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Swimming produces many psychophysiological effects, including blood, hormonal, enzymatic, pulmonary, cardiovascular and energetic adaptations. However, asthma and allergies are becoming increasingly prevalent medical issues among elite endurance-trained swimmers, where exercise-induced asthma or bronchospasm is frequently reported. Heavy endurance swimming training, especially under adverse conditions, stresses the airway mucosa, leading to inflammatory changes, as observed in induced sputum in competitive swimmers. In addition, chlorine-based disinfectants (CBDs) are commonly used in indoor pools due to their effectiveness and lower relative cost. Many of these substances have carcinogenic and genotoxic properties, and exposure to DBPs have been linked to adverse respiratory effects. The association between long-term exposure to a chlorinated swimming pool and elevated serum sIgE levels suggests a link between allergens, chlorine exposure and the development of various pulmonary dysfunctions. Thus, the combination of intense and repeated physical endurance training over extended periods, along with suboptimal environmental conditions, may contribute to the development of rhinitis, asthma and bronchial hyperresponsiveness in athletes. While occasional or low-level exposure to chlorine might not be harmful, regular swimmers, especially those at competitive levels, are at a higher risk of developing respiratory disorders. Because these potential risks of exposure to CBDs must be balanced against the benefits of swimming and the risk of microbial infections in pools, we recommend better pool management and regular health checks for swimmers. Fortunately, the reduction of bronchial symptoms in swimmers who reduce training volume and intensity suggests that the negative effects on pulmonary function may be reversible. For these reasons, it is crucial to develop effective respiratory protection strategies, including medical interventions and modifications to the pool environment. Practical steps such as reducing chlorine use, ensuring proper hygiene before swimming and using swim caps can minimise risks. Research should also explore safer alternatives to CBDs, such as ozonation, and improved ventilation to reduce air pollutants. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMaterials and methodsResultsConclusionsIt is well-known that children who suffer from obesity and asthma may also have exercise-induced bronchospasm. Exhaled nitric oxide is an indicator of airway inflammation, and could be affected by exercise. This study looked at how exercise, which is a typical cause of acute airway obstruction, affects the levels of FeNO and spirometric parameters in obese and asthmatic children.Seventy children between the ages of 6 and 18 were divided into four groups: healthy children, obese children with asthma, obese children without asthma, and normal-weight asthmatic children. FeNO and spirometric parameters were assessed before and after exercise. Their heart rate was raised to 160–170 beats per minute by walking on a flat surface.The highest mean FeNO was seen in the asthmatic-obese group, while the lowest mean FeNO was found in the healthy group. MEF25–75 increased with exercise in the obese non-asthmatic group. FEV1/FVC was the lowest in the asthmatic-obese group.FeNO and FEV1/FVC have a strong association with asthma. The highest values of FeNO found in asthma-obesity combined. It was seen that obesity increased inflammation but exercise did not affect FeNO values. FeNO and FEV1 values were found to be higher in obese patients with and without asthma than normal weight and overweight asthmatics and non-asthmatics. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether Opto-Electronic Plethysmography (OEP) can distinguish Exercise-Induced Bronchoconstriction (EIB) breathing patterns by comparing individuals with and without EIB, and between broncho-constriction and recovery. Breathing pattern was quantified in terms of regional contribution, breathing timing, and the phase between chest sub-compartments which indicates the synchronization in movement of the different sub-compartments. Methods: Individuals (n = 47) reporting no respiratory symptoms and no history of any respiratory disease or disorder were assumed to have a healthy breathing pattern. Of 38 participants reporting respiratory symptoms during exercise, and/or a previous diagnosis of asthma or EIB, 10 participants had a positive result to the Eucapnic Voluntary Hyperpnea test, defined as a fall of at least 10% in FEV1 from baseline at two consecutive time points and were classified into the EIB group. OEP data was obtained from 89 markers and an 11-camera motion capture system operating at 100 Hz as follows: pre- and post-EVH challenge, and post-inhaler in participants who experienced a bronchoconstriction, and 2) for the healthy group during tidal breathing. Results: RCpRCa-Phase (upper versus lower ribcage), RCaS-Phase (lower ribcage versus shoulders), and RCpS-Phase (upper ribcage versus shoulders) differed between bronchoconstriction and rest in athletes with EIB and rest in healthy participants (p < 0.05), in all cases indicating greater asynchrony post-bronchoconstriction, and later movement of the abdominal ribcage (RCa) post-bronchoconstriction. RCpS-Phase was different (p < 0.05) between all conditions (rest, post-bronchoconstriction, and post-inhaler) in EIB. Conclusions: OEP can characterize and distinguish EIB-associated breathing patterns compared to rest and individuals without EIB at rest. [ABSTRACT FROM AUTHOR]

Background: Exercise-induced bronchoconstriction (EIB) is common in children with asthma but can be present also in children without asthma, especially athletes. Differential diagnosis includes several conditions such as exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history, clinical examination and specific tests are mandatory to exclude alternative diagnoses. Given the high prevalence of EIB in children and its potential impact on health, sport performance, and daily levels of physical activity, health care professionals should be aware of this condition and able to provide a specific work-up for its identification. The aims of the present study were: (a) to assess the agreement among hospital pediatricians and primary care pediatricians of Emilia-Romagna Region (Italy) about the management of EIB in children and (b) formulate statements in a consensus document to help clinicians in daily clinical practice. Methods: According to Delphi method, a panel of specialists scored 40 statements that were then revised and discussed during online meetings to reach full consensus. Statements were then formulated. Results: To obtain full consensus, the questionnaire was administered in two rounds after full discussion of the uncertain topics on the basis of the latest evidence on EIB published over the last 10 years. Despite an overall agreement on EIB management, some gaps emerged in the sections dedicated to diagnosis and treatment. Nine summary statements on definition, pathogenesis, diagnostic work-up, treatment, and follow-up were eventually formulated. Conclusions: This study describes the knowledge of EIB in a group of pediatricians and highlights gaps and uncertainties in diagnosis and treatment. The creation of statements shared by the specialists of the same area may improve the management of EIB in children. However, more research and evidence are needed to better clarify the best treatment and to standardize the best diagnostic protocol limiting useless examinations but at the same time assuring the best management. [ABSTRACT FROM AUTHOR]

