclusion: VO 2max is significantly reduced in approximately 50% of cross-country skiers when a maximal exercise test is preceded by high-intensity submaximal exercise and a 20 min rest period; the role of EIH in causing these reductions is unclear.

Athletes are required to provide objective documentation of exercise-induced bronchoconstriction (EIB) to use beta2-agonists during Olympic competition. A positive response to bronchial provocation by eucapnic voluntary hyperventilation (EVH) is considered acceptable confirmation of EIB. Thirty times forced expiratory volume in the first second (FEV1) is recommended as EVH target ventilation (TV), an intensity intended to estimate 85% of maximal voluntary ventilation (MVV). There is a paucity of data examining the accuracy of predicting MVV from FEV1 in elite athletes. The purpose of this study was to evaluate the efficacy of 30 x FEV1 as standardized EVH TV. Maximal minute ventilation during exercise (VEmax) and pulmonary function of 78 elite winter athletes (25 males, 53 females; 25 EIB positive, 53 normal) were analyzed retrospectively. Adequacy and variability of the equation was ascertained by examining the ratio of EVH TV (30 x FEV1) to VEmax. VEmax was 99+/-11% of predicted MVV (35 x FEV1) and was positively related (r=0.85, por = 0.05). TV was 88+/-9% of VEmax (range: 64-109). For elite athletes, the high variability in 30 x FEV1 to standardize TV for EVH may result in under-diagnosis for low-end outliers. Since VEmax of elite endurance athletes is typically known (via maximal aerobic testing) we recommend 85% VEmax as a more accurate and reliable method to establish EVH TV for this group; if VEmax is not available, then 85% of measured MVV may be used.

Diagnosis and medical intervention for exercise-induced bronchospasm (EIB) are often based on self-reported symptoms, without spirometric confirmation. Inspiratory stridor (IS), a symptom of vocal cord dysfunction (VCD), is frequently mistaken for EIB wheeze. Athletes with exercise IS that spontaneously resolves on activity cessation are suspect for VCD and may not have EIB. This study estimated IS prevalence in elite athletes and determined its relationship to EIB.Three hundred seventy athletes (174 female and 196 male subjects) provided a medical history, and underwent spirometry before and after exercise challenge. Exercise challenges were conducted in cold, dry ambient conditions. EIB positive (EIB +) was defined as aor = 10% postexercise fall in FEV(1). Athletes were monitored for IS during exercise; 78.4% of the athletes in this study (n = 290) were tested on multiple occasions.EIB was identified in 30% of 370 athletes tested (58 female and 53 male subjects). IS was observed in 5.1% (18 female and 1 male subjects) during exercise and spontaneously resolved in these subjects within 5 min after exercise cessation. Ten IS-positive (IS +) athletes (52.6%) were EIB +, and 8 of these athletes had a previous EIB diagnosis; however, beta(2)-agonist treatment resolved IS in only 2 subjects. Eight of nine IS +/EIB-negative (EIB -) athletes had a previous EIB diagnosis; seven subjects received beta(2)-agonist treatment with no IS resolution. Resting spirometric measurements did not distinguish IS, but postexercise mid-flow (FEF(50)/FIF(50)) ratio1.5 was more frequent (33%, p0.05) among IS + athletes. The FEF(50)/FIF(50) ratio was higher for IS +/EIB + athletes than for IS -/EIB + athletes (1.97 +/- 1.69 vs 0.81 +/- 0.39, p0.05). The postexercise fall in FVC was greater (p0.05) for IS +/EIB - athletes (9.2 +/- 5.0%) than for IS-negative (IS -) /EIB - athletes (5.3 +/- 4.3%). No difference in postexercise FEV(1) was identified between IS + and IS - athletes (within EIB + or EIB - groups).Five percent of athletes were IS +, with EIB comorbidity observed in 53% of these subjects. Misdiagnosis of IS as EIB is common. The lack of a beta(2)-agonist response in combination with postexercise serial spirometry can be useful in excluding solitary IS and confirming EIB diagnosis.

