Abstract
The use of short-acting beta-2 agonists (SABAs) is more common in elite athletes than in the general population, especially in endurance sports. The World Anti-Doping Code places some restrictions on prescribing inhaled β2-agonists. These drugs are used in respiratory diseases (such as asthma) that might reduce athletes’ performances. Recently, studies based on the results of the Olympic Games revealed that athletes with confirmed asthma/airway hyperresponsiveness (AHR) or exercise-induced bronchoconstriction (EIB) outperformed their non-asthmatic rivals. This overuse of SABA by high-level athletes, therefore, raises some questions, and many explanatory hypotheses are proposed. Asthma and EIB have a high prevalence in elite athletes, especially within endurance sports. It appears that many years of intensive endurance training can provoke airway injury, EIB, and asthma in athletes without any past history of respiratory diseases. Some sports lead to a higher risk of asthma than others due to the hyperventilation required over long periods of time and/or the high environmental exposure while performing the sport (for example swimming and the associated chlorine exposure). Inhaled corticosteroids (ICS) have a low efficacy in the treatment of asthma and EIB in elite athletes, leading to a much greater use of SABAs. A significant proportion of these high-level athletes suffer from non-allergic asthma, involving the th1-th17 pathway.
Highlights
Regular physical activity is associated with better asthma control
Beta-adrenergic agonists could be effective at treating and preventing exercise-induced bronchoconstriction (EIB) in the highperformance athlete [7,29]. Their efficacy may be due to their bronchodilator effects and their effects on acute inflammation, even if overuse of short-acting beta-2 agonists (SABA) is known to be associated with increased risk of exacerbation and mortality in asthma [68]
This study showed that the opposite is true when combining an adrenergic beta-agonist and an inhaled corticosteroid (Budesonide and Fluticasone): in that case, there is no apoptotic effect on neutrophils [71]
Summary
Regular physical activity is associated with better asthma control. Our society encourages people to take part in sports, which helps to reduce the incidences of chronic diseases and allows patients with these diseases to maintain a better quality of life. Physical exercise has a beneficial effect on the quality of life of asthma patients [2–4]. There is a higher prevalence of the use of medication for the treatment of asthma, short-acting beta-2 agonists (SABA), in elite athletes than in the general population. Data collected among athletes at the Atlanta, Sydney, and Athens Olympic Games show significant use of short-acting adrenergic agonists in elite athletes (e.g., 15% of cyclists, 11% of swimmers, and 16% of speed skaters) [7]. This overconsumption involves only endurance sports as only 2.2% of tennis and handball and 1.1% of gymnastics athletes use them.
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