AbstractObjective: Physical exercise in treatment of asthma is scarcely studied with no clear exercise guidelines for asthmatics. We aimed to investigate the associations between physical exercise frequency, systemic inflammation and asthma control. This has not been previously studied in adult-onset asthma.Methods: This study is part of Seinäjoki Adult Asthma Study (SAAS), where 203 patients with adult-onset asthma were evaluated in 2012–2013. Exercise frequency was recorded with a structured lifestyle questionnaire. Study population was divided into two categories by exercise frequency: Low-frequency group exercised ≤2 times/week and high frequency group >2 times/week. Blood inflammatory markers were measured and IL-6 > 1.55 pg/ml and hs-CRP > 4.12 mg/l indicated systemic inflammation.Results: High-exercise frequency group had lower levels of hs-CRP (p = 0.007), IL-6 (p = 0.015), suPAR (p = 0.008) and adipsin (p = 0.031) and higher levels of adiponectin (p = 0.010) than low-exercise frequency group. In logistic multivariate regression models, higher-exercise frequency lowered odds for elevated hs-CRP (OR = 0.37, 95% CI 0.15–0.94) and IL-6 levels (OR = 0.43, 95% CI 0.20–0.91), after adjusting for possible confounding factors. There was no difference in lung function tests, asthma control test or airways questionnaire 20 scores between the exercise frequency groups. However, differences were found in single symptom questions; high-exercise frequency group had less symptoms during light housework and laughing but experienced more limitation of activity in self-reports.Conclusions: Higher-exercise frequency is associated with lower level of systemic inflammation in patients with adult-onset asthma but no clear association was found to asthma outcomes. Exercise frequency may be associated with lesser amount of some individual asthma symptoms. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsThe prevalence of asthma is increasing gradually worldwide. The pathophysiological process of asthma causes some alterations in the respiratory system and decreases oxygen-carbon dioxide exchange and respiration volume. These alterations may affect maximal exercise capacity, peripheral muscle strength, sleep quality, and disease-specific quality of life but have yet to be comprehensively investigated. To compare maximal exercise capacity, pulmonary function, peripheral muscle strength, dyspnea, sleep quality, and quality of life in adult patients with asthma, healthy controls were aimed.Forty-one adult stable asthmatic patients (GINA I–III) and 41 healthy subjects were compared. Exercise capacity (cardiopulmonary exercise test [CPET]), pulmonary function (spirometry), peripheral muscle strength (dynamometer), dyspnea (modified Medical Research Council [mMRC] dyspnea scale), quality of life (Asthma Quality of Life Questionnaire [AQLQ]) and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were evaluated.Peak VO2, VO2kg, MET, VE, HR, %VE, %HR, VCO2 parameters of CPET, FVC, FEV1, FEF25–75%, and FEV1/FVC and quadriceps femoris, shoulder abductors, and hand grip muscle strength were significantly decreased in patients with asthma (p < 0.05). MMRC dyspnea scale score was increased, and AQLQ and PSQI scores decreased in asthma patients (p < 0.05).Cardiac and pulmonary system responses to peak exercise worsened, and maximal exercise capacity and peripheral muscle strength decreased in adult patients with stable asthma. In addition, dyspnea during daily activities increases, and quality of life and sleep quality are impaired. A variety of exercise training that would benefit asthmatic patients’ outcomes should be investigated. [ABSTRACT FROM AUTHOR]

Previous studies based on animal models have raised concerns about salbutamol use in ozone air pollution with regard to ozone related lung injury. We conducted a double‐blind, randomized, placebo‐controlled crossover study including 18 subjects diagnosed with EIB by a eucapnic voluntary hyperpnea (EVH) test. Participants completed 30 min of standardized moderate to vigorous exercise in four conditions: ozone plus salbutamol; room air plus salbutamol; ozone plus placebo medication; and room air plus placebo medication. Spirometry, fraction of exhaled nitric oxide, and symptoms were measured before, immediately after, 30 min after and 1 h after exercise. Measurements between the four conditions were compared using percent change from pre to post exercise. There was a statistically significant difference between the salbutamol and placebo medication groups for spirometric variables including FEV1 (Estimate = 6.3, 95% CI: 4.23–8.37, p < 0.001). No differences were observed between ozone and room air exposures. There were no significant differences in FeNO response between experimental conditions. We found that salbutamol improved pulmonary function in individuals with EIB when exercising in ozone and did not increase eosinophilic airway inflammation as indicated by FeNO. This evidence suggests that it is safe for people with EIB to continue to use salbutamol as proscribed when ozone levels are elevated. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing (CPET) is a noninvasive test that provides a comprehensive assessment of the integrative exercise responses by measuring parameters calculated on a breath-by-breath basis. It can provide insight into the fitness level, cause of exercise limitation, and safe parameters for exercise prescription in children 6 years and older. Common indications for CPET include undiagnosed exercise-induced dyspnea, exercise intolerance in pediatric chronic conditions and for monitoring response after therapy/intervention. It can be utilized to assess the overall fitness, pre-operative risk, and prognosis in chronic conditions. CPET is accessible and dependable in pediatrics, yet challenges like a lack of standardized protocols are noted. With continued development and technological advancements in CPET, there is potential for revolutionizing pediatric diagnostic health care. [ABSTRACT FROM AUTHOR]