Purpose The asthmatic airway responds to exercise by bronchodilation (BD) during and bronchoconstriction (BC) after exercise. A refractory period induced by an initial exercise challenge that provides protection against BC during a subsequent exercise bout has also been observed. However, no studies examining during-exercise response or refractoriness during long-duration field exercise by elite athletes have been performed. This study examined airway response and refractoriness during approximately 42-min cross-country ski time trial preceded by a 6- to 9-min 2.5-km high-intensity warm-up ski. Methods Eighteen elite athletes cross-country skied seven successive 2.5-km loops. Spirometry was performed pre- and at 5, 10, and 15 min post loop 1; loops 2-7 were treated as a race (XCR) with maneuvers performed within 20 s after loops 2-6 and serially for 15 min after lap 7. Results Nine of 18 subjects demonstrated a >or=10% fall from baseline in FEV(1) (EIB+): five after lap 1 and four during or after laps 2-7. FEV(1) for EIB+ athletes during XCR was not different from post lap 1 FEV. Only one EIB+ subject demonstrated significant refractoriness. Four EIB+ athletes had a less than 10% fall in FEV after the initial 2.5-km exercise challenge but developed EIB (>or=10% fall) during the subsequent 6 x 2.5 km XCR exercise challenge. FEF(25-75) falls mirrored FEV(1), but demonstrated greater BD during XCR. Conclusion Bronchoconstriction occurs in athletes during prolonged exercise and may thus influence performance. Variability in bronchial hyperresponsiveness onset and the lack of significant refractoriness in our study cohort of athletes is consistent with an exercise bronchoconstrictive dysfunction that is different than frank asthma and is yet to be clearly defined.

WILBER, R. L., K. W. RUNDELL, L. SZMEDRA, D. M. JENKINSON, J. IM, and S. D. DRAKE. Incidence of exercise-induced bronchospasm in Olympic winter sport athletes. Med. Sci. Sports Exerc., Vol. 32, No. 4, pp. 732‐737, 2000. Purpose: The purpose of this project was to determine the incidence of exercise-induced bronchospasm (EIB) among U.S. Olympic winter sport athletes. Methods: Subjects included female and male members of the 1998 U.S. Winter Olympic Team from the following sports: biathlon, cross-country ski, figure skating, ice hockey, Nordic combined, long-track speedskating, and short-track speedskating. Assessment of EIB was conducted in conjunction with an “actual competition” (Olympic Trials, World Team Trials, World Cup Event, U.S. National Championships) or a “simulated competition” (time trial, game), which served as the exercise challenge. Standard spirometry tests were performed preexercise and at 5, 10, and 15 min postexercise. An athlete was considered EIB-positive based on a postexercise decrement in FEV1 $ 10%. Results: For the seven sports evaluated on the 1998 U.S. Winter Olympic Team, the overall incidence of EIB across all sports and genders was 23%. The highest incidence of EIB was found in cross-country skiers, where 50% of the athletes (female 5 57%; male 5 43%) were diagnosed with EIB. Across the seven sports evaluated, the prevalence of EIB among the female and male athletes was 26% and 18%, respectively. Among those individuals found to be EIB-positive were athletes who won a team gold medal, one individual silver medal, and one individual bronze medal at the Nagano Winter Olympics. Conclusions: These data suggest that: 1) EIB is prevalent in several Olympic winter sports and affects nearly one of every four elite winter sport athletes; 2) the winter sport with the highest incidence of EIB is cross-country skiing; 3) in general, EIB is more prevalent in female versus male elite winter sport

Patients are referred often because of self-reported symptoms of dyspnea and wheeze during exercise. The two common causes of exercise-induced dyspnea are exercise-induced bronchoconstriction (EIB) and vocal cord dysfunction (VCD). It can be extraordinarily difficult to differentiate between the two, especially because they may coexist in the same patient. EIB is caused by bronchial smooth muscle constriction in the lower airways due to the inhalation of dry air or allergens during exercise; it is associated with the release of bronchoconstricting mediators from airway cells. EIB can occur in patients with or without persistent asthma. In contrast, VCD is associated with the paradoxical adduction of the vocal cords, especially during inhalation, which may produce inspiratory stridor. VCD can be solitary or comorbid with asthma and/or EIB. EIB classically is most severe after the cessation of exercise, while VCD typically occurs during exercise and resolves quickly upon exercise cessation. However, history is not adequate to differentiate between EIB and VCD, and appropriate challenge tests and flexible laryngoscopy during exercise are often necessary for diagnosis. This article examines our current understanding of these entities and discusses the mechanism, prevalence, diagnosis, and treatment.

