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Annals of Physical and Rehabilitation... Jun 2022Healthy trained athletes generally have an "overbuilt" respiratory system in order to face the huge ventilation and gas-exchange demand imposed by strenuous exercise.... (Review)
Review
BACKGROUND
Healthy trained athletes generally have an "overbuilt" respiratory system in order to face the huge ventilation and gas-exchange demand imposed by strenuous exercise. Athletes frequently complain of respiratory symptoms regardless of whether they have a diagnosed respiratory disease, therefore evoking a kind of respiratory limitation during exercise. Some respiratory pathologies athletes present are closely linked to exercise and include asthma, exercise-induced bronchoconstriction (EIB) or exercise-induced laryngeal obstruction. Management of asthma and EIB are mainly based on pharmacological treatments. However, many athletes still complain of respiratory symptoms despite optimal pharmacological treatments, which highlights the need for non-pharmacological approaches including breathing retraining, inspiratory muscle training and/or laryngeal exercise performed under the guidance of a physiotherapist in this specific population.
OBJECTIVES
With this literature overview, we aimed to report evidence supporting the interest of rehabilitation for athletes with respiratory disorders and discuss whether inspiratory muscle training programs can improve performance in healthy athletes.
METHODS
We searched MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing respiratory rehabilitation and muscle training programs in athletes by using the MesH terms "athletes", "asthma", "dyspnea", "rehabilitation" and "education" published from January 2010 to March 2020. The selection of articles was based on the author's expertise to elaborate this review of the literature.
RESULTS
Major findings suggest that breathing retraining may help asthmatic athletes better control their respiratory symptoms and that inspiratory muscle training may improve respiratory symptoms of exercise-induced laryngeal obstruction in athletes. Improvement of performance by respiratory muscle training still remains controversial.
CONCLUSIONS
Respiratory rehabilitation could be of interest in the specific population of athletes but should be further evaluated to improve the level of evidence of such strategies.
Topics: Asthma; Asthma, Exercise-Induced; Athletes; Bronchoconstriction; Dyspnea; Humans; Respiratory Tract Diseases
PubMed: 33271343
DOI: 10.1016/j.rehab.2020.101461 -
Respirology (Carlton, Vic.) Jun 2019
Topics: Body Mass Index; Bronchoconstriction; Humans; Lung; Obesity
PubMed: 30897266
DOI: 10.1111/resp.13532 -
Prevalence of exercise-induced bronchoconstriction and laryngeal obstruction in adolescent athletes.Pediatric Pulmonology Dec 2020To study the prevalence of exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) in adolescent athletes.
OBJECTIVES
To study the prevalence of exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) in adolescent athletes.
METHODS
All adolescents (n = 549) attending first year at a sports high school in 2016 and 2017, were invited to answer a questionnaire on respiratory symptoms. The 367 responding participants were divided into two groups based on whether they reported exercise-induced dyspnea (dyspnea group) or not (nondyspnea group). Randomly selected participants in each group were invited to undergo two standardized exercise tests, an EIB test and a continuous laryngoscopy exercise (CLE) test, to investigate EILO.
RESULTS
In total, 98 participants completed an EIB test, 75 of whom also completed a CLE test. Positive EIB tests: eight of 41 in the dyspnea group and 16 of 57 in the nondyspnea group. Positive CLE tests: 5 of 34 in the dyspnea group and three of 41 in the nondyspnea group. The estimated prevalence of EIB was 23.1% (95% confidence interval [CI]: 14.5-33.8) and of EILO 8.1% (95% CI: 2.5-18.5) in the whole study population. No differences in prevalence of EIB or EILO were found between the dyspnea and the nondyspnea groups.
CONCLUSION
EIB was highly prevalent in this cohort of adolescent athletes. EILO was less prevalent, but represents an important differential diagnosis to EIB. Self-reported exercise-induced dyspnea is a weak indicator for both EIB and EILO and standardized testing should be provided.
Topics: Adolescent; Airway Obstruction; Asthma, Exercise-Induced; Athletes; Bronchoconstriction; Diagnosis, Differential; Dyspnea; Exercise; Exercise Test; Female; Humans; Laryngeal Diseases; Laryngoscopy; Male; Prevalence; Surveys and Questionnaires
PubMed: 33002318
DOI: 10.1002/ppul.25104 -
Respirology (Carlton, Vic.) Nov 2019
Topics: Airway Remodeling; Allergens; Asthma; Bronchoconstriction; Humans; Lung
PubMed: 31216084
DOI: 10.1111/resp.13625 -
The European Respiratory Journal Oct 1995Airflow-induced bronchoconstriction (AIB) in mammals can be broadly categorized as either vagal-dependent or vagal-independent. Among mammals, rabbits and cats belong to... (Review)
Review
Airflow-induced bronchoconstriction (AIB) in mammals can be broadly categorized as either vagal-dependent or vagal-independent. Among mammals, rabbits and cats belong to the former and guinea-pigs belong to the latter categories. Although insufficient data are available to classify monkeys, dogs and man appear to occupy the middle ground in which a small but significant parasympathetic component modulates airflow-induced bronchoconstriction. The fact that vagal activity can only partially account for airflow-induced bronchoconstriction in some asthmatic subjects suggests that vagal-dependent models may be of limited value in studying the human condition, but should prove valuable in elucidating the parasympathetic component of this mechanism. Although airflow-induced bronchoconstriction appears to be remarkably similar in guinea-pigs, dogs and humans, there are important differences concerning the potential role of specific mediators in producing airflow limitation. Concordant data from animal models and man suggest that: 1) airflow-induced bronchoconstriction is a basic mammalian response to airway desiccation; 2) airway drying stimulates and cooling inhibits this response; 3) hyperpnoea with dry air may damage the bronchial mucosa and contribute to this response; 4) biochemical mediators contribute to the development of this response; 5) vascular engorgement and airway oedema do not appear to be the primary effectors of this response, and in fact may antagonize it; 6) airway smooth muscle constriction is involved in the production of airflow-induced bronchoconstriction, and airway oedema may enhance its effect; and 7) airway and vascular responses to dehydration may protect against acute dry air-induced mucosal injury. Finally, although one must be cautious in extrapolating results from animals to humans, the similarities that do exist suggest that the investigation of airflow-induced bronchoconstriction in carefully selected animal models will continue to provide new insights concerning its development in humans.