Exercise-induced bronchospasm (EIB) is a problem encountered by many people, and although it can be controlled, it is often overlooked or attributed to deconditioning. Children and elite athletes tend to have an increased incidence of EIB, but this condition is also encountered in others. Unfortunately, many who must deal with this disease tend to limit the level of exercise that provokes symptoms or avoid exercise altogether. EIB can occur alone or in association with underlying asthma. This article discusses EIB, its management, and strategies for nurses when caring for patients with EIB. [ABSTRACT FROM AUTHOR]

Asthma is one of the most prevalent chronic respiratory diseases in childhood and adolescence. It is characterized by inflammation and bronchial hyperreactivity, which trigger bronchoconstriction and airway obstructions. This condition represents a significant public health issue due to its impact on emergency services, hospitalizations, and school absenteeism. In Ecuador, previous studies have revealed a prevalence of asthma symptoms in adolescents but a low rate of diagnosis, suggesting possible underdiagnosis and insufficient control of the condition. Exercise-induced bronchoconstriction (EIB) is a common manifestation in patients with uncontrolled asthma and can be assessed through provocation tests, such as the Exercise-Induced Bronchial Provocation Test (EIBPT). This study aims to evaluate the bronchial response to the EIBPT in Ecuadorian children and adolescents to contribute to a better understanding of asthma in this population. This nonexperimental, descriptive, observational study was conducted on 25 students aged 8 to 17 years without a prior asthma diagnosis. Participants underwent the EIBPT on a treadmill. The criterion for a positive result was set at a decrease in VEF1 %, observed in only 4% of the 25 participants. The low prevalence of EIB in this sample suggests that, in Ecuadorian children and adolescents without a prior asthma diagnosis, exercise does not induce significant bronchoconstriction, ruling out the existence of an asthma underdiagnosis. [ABSTRACT FROM AUTHOR]

Winter sports athletes training are more predisposed to the development of asthma and exercise-induced bronchoconstriction (EIB) than athletes training in milder ambient conditions. An increased incidence of asthma symptoms has been demonstrated, among others, in competitive cross-country skiers. Winter sports training in an indoor ice rink also contributes to an increase in the occurrence of asthma and EIB symptoms and to the influx of inflammatory cells into the respiratory tract. Hyperventilation with dry, cold air may predispose to development of bronchospasm. The frequency of symptoms varies depending on the discipline trained. The latest research highlights the involvement of neurogenic (excessive stimulation of the vegetative system) and inflammatory component (increased number of eosinophils, T lymphocytes and mast cells) in the development of asthma symptoms in athletes. The air quality at the indoor ice rinks has been significantly deteriorating for a long time due to exhaust emissions (increase in NO2, CO and PM1 particles) from ice cleaning machines. Switching to electric devices has drastically reduced the amount of harmful particles. Despite the changes introduced, athletes training on indoor ice rinks are still a group predisposed to exerciseinduced bronchospasm. [ABSTRACT FROM AUTHOR]

Copyright of SEMS-Journal is the property of Schwiez Zschr Sportmed Sporttraumatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Exercise-induced bronchoconstriction (EIB) is a common condition among athletes, particularly those involved in endurance sports, and can significantly impact their performance and quality of life. The underlying mechanisms of EIB remain complex and are influenced by various factors, including airway cooling, dehydration, increased exposure to allergens and pollutants, and intense physical exertion. The inflammatory responses in the airways of athletes with asthma are often unique, with increased airway sensitivity and reactivity. Factors such as increased ventilation, pollutants, allergens, and airway remodeling contribute to the high incidence of EIB in athletes. The diagnosis of asthma and EIB relies on clinical symptoms, peak expiratory flow measurements, and bronchoprovocation tests, including exercise challenge testing and methacholine challenges. These methods help establish airway hyperresponsiveness and assess the severity of bronchoconstriction. Diagnosis can be complicated by the need for multiple tests, as symptoms and airway responsiveness may fluctuate with training intensity. Treatment and management strategies for EIB in athletes are multifaceted and include both pharmacological and non-pharmacological approaches. Non-pharmacological strategies emphasize asthma education, environmental control, and exercise modification. Pharmacological interventions commonly include inhaled glucocorticoids, β2-agonists, leukotriene modifiers, and mast cell stabilizers. These treatments aim to manage symptoms, improve lung function, and reduce the occurrence of bronchoconstriction. Successful management requires a coordinated approach, involving healthcare providers, sports medicine professionals, and coaches, to ensure proper diagnosis, treatment adherence, and the continued participation of athletes in their chosen sports.

Airway hyperresponsiveness, a key feature of asthma, is associated with exercise-induced asthma. Tezepelumab was reported to reduce airway hyperresponsiveness. Tezepelumab was confirmed through 3-dimensional bronchial tree visualization to be effective for exercise-induced asthma, reducing the need for a short-acting β2 agonist.