The "sitting" posture of speed skating may result in compromised blood flow to the working muscles, thus limiting oxygen uptake. To examine this metabolic problem, male (N = 7) short track speed skaters performed running (TR), in-line skating upright (US), and in-line skating in the "sitting" position (LS) on a motor driven treadmill on randomized days. Each test consisted of four 4-min stages at 2.24, 2.68, 3.13, and 3.58 m.s-1 (5, 6, 7, and 8 mph) at 5% incline. After a brief rest, athletes performed at 4.03 m.s-1 (9 mph) with elevation increasing 1% each minute to exhaustion. Two on-ice 1000-m time trials (TT) were performed to assess the relationship between performance and laboratory measurements. Peak VO2 was lower during LS (57.2 +/- 2.7, 62.3 +/- 4.0, and 64.3 +/- 1.6; for LS, US, and TR, respectively; P < 0.05). At equivalent speeds, submaximal O2 uptake was lower for LS and blood lactate was higher (P < 0.05). LS peak VO2 (ml.kg-1.min-1) was strongly related to TT (P < 0.05). The depressed VO2 and higher blood lactate during LS may be related to decreased knee or trunk angle. Peak VO2 values during skating did not approach values during running. Evaluation of speed skaters in a sports-specific test is congruent with performance and demonstrates potential in addressing the unique physiological demands of the sport.

What you need to know EIB is defined as “the transient narrowing of the lower airway following exercise in the presence or absence of clinically recognized asthma.”1 Bronchoconstriction typically develops within 15 minutes after exercise and spontaneously resolves within 60 minutes. After an episode of EIB, there is often a refractory period of about 1-3 hours in which, if exercise is repeated, the bronchoconstriction is less emphasised in 40-50% of patients.2 3 EIB can also occur during exercise.4 5 The term “exercise induced bronchoconstriction” is preferred to that of “exercise induced asthma” since asthma is a chronic condition which is not induced by a single bout of exercise. EIB is more likely in people with asthma, but it also occurs in individuals without asthma.1 6 EIB is characterised by falls in forced expiratory volume in one second (FEV1) after exercise, while in people with asthma there is persistent airway inflammation and recurrent symptoms outside of exercise (that is, …

The increased risk of morbidity and mortality among adults and children with pre-existing cardiovascular or respiratory illness from emission-derived particulate matter (PM) is well documented. However, the detrimental effects of PM inhalation on the exercising, healthy population is still in question. This review will focus on the acute and chronic responses to PM inhalation during exercise and how PM exposure influences exercise performance. The smaller ultrafine PM (

Elite athletes, particularly those engaged in endurance sports and those exposed chronically to airborne pollutants/irritants or allergens, are at increased risk for upper and lower airway dysfunction. Airway epithelial injury may be caused by dehydration and physical stress applied to the airways during severe exercise hyperpnoea and/or by inhalation of noxious agents. This is thought to initiate an inflammatory cascade/repair process that, ultimately, could lead to airway hyperresponsiveness (AHR) and asthma in susceptible athletes. The authors review the evidence relating to prevention or reduction of the risk of AHR/asthma development. Appropriate measures should be implemented when athletes exercise strenuously in an attempt to attenuate the dehydration stress and reduce the exposure to noxious airborne agents. Environmental interventions are the most important. Non-pharmacological strategies can assist, but currently, pharmacological measures have not been demonstrated to be effective. Whether early prevention of airway injury in elite athletes can prevent or reduce progression to AHR/asthma remains to be established.

Unfavourable effects on the respiratory and the cardiovascular systems from short-term and long-term inhalation of air pollution are well documented. Exposure to freshly generated mixed combustion emissions such as those observed in proximity to roadways with high volumes of traffic and those from ice-resurfacing equipment are of particular concern. This is because there is a greater toxicity from freshly generated whole exhaust than from its component parts. The particles released from emissions are considered to cause oxidative damage and inflammation in the airways and the vascular system, and may be related to decreased exercise performance. However, few studies have examined this aspect. Several papers describe deleterious effects on health from chronic and acute air pollution exposure. However, there has been no research into the effects of long-term exposure to air pollution on athletic performance and a paucity of studies that describe the effects of acute exposure on exercise performance. The current knowledge of exercising in the high-pollution environment and the consequences that it may have on athlete performance are reviewed.

