Exercise-Induced Bronchoconstriction in Healthy Athletes-To the Editor

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In the article “Exercised-Induced Asthma in Figure Skaters” by Mannix and colleagues (February 1996),1Mannix ET Farber MO Palange P et al.Exercise-induced asthma in figure skaters.Chest. 1996; 109: 312-315Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar the authors state that similar studies have not been published. Two years ago our group published a paper on the bronchoconstrictor effect of strenuous exercise at low temperatures in healthy athletes (members of the Dutch speed skating team) participating in world championships and Olympic games.2Paul DW Bogaard JM Hop WC. The bronchoconstrictor effect of strenuous exercise at low temperatures in normal athletes.Int J Sports Med. 1993; 14: 433-436Crossref PubMed Scopus (22) Google Scholar Our investigation was focused on the exercise-induced bronchoconstriction occurring after a 2-min 1.500-m race. Usually the athletes complained of subjective variants of exercise-induced bronchoconstriction such as coughing (“the 1.500-m cough”), chest tightness, and excessive mucus production. Peak expiratory flow (PEF) measurements were performed at 3,10, 20, 60, 90, and 120 min after the race. A significant decrease in PEF was found at 10, 90, and 120 min when measured in Calgary (Canada) and at 90 and 120 min when measured in The Hague (Netherlands). This decrease in PEF could not be explained by daily variations measured in resting conditions (Fig 1). In contradiction with the study of Mannix et al, the decline in PEF was gradual.A possible explanation for our results could be the strong drying influence of cold air and the accompanying temperature loss in the airways, stimulating vagal nerve activity, not only causing the cough and mucus production but also a gradually increasing minor bronchoconstriction.Usually in exercise-induced bronchoconstriction the largest fall in FEV1 occurs between 7 and 15 min postexercise,3Anderson SD. Exercise-induced asthma: stimulus, mechanism and management.Asthma: basic mechanisms and clinical management. Acad Press Ltd, London, United Kingdom1988: 503-522Google Scholar immediately followed by a rise in FEV1. This last increase in FEV1, however, is not present in the study of Mannix et al. This suggests in their asthmatic athletes at least some of the same mechanism as we have postulated. It would be of interest to know whether these athletes also show a decrease in the histamine or methacholine PC20, which are other markers of bronchial hyperreactivity. In the article “Exercised-Induced Asthma in Figure Skaters” by Mannix and colleagues (February 1996),1Mannix ET Farber MO Palange P et al.Exercise-induced asthma in figure skaters.Chest. 1996; 109: 312-315Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar the authors state that similar studies have not been published. Two years ago our group published a paper on the bronchoconstrictor effect of strenuous exercise at low temperatures in healthy athletes (members of the Dutch speed skating team) participating in world championships and Olympic games.2Paul DW Bogaard JM Hop WC. The bronchoconstrictor effect of strenuous exercise at low temperatures in normal athletes.Int J Sports Med. 1993; 14: 433-436Crossref PubMed Scopus (22) Google Scholar Our investigation was focused on the exercise-induced bronchoconstriction occurring after a 2-min 1.500-m race. Usually the athletes complained of subjective variants of exercise-induced bronchoconstriction such as coughing (“the 1.500-m cough”), chest tightness, and excessive mucus production. Peak expiratory flow (PEF) measurements were performed at 3,10, 20, 60, 90, and 120 min after the race. A significant decrease in PEF was found at 10, 90, and 120 min when measured in Calgary (Canada) and at 90 and 120 min when measured in The Hague (Netherlands). This decrease in PEF could not be explained by daily variations measured in resting conditions (Fig 1). In contradiction with the study of Mannix et al, the decline in PEF was gradual. A possible explanation for our results could be the strong drying influence of cold air and the accompanying temperature loss in the airways, stimulating vagal nerve activity, not only causing the cough and mucus production but also a gradually increasing minor bronchoconstriction. Usually in exercise-induced bronchoconstriction the largest fall in FEV1 occurs between 7 and 15 min postexercise,3Anderson SD. Exercise-induced asthma: stimulus, mechanism and management.Asthma: basic mechanisms and clinical management. Acad Press Ltd, London, United Kingdom1988: 503-522Google Scholar immediately followed by a rise in FEV1. This last increase in FEV1, however, is not present in the study of Mannix et al. This suggests in their asthmatic athletes at least some of the same mechanism as we have postulated. It would be of interest to know whether these athletes also show a decrease in the histamine or methacholine PC20, which are other markers of bronchial hyperreactivity.