Introduction The convergence of sports and health is a developing area, focusing on the therapeutic potential of physical activities in numerous chronic disease management strategies as a necessary part of a holistic strategy. Acknowledging sports as a therapeutic tool emphasizes the necessity for a comprehensive understanding of how sports engagement contributes to innovative healthcare interventions. Purpose This research aims to investigate the therapeutic potential of prescribing sports and physical exercise in treating primary chronic diseases, exploring its integration into health care practices with a focus on efficacy and implications for disease management. State of Knowledge Physical activity is recommended for treating diabetes, chronic obstructive pulmonary disease, asthma, and rheumatoid arthritis. It reduces the risk of cardiovascular disease and death, lowers blood pressure, ads prevents and manages atherosclerosis and osteoporosis. Non-physical sports like chess and board games also promise protection against dementia, depression, and Alzheimer's. Conclusions Incorporating sports into healthcare policies and prescribing personalized exercise are essential components of holistic chronic disease management and show widespread benefits. Professional guidance and clear recommendations, aligned with disease-specific guidelines, play a crucial role in ensuring safe and effective physical activity for patients. Potential risks in specific populations, particularly injury risks, can be minimized through proper preventive measures, adjusting the character of exercises, and heightened patient awareness. To ensure good compliance, exercise prescriptions should offer clear and precise guidelines. [ABSTRACT FROM AUTHOR]

Aim: Exercise test outdoors is widely used to diagnose asthma in children, but it is unclear how much outdoor air factors affect the results. Methods: We analysed 321 outdoor exercise challenge tests with spirometry in children 6–16 years conducted due to suspicion of asthma or for assessing the effect of medication on asthma. We studied the association of FEV1 decrease and incidence of exercise‐induced bronchoconstriction (EIB) with temperature, relative humidity (RH) and absolute humidity (AH). Results: Asthma was diagnosed in 57% of the subjects. AH ≥5 g/m3, but not RH or temperature, was associated with the EIB incidence (p = 0.035). In multivariable logistic regression, AH ≥5 g/m3 was negatively associated (OR = 0.51, 95% CI [0.28─0.92], p = 0.026) while obstruction before exercise (OR = 2.11, 95% CI [1.16─3.86], p = 0.015) and IgE‐mediated sensitisation were positively associated with EIB (OR = 2.24, 95% CI [1.11─4.51], p = 0.025). AH (r = −0.12, p = 0.028) and temperature (r = −0.13, p = 0.023) correlated with decrease in FEV1. In multivariable linear regression, only AH was associated with FEV1 decrease (coefficient = −0.044, 95% CI [−0.085 to −0.004], p = 0.033). Conclusion: AH of outdoor air associates with occurrence and severity of EIB in outdoor exercise tests in children. Care should be taken when interpreting negative outdoor exercise test results if AH of air is high. [ABSTRACT FROM AUTHOR]

Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. "Osmotic theory" and "thermal or vascular theory" have been proposed. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. Treatment options include both pharmacological and behavioral approaches. Considering medications, the use of short-acting beta-agonists (SABA) just before exercise is the commonest option strategy, but daily inhaled corticosteroids (ICS) can also be considered, especially when EIB is not controlled with SABA only or when the patients practice physical activity very often. Among the behavioral approaches, warm-up before exercise, breathing through the nose or face mask, and avoiding polluted environments are all recommended strategies to reduce EIB risk. This review summarizes the latest evidence published over the last 10 years on the pathogenesis, diagnosis using spirometry and indirect bronchoprovocation tests, and treatment strategies, including SABA and ICS, of EIB. A specific focus has been placed on EIB management in young athletes, since this condition can not only prevent them from practicing regular physical activity but also competitive sports. [ABSTRACT FROM AUTHOR]

Aquatic exercises are among the types of exercise most tolerated by people with asthma. Therefore, the objective of this study was to synthesize the evidence on the effects of aquatic exercise on lung function and quality of life in asthmatic patients. A systematic search encompassing the Medline, CINAHL, Cochrane Library, Embase, AMED, SPORTDiscus, and Physiotherapy Evidence Database databases was conducted to identify randomized controlled trials assessing the impact of aquatic exercise in comparison to control conditions or land-based exercise on lung function and quality of life in individuals diagnosed with asthma. The stages of selection, data extraction and methodological evaluation, and level of evidence of the manuscripts were carried out independently by two authors. Ten studies, comprising a total of 393 participants, were incorporated into this systematic review. Very low-quality evidence was found in favor of aquatic exercise in asthmatic patients for forced expiratory volume in 1 s (MD: 0.20 L, 95% CI: 0.02 L–0.38L N: 91) and for forced vital capacity (MD: 0.32 L, 95% CI: 0.08 L–0.56L N: 80). No effect of aquatic exercise was observed on the FEV1/FVC ratio (MD:1.11L, 95% CI: −1.28 L–3.49L N:80) compared with control. Only one study evaluated the effect of aquatic exercise on patients' quality of life. Improvements in lung function and quality of life in asthmatic patients undergoing aquatic exercise are not supported by high-quality evidence. The present findings will need to be confirmed by new, methodologically more rigorous clinical trials. The effect of aquatic exercise on pulmonary function and quality of life in asthma patients is still uncertain. The current quality of evidence for aquatic exercise in asthma patients is low. There is an urgent need for higher-quality studies investigating the effects of aquatic exercise among asthma patients. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic respiratory disease in children. It has a serious impact on children's physical and mental health. Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory disease, whose major components include breathing training, inspiratory muscle training and exercise training. Pulmonary rehabilitation is a multidisciplinary and comprehensive intervention for patients with chronic respiratory diseases, the main components of which are breathing training, inspiratory muscle training and exercise training. Pulmonary rehabilitation can improve the physical and mental condition of patients with chronic respiratory diseases and promote healthy behaviors. However, there is little research on pulmonary rehabilitation in children with asthma. This review comprehensively evaluated the effect of pulmonary rehabilitation in children with asthma at home and abroad, aiming to provide reference for clinical research on pulmonary rehabilitation in children with asthma. [ABSTRACT FROM AUTHOR]