International audience; Exercise-induced bronchoconstriction (EIB) is exaggerated constriction of the airways usually soon after cessation of exercise. This is most often a response to airway dehydration in the presence of airway inflammation in a person with a responsive bronchial smooth muscle. Severity is related to water content of inspired air and level of ventilation achieved and sustained. Repetitive hyperpnea of dry air during training is associated with airway inflammatory changes and remodeling. A response during exercise that is related to pollution or allergen is considered EIB. Ozone and particulate matter are the most widespread pollutants of concern for the exercising population; chronic exposure can lead to new-onset asthma and EIB. Freshly generated emissions particulate matter less than 100 nm is most harmful. Evidence for acute and long-term effects from exercise while inhaling high levels of ozone and/or particulate matter exists. Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool. Swimmers typically do not respond in the pool; however, a large percentage responds to a dry air exercise challenge. Studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic. Winter sport athletes and swimmers have a higher prevalence of EIB, asthma and airway remodeling than other athletes and the general population. Because of fossil fuel powered ice resurfacers in ice rinks, ice rink athletes have shown high rates of EIB and asthma. For the athlete training in the urban environment, training during low traffic hours and in low traffic areas is suggested.

Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.

The prevalence of exercise-induced bronchoconstriction is reported to be high among recreational and elite athletes, yet diagnosis is often symptom-based. Indirect challenges such as the laboratory exercise challenge provide objective criteria for proper diagnosis and treatment. However, a standardized protocol using appropriate exercise intensity, duration, and dry air inhalation is often not implemented, and thus a false-negative test may result. This article reviews and describes the symptom-based diagnosis, the exercise challenge, and other indirect challenges such as eucapnic voluntary hyperpnea, hypertonic saline inhalation, and inhaled powdered mannitol as methods to diagnose and evaluate exercise-induced bronchoconstriction. Advantages and disadvantages of each diagnostic procedure are presented.

Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled beta(2)-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to beta(2)-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale beta(2)-agonists will continue.

BAUMANN, J. M., K. W. RUNDELL, T. M. EVANS, and A. M. LEVINE. Effects of Cysteine Donor Supplementation on Exercise-Induced Bronchoconstriction. Med. Sci. Sports Exerc., Vol. 37, No. 9, pp. 1468 –1473, 2005. Purpose: Reactive oxygen/ nitrogen species (ROS/RNS) in resident airway cells may be important in bronchoconstriction following exercise. Glutathione (GSH) is a major lung antioxidant and could influence pathological outcomes in individuals with exercise-induced bronchoconstriction (EIB). This study examined the effects of supplementation with undenatured whey protein (UWP) in subjects exhibiting airway narrowing following eucapnic voluntary hyperventilation (EVH), a surrogate challenge for diagnosis of EIB. UWP is a cysteine donor that augments GSH production. Methods: In a randomized, double-blind, placebo-controlled study, 18 EIB-positive subjects (age: 25.2 9.01 yr; weight: 77.3 18.92 kg; height: 1.7 0.09 m) with post-EVH falls of 10% in FEV1 received 30 g UWP (TX) or casein placebo (PL)/d. Subjects performed 6-min EVH challenges before and after 4 and 8 wk of supplementation. Exhaled nitric oxide (eNO) was measured serially before spirometry and at 1-wk intervals. Spirometry was performed pre- and 5, 10, and 15 min postchallenge Results: Subjects exhibited significant mean improvement in postchallenge falls in FEV1 from 0w k (22.6 12.22%) with TX at 4( 18.9 12.89%, P 0.05) and 8 wk (16.98 11.61%, P 0.05) and significant mean reduction in post-EVH peak falls in FEF25–75 from 0w k (40.6 15.28%) with TX at 4 (33.1 17.11%, P 0.01) and 8 (29.7 17.42%, P 0.05) wk. No changes in FEV1 or FEF25–75 were observed in the PL group at any time point. Mean eNO for PL and TX groups at 0, 4, and 8 wk (46.8 31.33, 46.5 35.73, 49.3 37.12 vs 35.2 26.87, 29.1 17.26, 34.7 21.11 ppb, respectively) was not significantly different. Conclusions: UWP may augment pulmonary antioxidant capacity and be therapeutically beneficial in individuals exhibiting EIB, as postchallenge pulmonary function improved with supplementation. The lack of significant change in eNO suggests that the pulmonary function improvements from UWP supplementation are independent of eNO. Key Words: ASTHMA, INFLAMMATION, PULMONARY FUNCTION, WHEY PROTEIN, GLUTATHIONE.