Topics: Animals; Asthma, Exercise-Induced; Bronchoconstriction; Disease Models, Animal; Humans
PubMed: 8586137
DOI: 10.1183/09031936.95.08101770 -
Polskie Archiwum Medycyny Wewnetrznej Nov 2009There are no standardized methods to demonstrate in-vivo bioequivalence of inhaled bronchodilators. The most practical method of showing therapeutic equivalence in vivo... (Review)
Review
There are no standardized methods to demonstrate in-vivo bioequivalence of inhaled bronchodilators. The most practical method of showing therapeutic equivalence in vivo is by estimating their relative potencies (RP) in clinical efficacy studies. The RP of bronchodilators may be estimated by comparing either their bronchodilator or bronchoprotective properties. Bronchodilator studies are easier to perform and may better model the physiologic effect of many agents, including inhaled beta-agonists. However, it may be difficult to demonstrate steep dose-response for these outcomes, except in cumulative study designs. Bioequivalence trials may be especially challenging when involving pressurized metered-dose inhalers, as a single actuation - the lowest feasible dose to include in the evaluation, may already produce bronchodilation that is at or near the plateau of the dose-response curve. Protection against bronchoconstriction induced by a direct inhaled stimulus like methacholine or histamine affords a reliable and practical method of comparing inhaled bronchodilators and estimating their RP. Inhalational bronchoprovocation testing allows for easier repeatability and quantitation of the stimulus necessary to produce a predetermined degree of bronchoconstriction, and the degree of protection afforded by the bronchoprotection agent. RP studies using adequate methodology are necessary to compare long-acting bronchodilators and both short- and long-acting bronchodilators in patients who are also on inhaled corticosteroids.
Topics: Administration, Inhalation; Asthma; Bronchoconstriction; Bronchodilator Agents; Dose-Response Relationship, Drug; Equipment Design; Humans; Metered Dose Inhalers; Technology Assessment, Biomedical; Therapeutic Equivalency
PubMed: 19920798
DOI: No ID Found -
Respiratory Physiology & Neurobiology Jan 2019To clarify the potential of dopamine to alter airway tone in the presence of different bronchoconstrictor stimuli, changes in airway function following dopamine...
To clarify the potential of dopamine to alter airway tone in the presence of different bronchoconstrictor stimuli, changes in airway function following dopamine administrations were characterized when the bronchial tone was elevated by stimulating the histaminic or cholinergic pathway. Airway resistance, tissue damping and tissue elastance were measured in anesthetized mechanically ventilated rabbits under baseline conditions, during steady-state bronchoconstriction induced by methacholine or histamine, and following intravenous dopamine (5 and 15 μg/kg/min). Bronchoconstriction induced by methacholine and histamine was significantly ameliorated by dopamine (14.8 ± 2.9% and 14.9 ± 2.9%; p < 0.05 for both), with no difference between the mode of stimuli. Dopamine had no effect on the tissue mechanics. These findings indicate that dopamine relaxes the elevated airway smooth muscle tone without affecting the lung periphery, and this effect is independent of the mode of constrictor stimuli. This profile of dopamine suggests its ability to treat effectively cholinergic and histaminergic bronchoconstriction, besides its positive inotropic effects on the myocardial contractility.
Topics: Airway Resistance; Animals; Blood Pressure; Bronchoconstriction; Dopamine; Heart Rate; Histamine; Methacholine Chloride; Muscarinic Agonists; Muscle, Smooth; Rabbits; Respiratory Mechanics
PubMed: 30367990
DOI: 10.1016/j.resp.2018.10.006 -
British Journal of Pharmacology Sep 2020Cough is an adverse effect that may hinder the delivery of drugs into the lungs. Chemical or mechanical stimulants activate the transient receptor potential in some... (Review)
Review
Cough is an adverse effect that may hinder the delivery of drugs into the lungs. Chemical or mechanical stimulants activate the transient receptor potential in some airway afferent nerves (C-fibres or A-fibres) to trigger cough. Types of inhaler device and drug, dose, excipients and formulation characteristics, including pH, tonicity, aerosol output and particle size may trigger cough by stimulating the cough receptors. Release of inflammatory mediators may increase the sensitivity of the cough receptors to stimulants. The cough-provoking effect of aerosols is enhanced by bronchoconstriction in diseased airways and reduces drug deposition in the target pulmonary regions. In this article, we review the factors by which inhalation products may cause cough.
Topics: Administration, Inhalation; Aerosols; Bronchoconstriction; Cough; Humans; Lung; Particle Size
PubMed: 32668011
DOI: 10.1111/bph.15197 -
Thorax Mar 1993
Topics: Asthma; Bronchi; Bronchial Provocation Tests; Bronchoconstriction; Dinoprostone; Diuretics; Furosemide; Humans
PubMed: 8497813
DOI: 10.1136/thx.48.3.195 -
Thorax Jun 1992
Topics: Asthma; Bronchoconstriction; Humans; Perception
PubMed: 1496496
DOI: 10.1136/thx.47.6.408