Objective: To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH). Materials and Methods: Cross‐sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise‐induced bronchospasm compatible response (EIB‐cr) and 24 asthmatics with EIB‐cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH. Results: Twenty‐four (52.1%) of asthmatics had EIB‐cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB‐cr compared to nonasthmatics in the rectus abdominis area (p < 0.05). Conclusion: There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB‐cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to evaluate the accuracy of a combined airway inflammatory biomarker assessment in diagnosing asthma in elite water sports athletes. Methods: Members of the Hungarian Olympic and Junior Swim Team and elite athletes from other aquatic disciplines were assessed for asthma by objective lung function measurements, and blood eosinophil count (BEC), serum total immunoglobulin E (IgE), fractional exhaled nitric oxide (FENO) measurements, and skin prick testing were performed. A scoring system from BEC, FENO, serum IgE, and skin test positivity was constructed by dichotomizing the variables and assigning a score of 1 if the variable is elevated. These scores were summed to produce a final composite score ranging from0 to 4. Results: A total of 48 participants were enrolled (age 21 ± 4 yr, 42% male), of which 22 were diagnosed with asthma. Serum total IgE and FENO levels were higher in asthmatic individuals (68 [27-176] vs 24 [1-43], P = 0.01; 20 [17-26] vs 15 [11-22], P = 0.02), and positive prick test was also more frequent (55% vs 8%, P < 0.01). Asthmatic participants had higher composite variable scores (2 [1-3] vs 1 [0-1], P = 0.02). Receiver operating characteristic analysis showed that total IgE, FENO, and composite variable were suitable for identifying asthmatic participants (area under the curve = 0.72, P = 0.01; 0.70, P = 0.02, and 0.69, P = 0.03). A composite score of >2 reached a specificity of 96.2%, a sensitivity of 36.4%, and a likelihood ratio of 9.5. Logistic regression model revealed a strong association between the composite variable and the asthma diagnosis (OR = 2.71, 95% confidence interval = 1.17-6.23, P = 0.02). Conclusions: Our data highlight the diagnostic value of combined assessment of Th2-type inflammation in elite water sports athletes. The proposed scoring system may be helpful in ruling in asthma in this population upon clinical suspicion. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Respiratory, Critical Care, & Sleep Medicine is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.

The article "Nutritional and environmental exposures in athletes: Implications on the epithelial barrier function" discusses how modern lifestyle factors, such as exposure to pollutants and processed foods, can disrupt the protective epithelial barriers in athletes. The authors highlight that intense physical training and exposure to toxic substances can impair the epithelial barrier, leading to increased susceptibility to infections and chronic inflammatory diseases among athletes. They call for strategies to mitigate these harmful effects and repair the epithelial barrier tight junctions to improve athletes' overall health and sports performance. [Extracted from the article]

This article discusses a case report of a 36-year-old woman with chronic hand eczema and lymphedema. The patient experienced frequent flare-ups of lesions on her hands, which often led to infections and worsening lymphedema. After failed treatments with corticosteroids and alitretinoin, the patient was prescribed dupilumab, a monoclonal antibody, which resulted in significant improvement of the eczema, lymphedema, and episodes of lymphangitis. The article suggests that dupilumab may be an effective treatment option for severe chronic hand dermatitis associated with lymphedema. [Extracted from the article]

The article discusses the prevalence of exercise-induced bronchoconstriction (EIB) in athletes, particularly in the context of the Paris 2024 Olympic Games. It highlights the importance of treating EIB with daily inhaled corticosteroids to inhibit its effects and potentially achieve remission. The text also explores the similarities between EIB and asthma, emphasizing the need for objective monitoring and optimal treatment to improve respiratory health in athletes. The discussion on achieving 'remission' in severe asthma patients and the potential long-term benefits of inhibiting EIB with daily corticosteroids adds depth to the understanding of airway diseases in elite athletes. [Extracted from the article]

The article discusses the prevalence of exercise-induced bronchoconstriction (EIB) in adolescent recreational athletes and the challenges in diagnosing and managing this condition. Screening strategies, such as the use of FeNO levels and the AQUA questionnaire, are highlighted as potential tools for early detection of EIB. The study emphasizes the need for better screening methods to identify athletes with EIB and ensure appropriate management. Additionally, the correlation between atopy, asthma, and EIB is explored, with findings suggesting that atopy may be linked to underlying Type 2 inflammation. [Extracted from the article]

Swimming is a widely practiced exercise in modern society, where there is a heightened interest in health. The exceptional benefits of swimming are well-known, yet the issue of water quality management inevitably arises due to its nature as an aquatic exercise. Several studies reported that chlorine disinfectants commonly used in swimming pool water disinfection could degrade into toxic disinfection by-products (DBPs) and suggested that the DBPs might induce respiratory disorders, including asthma. Conversely, there were also reports that the DBPs had no significant effects on respiratory conditions. In this study, we investigated the influence of swimming exercise and DBPs on asthma. The decomposition products had little effect on the number of T cells in various immune organs. However, swimming exercise was found to increase the cell count in proportion to the exercise duration. Nevertheless, there were no significant changes in other immune cells and the secretion of asthma-related cytokines. These findings indicate that the effects of swimming pool DBPs on respiratory conditions during swimming exercise are either negligible or absent, and instead, the immunological benefits gained through consistent swimming exercise outweigh any potential drawbacks. [ABSTRACT FROM AUTHOR]