HISTORIQUE : L'efficacite de l'oscillometrie a impulsion pour mesurer les changements de calibre des voies respiratoires est plus ou moins bien etablie. OBJECTIF : Mesurer les changements de fonction pulmonaire apres hyperventilation volontaire eucapneique (HVE) et comparer les indices d'oscillometrie aux debits expiratoires de pointe obtenus par spirometrie. METHODES : Vingt sujets (10 aux voies respiratoires hyperreactives [VRHR+] et 10 normaux [VRHR-]) ont subi une oscillometrie et une spirometrie avant, puis 15 minutes apres 6 minutes d'HVE (inhalation de CO 2 a 5 %, d'O 2 a 21 %, N 2 equilibre) a une ventilation cible de 30 fois la valeur de depart du VEMS a 20 °C. Les sujets VRHR+ etaient definis par une chute du VEMS de 10 % ou plus comparativement au depart, apres le test de provocation. La resistance respiratoire a 5 Hz (R 5 ), la reactivite a 5 Hz, la frequence de resonance (F r e s ), la surface de reactivite integree de 5 Hz a F r e s (AX) et le VEMS ont ete determines. RESULTATS : Aucune valeur de spirometrie de base n'etait en correlation avec les declins du VEMS. Les valeurs R 5 et AX de base etaient en correlation avec les declins de pointe du VEMS (r = - 0,51 et - 0,46, respectivement; p < 0,05). Les sujets HRVR+ ont presente un pourcentage de declin de pointe du VEMS plus marque que les sujets HRVR- apres l'hyperventilation (30,6 ′ 14,0 % versus 7,5 ′ 2,6 %, respectivement; p < 0,05). Les changements de R 5 , de F r e s , de reactivite et d'AX ont ete plus marques chez les sujets HRVR+ que chez les sujets HRVR- et ont ete en correlation avec un declin du VEMS (r = - 0,74, - 0,70, 0,69 et - 0,73, respectivement; p < 0,05). A une specificite designee de 80 %, le changement de pourcentage du R 5 (50 % ou plus) et l'AX post-hyperventilation (12 cm H 2 O/L ou plus) ont donne des sensibilites de 90 % pour ce qui est d'une baisse de 10 % de VEMS. CONCLUSION: L'oscillometrie a impulsion est une mesure acceptable pour determiner l'hyperreactivite des voies respiratoires et peut completer la spirometrie lors d'evaluation de la fonction pulmonaire.

Despite the progress that has been made in the treatment of asthma, the prevalence and burden of this disease has continued to increase. Exercise is a powerful trigger of asthma symptoms and reversible airflow obstruction and may result in the avoidance of physical activity by patients with asthma, resulting in detrimental consequences to their health. Approximately 90% of patients with asthma are hyperresponsive to exercise and experience exercise-induced bronchoconstriction (EIB). While pharmacologic treatment of asthma is usually highly effective, medications often have significant side-effects or exhibit tachyphylaxis. Alternative therapies for treatment (complementary medicine) that reduce the dose requirements of pharmacologic interventions would be beneficial, and could potentially reduce the public health burden of this disease. There is accumulating evidence that dietary modification has potential to influence the severity of asthma and reduce the prevalence and incidence of this condition. A possible contributing factor to the increased incidence of asthma in Western societies may be the consumption of a proinflammatory diet. In the typical Western diet, 20- to 25-fold more omega- 6 polyunsaturated fatty acids (PUFA) than omega-3 PUFA are consumed, which causes the release of proinflammatory arachidonic acid metabolites (leukotrienes and prostanoids). This review analyzes the existing literature on omega-3 PUFA supplementation as a potential modifier of airway hyperresponsiveness in asthma and includes studies concerning the efficacy of omega-3 PUFA supplementation in EIB. While clinical data evaluating the effect of omega-3 PUFA supplementation in asthma has been equivocal, it has recently been shown that pharmaceutical-grade fish oil (omega-3 PUFA) supplementation reduces airway hyperresponsiveness after exercise, medication use, and proinflammatory mediator generation in nonatopic elite athletes with EIB. These findings are provocative and suggest that dietary omega-3 PUFA supplementation may be a viable treatment modality and/or adjunct therapy in airway hyperresponsiveness. Further studies are needed to confirm these results and understand their mechanism of action.

