Abstract
Asthma is highly prevalent among winter endurance athletes. This “occupational disease” of cross-country skiers, among others, was acknowledged during the 1990s, with the pathogenesis attributed to repeated and prolonged exposure to cold, dry air combined with high rates of ventilation during exercise. Nevertheless, more than 25 years later, the prevalence of asthma among Scandinavian cross-country skiers is unchanged, and prevention remains a primary concern for sports physicians. Heat-and-moisture-exchanging breathing devices (HMEs) prevent exercise-induced bronchoconstriction in subjects with pre-existing disease and may have potential as a preventative intervention for healthy athletes undertaking training and competition in winter endurance sports. Herein we firstly provide an overview of the influence of temperature and humidity on airway health and the implications for athletes training and competing in sub-zero temperatures. We thereafter describe the properties and effects of HMEs, identify gaps in current understanding, and suggest avenues for future research.
Highlights
Athletes training and competing outdoors will, most likely, be periodically exposed to cold, and sometimes sub-zero air
Exposure to cold air is associated with increased morbidity and mortality in the general population (Rocklöv and Forsberg, 2008)
A recent study found that experimental exposure to sub-zero temperatures at rest and when performing light exercise elicited 50 distinct symptoms among healthy subjects and patients with obstructive lung disease (Sjöström et al, 2019)
Summary
Athletes training and competing outdoors will, most likely, be periodically exposed to cold, and sometimes sub-zero air. Cold climates can present a challenge to facilitate physical activity from a public health perspective, and individuals who habitually undertake physical activity in cold environments may experience airway symptoms and/or morbidity as a result of their training Winter endurance athletes, such as cross-country skiers, frequently undertake prolonged exercise in cold environments and report an increased prevalence of airway symptoms, bronchial hyper-reactivity and asthma (Carlsen et al, 2008). A handful of studies have shown that elite cross-country skiers, including those with and without asthma, display markers of chronic airway inflammation and damage to the airway epithelial lining These studies report increased bronchoalveolar and/or mucosal infiltration of eosinophils, neutrophils, macrophages, mast cells, and lymphoid aggregates in athletes training in cold climates compared to healthy controls, but fewer eosinophils and mast cells and more neutrophils than in subjects with asthma (Sue-Chu et al, 1998, 1999; Karjalainen et al, 2000). A more recent longitudinal study of female cross-country skiers over the course of a training season reported an increase in sputum eosinophils and lymphocytes between the beginning of the training year (late spring) and the peak of the winter competitive
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