Background: Professional cycling puts significant demands on the respiratory system. Exercise-induced bronchoconstriction (EIB) is a common problem in professional athletes. Small airways may be affected in isolation or in combination with a reduction in forced expiratory volume at the first second (FEV1). This study aimed to investigate isolated exercise-induced small airway dysfunction (SAD) in professional cyclists and assess the impact of this phenomenon on exercise capacity in this population. Materials and Methods: This research was conducted on professional cyclists with no history of asthma or atopy. Anthropometric characteristics were recorded, the training age was determined, and spirometry and specific markers, such as fractional exhaled nitric oxide (FeNO) and immunoglobulin E (IgE), were measured for all participants. All of the cyclists underwent cardiopulmonary exercise testing (CPET) followed by spirometry. Results: Compared with the controls, 1-FEV3/FVC (the fraction of the FVC that was not expired during the first 3 s of the FVC) was greater in athletes with EIB, but also in those with isolated exercise-induced SAD. The exercise capacity was lower in cyclists with isolated exercise-induced SAD than in the controls, but was similar to that in cyclists with EIB. This phenomenon appeared to be associated with a worse ventilatory reserve (VE/MVV%). Conclusions: According to our data, it appears that professional cyclists may experience no beneficial impacts on their respiratory system. Strenuous endurance exercise can induce airway injury, which is followed by a restorative process. The repeated cycle of injury and repair can trigger the release of pro-inflammatory mediators, the disruption of the airway epithelial barrier, and plasma exudation, which gradually give rise to airway hyper-responsiveness, exercise-induced bronchoconstriction, intrabronchial inflammation, peribronchial fibrosis, and respiratory symptoms. The small airways may be affected in isolation or in combination with a reduction in FEV1. Cyclists with isolated exercise-induced SAD had lower exercise capacity than those in the control group. [ABSTRACT FROM AUTHOR]

Background: Asthma is a very common respiratory disorder, affecting more than 360 million people worldwide. It is a chronic inflammatory disorder of the airways with the symptoms of shortness of breath, coughing, chest tightness, wheezing, and sometimes chest pain. Leukotrienes play an important role in bronchoconstriction during the allergen or exercise-induced acute asthma attack. Aim: The study aims to predict the interactions between leukotriene antagonist drugs and CysLT receptor-1 (CysLTR1), P2Y12 and peroxisome proliferator-activated receptor gamma (PPAR-γ) on a competitive basis. The study also has the objective of understanding the cardioprotective roles of the drugs. Introduction: Asthma is strongly linked to the development of acute coronary syndrome by the leukotriene-induced activation of CysLTR1, platelet aggregation and thrombosis by activating P2Y12. PPAR-γ is considered to show benefits against atherosclerosis, diabetes, hypertension, obesity and dyslipidaemia, which are risk factors for the development of cardiovascular disorders. Leukotriene receptor inhibitors act with these three types of receptors to show therapeutic effects. Materials and Methods: To predict the possible interactions between the drugs and the receptors, the study has used in silico methods. Results and Discussion: Montelukast, Zafirlukast and Gemilukast are potential antagonists of CysLTR1 and P2Y12. They are also responsible for the upregulation of PPAR-γ. Thus, these drugs show a cardioprotective role in asthma-induced cardiac disorders. Conclusion: A competitive in silico study of Montelukast, Zafirlukast and Gemilukast to predict their binding to CysLTR1, P2Y12 & PPAR-γ revealed that Montelukast is more effective than the other two drugs for showing a cardioprotective role. [ABSTRACT FROM AUTHOR]

The impact of exercise-specific face masks (ESFMs) in aerobically fit individuals on physiological, perceptual, respiratory, and performance responses remains unclear. How ESFMs mitigate exercise-induced bronchoconstriction (EIB) is also unknown. Thus, this study aimed to determine how an ESFM altered within-exercise physiological, perceptual, respiratory, and performance responses to graded treadmill exercise. Twenty-four individuals (11 females) completed a discontinuous graded exercise test on a treadmill under two conditions (ESFM and unmasked). Physiological, respiratory function, and perceptual measures were assessed. Performance was determined by time to exhaustion. Statistical analyses included linear mixed-effects modeling, repeated measures analysis of variance, and pairwise comparisons using an alpha value of 0.05. ESFM use significantly impaired performance (median = −150.5 s) and decreased arterial oxygen saturation at maximal intensity (mean = −3.7%). Perceptions of air hunger and work of breathing were elevated across submaximal and maximal intensities. Perceived exertion and breathing discomfort were significantly elevated submaximally but not maximally. Spirometry measures were not significantly different at termination but were significantly improved at submaximal intensities in participants with and without EIB. ESFM use in fit individuals increased perceptual discomfort, impaired performance, and augmented arterial desaturation. Respiratory function improvements were observed but were accompanied by adverse perceptual sensations. Despite this, performance impairments may limit the real-world utility of ESFMs for athletes. [ABSTRACT FROM AUTHOR]

Asthma is a complex respiratory condition characterized by chronic airway inflammation and variable expiratory airflow limitation, affecting millions globally. Among athletes, particularly those competing at elite levels, the prevalence of respiratory conditions is notably heightened, varying between 20% and 70% across specific sports. Exercise-induced bronchoconstriction (EIB) is a common issue among athletes, impacting their performance and well-being. The prevalence rates vary based on the sport, training environment, and genetics. Exercise is a known trigger for asthma, but paradoxically, it can also improve pulmonary function and alleviate EIB severity. However, athletes' asthma phenotypes differ, leading to varied responses to medications and challenges in management. The unique aspects in athletes include heightened airway sensitivity, allergen, pollutant exposure, and temperature variations. This review addresses EIB in athletes, focusing on pathogenesis, diagnosis, and treatment. The pathogenesis of EIB involves complex interactions between physiological and environmental factors. Airway dehydration and cooling are key mechanisms, leading to osmotic and thermal theories. Airway inflammation and hyper-responsiveness are common factors. Elite athletes often exhibit distinct inflammatory responses and heightened airway sensitivity, influenced by sport type, training, and environment. Swimming and certain sports pose higher EIB risks, with chlorine exposure in pools being a notable factor. Immune responses, lung function changes, and individual variations contribute to EIB in athletes. Diagnosing EIB in athletes requires objective testing, as baseline lung function tests can yield normal results. Both EIB with asthma (EIBA) and without asthma (EIBwA) must be considered. Exercise and indirect bronchoprovocation tests provide reliable diagnoses. In athletes, exercise tests offer effectiveness in diagnosing EIB. Spirometry and bronchodilation tests are standard approaches, but the diagnostic emphasis is shifting toward provocation tests. Despite its challenges, achieving an optimal diagnosis of EIA constitutes the cornerstone for effective management, leading to improved performance, reduced risk of complications, and enhanced quality of life. The management of EIB in athletes aligns with the general principles for symptom control, prevention, and reducing complications. Non-pharmacological approaches, including trigger avoidance and warming up, are essential. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy in athletes. Short-acting beta agonists (SABA) are discouraged as sole treatments. Leukotriene receptor antagonists (LTRA) and mast cell stabilizing agents (MCSA) are potential options. Optimal management improves the athletes' quality of life and allows them to pursue competitive sports effectively. [ABSTRACT FROM AUTHOR]