Fossil-fueled ice rink resurfacing machines emit high levels of ultrafine and fine particulate matter (PM(1)) and may be related to asthmalike symptoms in skaters. We examined PM(1) exposure and airway status in elite women ice hockey players over 4 training years. Lung function, asthma symptoms, and rink PM(1) were evaluated. Pre- and postexercise spirometry was performed on 14 female hockey players and 9 female control nordic skiers 4 times over 4 yr. Baseline lung functions were normalized to height cubed (Ht(3)) and recalculated to subject mean height (1.69 m) to evaluate change. Venue CO, NO(2), and PM(1) were measured. Training history for hockey players included 2 yr in a low-[PM(1)] rink, followed by transition to high-[PM(1)] fossil fuel machine resurfaced rinks; [PM(1)] for control ski venue was low. [CO] and [NO(2)] were acceptable at all venues. Controls showed no baseline function change over 4 yr. For hockey players, 1997 lung function values at the low-[PM(1)] venue were significantly higher than 2001 high-[PM(1)] venue values (p.05); decay per year between 1997 and 2001 was greater for FEF(25-75) (251 +/- 185, 83 +/- 40, 109 +/- 58, 109 +/- 187 ml yr(-1), mean +/- SD for FEF(25-75), FVC, FEV1, PEF, respectively; p.05). No relationships between baseline lung functions and airway hyperresponsiveness or symptoms were identified. Five of 9 controls had symptoms, and 10 of 14 subjects had symptoms. This preliminary study suggests [PM(1)] is related to airway function decay in ice rink athletes.

PURPOSE: Exercise-induced bronchoconstriction (EIB) is high among ice rink athletes and may be related to exercise ventilation of rink air pollutants. Impaired postchallenge expiratory flows are common for this population; however, baseline lung function and symptoms have not been fully evaluated. METHODS: We examined resting lung function and asthma-like symptoms in relation to airway hyperresponsiveness in National Team female ice hockey players (N = 43). Subjects were grouped according to observed symptoms and medical history as symptomatic ('S') or asymptomatic ('A'). Baseline and postexercise lung function was determined. RESULTS: Seventeen (39.5%) presented symptoms and 9 (21%) had EIB. Baseline FEV1, FEV1/FVC, and FEF25-75 were different between 'S' and 'A' (102 +/- 14% vs 116 +/- 12%, 77.7 +/- 7.5 vs 88.2 +/- 4.5, and 74 +/- 22% vs 118 +/- 24%, respectively; P < 0.05); FVC and PEF were not different. Ten 'S' athletes had

HOFFMAN, J. R., J. IM, K. W. RUNDELL, J. KANG, S. NIOKA, B. A. SPEIRING, R. KIME, and B. CHANCE. Effect of Muscle Oxygenation during Resistance Exercise on Anabolic Hormone Response. Med. Sci. Sports Exerc., Vol. 35, No. 11, pp. 1929 –1934, 2003. Purpose: The mechanisms that underlie the affect of acute program variables on muscle growth and strength development for strength/power athletes have been of great interest. This investigation examined the affects of two different resistance exercise protocols on muscle oxygenation, and the anabolic hormonal response to such exercise. Methods: Eleven experienced resistance-trained male athletes performed four sets of the squat exercise using either a low-intensity, high-volume (LI; 15 repetitions at 60% one-repetition maximum [1-RM]) or high-intensity, low-volume (HI; 4 repetitions at 90% 1-RM) load. Venous blood samples were obtained before (Pre), immediate (IP), 20- (20P), and 40-min (40P) postexercise. Continuous-wave near-infrared spectroscopy was used to measure oxygen desaturation during exercise. Results: No differences in muscle deoxygenation were seen between LI and HI. However, time-dependent postexercise reoxygenation was significantly different between the two exercise sessions (35.3 17.4 s vs 24.5 14.3 s in LI and HI, respectively). Testosterone and growth hormone (GH) concentrations were significantly elevated from Pre at IP, 20P, and 40P in both LI and HI. GH concentrations were higher (P 0.05) for LI than at HI at 20P and 40P. Conclusion: Muscle oxygen recovery kinetics appeared to be influenced by differences in the intensity and volume of exercise, and delayed reoxygenation appears to affect the GH response to exercise. Key Words: TESTOSTERONE, GROWTH HORMONE, WEIGHT TRAINING, NEAR-INFRARED SPECTROSCOPY, MUSCLE ISCHEMIA

