Effect of Pharmacological Treatment on Exercise-Induced Bronchoconstriction and Allergic Inflammatory Response in Endurance Athletes.

BACKGROUND

Endurance athletes (EA) with lung disease and allergic inflammation have worse performance.

PURPOSE: To examine whether pharmacological treatment can reduce airway disorders such as exercise-induced bronchoconstriction (EIB) and allergic inflammatory response (AIR) in EA.

STUDY

DESIGN

Prospective, controlled clinical trial.

METHODS

EA who were marathon runners underwent eucapnic voluntary hyperventilation (EVH) for screening assessment. EA who fulfilled the criteria for an EIB+ after an EVH were included in the treatment group (EIB+; n=13), and those who did not were included in the control group (CON; n=18). The athletes were assessed before and 30 days after the intervention. Outcomes included cardiopulmonary exercise testing, lung function, allergic symptoms (allergic questionnaire for athletes [AQUA©]), AIR (T helper [Th]-1, Th2, and Th17 lymphocytes in cell cultures), inflammatory mediator expression, salivary immunoglobulin (Ig)A, blood cortisol, blood IgE levels, and airway inflammation (fraction exhaled nitric oxide [FeNO]). Both groups were advised to keep the same training routine, and only the EIB+ received pharmacological treatment with inhaled corticosteroids (400-800 mcg/day) and long-acting bronchodilators (12 mcg/day). The CON and EIB+ groups underwent the same assessments after the intervention and were compared pre- and post-intervention, and effect sizes were calculated.

RESULTS

EIB+ (males, age 28.1±7.4 years, BMI 20.3±1.0 kg/m2) CON (males, age 29.8±6.5 years, BMI 20.5±1.6 kg/m2) participated. At baseline, the O2 peak, lung function, allergic symptoms, IgE, IgA, FeNO levels, and AIR were not significancly different between groups (p>0.05). After pharmacological treatment, only the EIB+ group showed a decrease in EIB (p<0.001) and an increase in VO2peak compared to baseline (p<0.05). However, no difference was observed in the expression of inflammatory mediators (p>0.05).

CONCLUSION

Pharmacological treatment reduces EIB and increases the aerobic perforance/fitness in endurance athletes. These benefits occur without modification of the AIR.

LEVEL OF EVIDENCE: Level II- Prospective Comparative Study.