Introduction The convergence of sports and health is a developing area, focusing on the therapeutic potential of physical activities in numerous chronic disease management strategies as a necessary part of a holistic strategy. Acknowledging sports as a therapeutic tool emphasizes the necessity for a comprehensive understanding of how sports engagement contributes to innovative healthcare interventions. Purpose This research aims to investigate the therapeutic potential of prescribing sports and physical exercise in treating primary chronic diseases, exploring its integration into healthcare practices with a focus on efficacy and implications for disease management. State of Knowledge Physical activity is recommended for treating diabetes, chronic obstructive pulmonary disease, asthma, and rheumatoid arthritis. It reduces the risk of cardiovascular disease and death, lowers blood pressure, ads prevents and manages atherosclerosis and osteoporosis. Non-physical sports like chess and board games also promise protection against dementia, depression, and Alzheimer's. Conclusions Incorporating sports into healthcare policies and prescribing personalized exercise are essential components of holistic chronic disease management and show widespread benefits. Professional guidance and clear recommendations, aligned with disease-specific guidelines, play a crucial role in ensuring safe and effective physical activity for patients. Potential risks in specific populations, particularly injury risks, can be minimized through proper preventive measures, adjusting the character of exercises, and heightened patient awareness. To ensure good compliance, exercise prescriptions should offer clear and precise guidelines.

Objective: The prevalence of exercise-induced laryngeal obstruction is largely unknown. This study aimed to evaluate the prevalence of this condition in a selected study population of patients with exercise-induced dyspnoea. Method: A retrospective analysis was conducted of demographic data, co-morbidities, medication, symptoms, performance level of sporting activities, continuous laryngoscopy exercise test results and subsequent treatment. Results: Data from 184 patients were analysed. The overall prevalence of exercise-induced laryngeal obstruction in the study population was 40 per cent, and the highest prevalence was among females aged under 18 years (61 per cent). However, a high prevalence among males aged under 18 years (50 per cent) and among adults regardless of gender (34 per cent) was also found. Conclusion: The prevalence of exercise-induced laryngeal obstruction is clinically relevant regardless of age and gender. Clinicians are encouraged to consider exercise-induced laryngeal obstruction as a possible diagnosis in patients suffering from exercise-induced respiratory symptoms. No single characteristic that can distinguish exercise-induced laryngeal obstruction from other similar conditions was identified. [ABSTRACT FROM AUTHOR]

Spontaneous pneumomediastinum (SPM) is a rare but described complication of exercise-induced bronchoconstriction (EIB), more commonly observed in children with asthma. We present a 23-year-old active duty military male and avid distance runner who developed progressive radiating retrosternal chest pain preceded by wheezing and coughing paroxysm. A chest computed tomography revealed extensive pneumomediastinum. SPM results from increased intrathoracic pressure with alveolar rupture and subsequent tracking of air between fascial planes. Like most cases of SPM, our patient remained hemodynamically stable and responded well to conservative therapies with complete resolution. After thorough evaluation, undiagnosed asthma was determined to be the inciting etiology. The patient is now well controlled and symptom free on a daily low-dose inhaled corticosteroid without SPM reoccurrence. In young adult patients presenting with SPM, EIB and asthma should be considered on the differential diagnosis as appropriate medical therapy will improve symptoms and reduce risk of reoccurrence. [ABSTRACT FROM AUTHOR]

Athletes often experience lower airway dysfunction, such as asthma and exercise‐induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti‐doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti‐doping regulations. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this pilot study was to examine potential differences in motor competence (MC) and physical activity (PA) between children with and without asthma. Methods: Thirty-seven children and adolescents completed the Exercises for a Healthy Asthma Lifestyle and Enjoyment study (46% with asthma, 51% female, 11.1 ± 0.4 years, and 46% White). Motor competence was assessed using the Movement Assessment Battery for Children 2nd edition (MABC-2). PA was assessed using accelerometry. Results: Children with asthma had significantly lower MC in the domain of aiming and catching (with asthma: 8.2 ± 0.4 vs. without asthma: 9.9 ± 0.5; p = 0.03) and fewer daily minutes spent in moderate-to-vigorous PA (MVPA) (with asthma: 18.0 ± 2.3 min vs. without asthma: 27.2 ± 3.6 min; p = 0.047). There were no significant group differences in manual dexterity, balance, total MABC-2 score, or total daily PA (all ps > 0.05). Conclusions: This study provides confirmatory evidence that children with asthma display lower MC and spend less time in MVPA compared to children without asthma. Because MC is a prerequisite for engaging in PA, future research should seek to determine if the differences observed in MC contribute to disparities in MVPA observed in this clinical population. [ABSTRACT FROM AUTHOR]