The term exercise-induced bronchospasm (EIB) describes the acute transient airway narrowing that occurs during and most often after exercise in 10 to 50% of elite athletes, depending upon the sport examined. Although multiple factors are unquestionably involved in the EIB response, airway drying caused by a high exercise-ventilation rate is primary in most cases. The severity of this reaction reflects the allergic predisposition of the athlete, the water content of the inspired air, the type and concentration of air pollutants inspired, and the intensity (or ventilation rate) of the exercise. The highest prevalence of EIB is seen in winter-sport populations, where athletes are chronically exposed to cold dry air and/or environmental pollutants found in indoor ice arenas. When airway surface liquid lost during the natural warming and humidification process of respiration is not replenished at a rate equal to the loss, the ensuing osmolarity change stimulates the release of inflammatory mediators and results in bronchospasm; this cascade of events is exacerbated by airway inflammation and airway remodelling. The acute EIB response is characterised by airway smooth muscle contraction, membrane swelling, and/or mucus plug formation. Evidence suggests that histamine, leukotrienes and prostanoids are likely mediators for this response. Although the presence of symptoms and a basic physical examination are marginally effective, objective measures of lung function should be used for accurate and reliable diagnosis of EIB. Diagnosis should include baseline spirometry, followed by an appropriate bronchial provocation test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity dry air exercise. A 10% post-challenge fall in forced expiratory volume in 1 second is used as diagnostic criteria. The goal of medical intervention is to limit EIB exacerbation and allow the athlete to train and compete symptom free. This is attempted through daily controller medications such as inhaled corticosteroids or by the prophylactic use of medications before exercise. In many cases, EIB is difficult to control. These and other data suggest that EIB in the elite athlete is in contrast with classic asthma.

Objectives To survey the prevalence of body art (body piercing and tattooing) in university undergraduate students and to determine the incidence of medical complications from these procedures. Subjects and Methods Between February and May 2001, students were offered the opportunity to complete an anonymous, voluntary survey at the beginning of class or organizational meetings. The survey instrument requested information concerning body piercing and tattooing (current or removed) by body site, age, sex, height, weight, body mass index, undergraduate class, athletic status, and the occurrence of medical complications. Results Four hundred fifty-four (94.4%) of 481 students completed the survey (14.7% of total campus enrollment). The prevalence of body piercing was 51%, and that of tattooing was 23%. The χ 2 analysis showed female students were more likely to be pierced than males ( P =.002); there was no significant difference in the prevalence of tattooing by sex. Male athletes were more likely to be tattooed than male nonathletes ( P =.02). No relationships were shown between piercing/tattooing and age or measures of body somatotype. The incidence of medical complications of piercing was 17%, and these complications included bleeding, tissue trauma, and bacterial infections. Pierced navels were particularly prone to infection. There were no reported medical complications from tattooing. Eighteen percent of piercings (58/315) and 4% of tattoos (6/149) had been removed. Conclusions Body art is prevalent among undergraduate university students, and there is a significant incidence of medical complications among students with piercing. Male athletes were significantly more likely to be tattooed than male nonathletes.