Most children with asthma respond well to low-dose inhaled corticosteroids, sometimes with the addition of a long-acting β-2 agonist. Failure to respond is usually because either the diagnosis is wrong or they are not taking their treatment. If the diagnosis truly is asthma and the child is not responding, then, instead of prescribing ever more and higher doses of medications, a complete review to determine what it is about the child and their asthma which is making treatment response suboptimal should be undertaken. The factors to be considered in such a review include adherence, adverse environmental factors and psychosocial influences, and relevant co-morbidities such as obesity and exercise-induced laryngeal obstruction. Such a review means that most children referred for the consideration of biological therapy can in fact be managed with standard treatment approaches. Adherence may be improved by simplifying the regime - for example, the single inhaler for reliever and treatment approach or a once-daily treatment combined with directly observed therapies. In the rare cases of children with true therapy-resistant asthma, a range of expensive injectable biologicals may help, but the need for these is the exception. Sadly, the most common cause of non-responsive asthma globally remains that the medications are either inaccessible or too expensive. [ABSTRACT FROM AUTHOR]

Exercise-induced bronchoconstriction (EIB) is the most common chronic disease among elite athletes and when left untreated, can impact both respiratory health and sports performance. In recent years, there has been an increase in the awareness and detection of EIB in elite athletes. This narrative review aims to evaluate the risk, prevention, diagnosis, medication, and anti-doping policies of EIB in elite athletes, and to provide more references for athletes with EIB. The results showed that athletes of endurance, winter, and water sports generally have a higher prevalence of EIB than athletes of other sports. Adaptive warm-up before formal exercise and using heat exchange masks at low temperatures are effective ways for athletes to prevent EIB. For physicians, the exercise challenge test and eucapnic voluntary hyperpnea are the recommended diagnostic methods for EIB in athletes. The treatment of athletes with EIB is medication-based, such as inhaled corticosteroids and beta-2 agonists, but current anti-doping policies should be considered when used. [ABSTRACT FROM AUTHOR]

The letter published in the Annals of the American Thoracic Society discusses postdeployment respiratory health (PDRH) in young, active-duty service members. The authors challenge the focus on lung injury as the primary cause of dyspnea and exercise intolerance, suggesting other factors like laryngeal disorders, deconditioning, and obesity may play a significant role. They recommend a comprehensive evaluation for veterans with postdeployment respiratory symptoms to identify treatable contributors to dyspnea. The authors emphasize the importance of considering a wide range of potential causes for postdeployment respiratory issues beyond lung injury. [Extracted from the article]

Exercise‐induced bronchoconstriction (EIB) is usually assessed by changes in forced expiratory volume in 1 s (FEV1) which is effort dependent. The purpose of this study was to determine whether the diaphragm electromyogram (EMGdi) recorded from chest wall surface electrodes could be used to reflect changes in airway resistance during an exercise challenge test and to distinguish patients with EIB from those without EIB. Ninety participants with or without asthma history were included in the study. FEV1 was recorded before and 5, 10, 15, and 20 min after exercise. EIB was defined as an FEV1 decline greater than 10% after exercise. A ratio of root mean square of EMGdi to tidal volume (EMGdi/VT) was used to assess changes in airway resistance. Based on changes in FEV1, 25 of 90 participants exhibited EIB; the remainder were defined as non‐EIB participants. EMGdi/VT in EIB increased by 124% (19%–478%) which was significantly higher than that of 21% (−39% to 134%) in non‐EIB participants (p < 0.001). At the optimal cutoff point (54% in EMGdi/VT), the area under the ROC curve (AUC) for detection of a positive test was 0.92 (p < 0.001) with sensitivity 92% and specificity 88%. EMGdi/VT can be used to assess changes in airway resistance after exercise and could be used to distinguish participants with EIB from those without EIB. [ABSTRACT FROM AUTHOR]

Combined exposure to the alarmins TSLP, IL-33 and IL-25 enhances mast cell-dependent contractions of human bronchi Keywords: airway hyperresponsiveness; anti-IgE; asthma; histamine; IL-33; prostaglandin D2; TSLP EN airway hyperresponsiveness anti-IgE asthma histamine IL-33 prostaglandin D2 TSLP 1062 1066 5 10/09/23 20231001 NES 231001 Key Messages Combined pretreatment with TSLP, IL-33 and IL-25 (epithelial alarmins) enhanced IgE-triggered contraction in isolated human bronchi. The release of histamine in response to IgE-mediated stimulation increased only in the alarmin mix pretreated group, indicating that, as shown for PGD SB 2, sb the alarmin mix enhanced the IgE-triggered release of histamine, presumably by increasing mast cell reactivity. Airway hyperresponsiveness, asthma, histamine, IL-33, anti-IgE, TSLP, prostaglandin D2. [Extracted from the article]

Exercise-induced bronchospasm (EIB) is a respiratory condition that causes temporary airflow obstruction during or after physical exercise. It is important to note that not everyone with EIB has asthma. Symptoms of EIB include difficulty breathing, coughing, wheezing, shortness of breath, and chest pain. The severity of bronchospasm depends on factors such as the air's ventilation, temperature, and humidity. Diagnosis of EIB can be done through challenge tests, and treatment options include preventive therapy and regular asthma treatment. It is crucial to differentiate EIB from other conditions like vocal cord dysfunction and gastroesophageal reflux disease (GERD). The article also discusses digestive symptoms associated with GERD, such as postprandial regurgitation and rumination syndrome. GERD can also cause respiratory disorders like otitis media, asthma, and chronic cough. The article provides information on non-pharmacological and pharmacological treatments for these conditions, including the use of short-acting ß2 agonists and leukotriene inhibitors. It emphasizes the importance of proper diagnosis and management, especially in athletes and teenagers who may be hesitant to use medication. [Extracted from the article]