The purpose of this study was to compare self-reported symptoms for exercise-induced asthma (EIA) to postexercise challenge pulmonary function test results in elite athletes.Elite athletes (N = 158; 83 men and 75 women; age: 22 +/- 4.4 yr) performed pre- and post-exercise spirometry and were grouped according to postexercise pulmonary function decrements (PFT-positive, PFT-borderline, and PFT-normal for EIA). Before the sport/environment specific exercise challenge, subjects completed an EIA symptoms-specific questionnaire.Resting FEV1 values were above predicted values (114--121%) and not different between groups. Twenty-six percent of the study population demonstrated10% postexercise drop in FEV1 and 29% reported two or more symptoms. However, the proportion of PFT-positive and PFT-normal athletes reporting two or more symptoms was not different (39% vs. 41%). Postrace cough was the most reported symptom, reported significantly more frequently for PFT-positive athletes (P0.05). Sensitivity/specificity analysis demonstrated a lack of effectiveness of self-reported symptoms to identify PFT-positive or exclude PFT-normal athletes. Postexercise lower limit reference ranges (MN-2SDs) were determined from normal athletes for FEV1, FEF25--75% and PEF to be -7%, -12.5%, and -18%, respectively.Although questionnaires provide reasonable estimates of EIA prevalence among elite cold-weather athletes, the use of self-reported symptoms for EIA diagnosis in this population will likely yield high frequencies of both false positive and false negative results. Diagnosis should include spirometry using an exercise/environment specific challenge in combination with the athlete's history of asthma symptoms.

The purpose of this study was to compare a laboratory based exercise challenge (LBC) to a field based exercise challenge (FBC) for pulmonary function test (PFT) exercise-induced asthma (EIA) screening of elite athletes.Twenty-three elite cold weather athletes (14 men, 9 women) PFT positive for EIA (FBC screened) served as subjects. Twenty-three gender and sport matched controls (nonasthmatics) were randomly selected to establish PFT reference values for normal elite athletes. Before FBC, athletes completed a medical history questionnaire for EIA symptoms. FBC evaluations consisted of baseline spirometry, actual or simulated competition, and 5, 10, and 15 min postexercise spirometry. PFT positive athletes were evaluated in the laboratory using an exercise challenge simulating race intensity (ambient conditions: 21 degrees C, 60% relative humidity). PFT procedures were identical to FBC.91% of PFT positive and 48% of PFT normal athletes reported at least one symptom of EIA, with postrace cough most frequent. Baseline spirometry was the same for PFT positives and normal controls. Lower limit reference range (MN - 2 SD) of FEV1 for controls suggests that postexercise decrements of greater than approximately -7% indicate abnormal airway response in this population. Exercise time duration did not effect bronchial reactivity; 78% of FBC PFT positives were PFT normal post-LBC.Self-reported symptoms by elite athletes are not reliable in identifying EIA. Reference range criterion for FEV1 decrement in the elite athlete postexercise contrasts current recommended guidelines. Moreover, a large number of false negatives may occur in this population if EIA screening is performed with inadequate exercise and environmental stress.

Since biathlon racing involves cross-country skiing while carrying a minimum weight 3.5-kg rifle, energy cost for rifle carriage could be significant to race outcome. The purposes of this study were to: 1) compare physiological measurements of biathletes roller skiing with and without rifle carriage, 2) compare energy cost of rifle carriage between women and men, 3) examine the relationship of cycle length and cycle rate to energy cost of rifle carriage, and 4) compare physiological measurements to calculated estimates of power requirements of rifle carriage.We examined metabolic cost of rifle carriage during inclined roller ski-skating. National Team Biathletes (7 W, 8 M) performed treadmill roller ski-skating (2.46, 2.68, and 2.91 m.s-1, 8% incline, 5-min stages) with and without a 3.65 kg rifle.For W, HR, VO2, and VE during carriage were higher at all speeds, LA was higher at the fastest speed (P0.05). For M, VO2 and VE were higher at all speeds, HR and LA were higher at 2.68 and 2.91 m.s-1 (P0.05). Rifle mass as percent of body mass was different between W and M (6.6 +/- 0.7% vs 5.0 +/- 0.3%, P0.05). Percent increase in VO2 (2.1% and 1.3% per kg load; for W and M, respectively) was not different than rifle mass as percent body wt. Cycle length was related to increased VO2 and LA during rifle carriage for W (r = -0.59 and -0.70 to -0.85), and to LA for M (r = -0.66 to -0.83).The large range in cost between individuals (0.2 +/- 0.08 and 0.19 +/- 0.17 L.min-1; for WM, respectively) suggests that individual economies for load carriage can be improved.