Asthma in Elite Athletes - Do They Have Type 2 or Non-Type 2 Disease? A New Insight on the Endotypes Among Elite Athletes

Overview

Journal Front Allergy

Specialty Allergy & Immunology

Date 2022 Nov 7

PMID 36340019

Authors

Soren Malte Rasmussen

Erik Soren Halvard Hansen

Vibeke Backer

Affiliations

Soon will be listed here.

Abstract

Asthma and exercise-induced bronchoconstriction are highly prevalent in elite athletes compared with the general population. Some athletes have classic asthma with allergic sensitization; however, it seems that a proportion of athletes develop asthma as a result of several years of intensive training. It leads us to believe that asthma in athletes consists of at least two distinct endotypes - classic early-onset, Type 2 mediated asthma, and asthma with later onset caused by exercise which might be classified as non-Type 2 asthma. The purpose of this review is to evaluate the current literature on asthma in athletes focusing on inflammation and examine if asthma in athletes could be characterized as either Type 2- or non-Type 2 asthma.

Citing Articles

Health status of senior netball players, their medication use and attitudes towards doping.

de Abreu M, Nolte K, van Rensburg D, Swart X Front Sports Act Living. 2024; 6:1436080.

PMID: 39346496 PMC: 11438481. DOI: 10.3389/fspor.2024.1436080.

Phenotypes and Endotypes in Asthma.

McIntyre A, Viswanathan R Adv Exp Med Biol. 2023; 1426:119-142.

PMID: 37464119 DOI: 10.1007/978-3-031-32259-4_6.

References

Dougherty R, Sidhu S, Raman K, Solon M, Solberg O, Caughey G . Accumulation of intraepithelial mast cells with a unique protease phenotype in T(H)2-high asthma. J Allergy Clin Immunol. 2010; 125(5):1046-1053.e8. PMC: 2918406. DOI: 10.1016/j.jaci.2010.03.003. View

Hoshino Y, Koya T, Kagamu H, Tsukioka K, Toyama M, Sakagami T . Effect of inhaled corticosteroids on bronchial asthma in Japanese athletes. Allergol Int. 2015; 64(2):145-9. DOI: 10.1016/j.alit.2014.10.004. View

Surda P, Walker A, Putala M, Siarnik P . Prevalence of Rhinitis in Athletes: Systematic Review. Int J Otolaryngol. 2017; 2017:8098426. PMC: 5568626. DOI: 10.1155/2017/8098426. View

Helenius I, Rytila P, Metso T, Haahtela T, Venge P, Tikkanen H . Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers. Allergy. 1998; 53(4):346-52. DOI: 10.1111/j.1398-9995.1998.tb03904.x. View

Larsson K, OHLSEN P, Larsson L, Malmberg P, Rydstrom P, Ulriksen H . High prevalence of asthma in cross country skiers. BMJ. 1993; 307(6915):1326-9. PMC: 1679468. DOI: 10.1136/bmj.307.6915.1326. View

Bonini S, Bonini M, Bousquet J, Brusasco V, Canonica G, Carlsen K . Rhinitis and asthma in athletes: an ARIA document in collaboration with GA2LEN. Allergy. 2006; 61(6):681-92. DOI: 10.1111/j.1398-9995.2006.01080.x. View

Helenius I, Rytila P, Sarna S, Lumme A, Helenius M, Remes V . Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers. J Allergy Clin Immunol. 2002; 109(6):962-8. DOI: 10.1067/mai.2002.124769a. View

Hallstrand T, Altemeier W, Aitken M, Henderson Jr W . Role of cells and mediators in exercise-induced bronchoconstriction. Immunol Allergy Clin North Am. 2013; 33(3):313-28, vii. PMC: 3763828. DOI: 10.1016/j.iac.2013.02.003. View

Van der Eycken S, Schelpe A, Marijsse G, Dilissen E, Troosters T, Vanbelle V . Feasibility to apply eucapnic voluntary hyperventilation in young elite athletes. Respir Med. 2016; 111:91-3. DOI: 10.1016/j.rmed.2015.12.012. View

10.

Demarche S, Schleich F, Henket M, Paulus V, Van Hees T, Louis R . Effectiveness of inhaled corticosteroids in real life on clinical outcomes, sputum cells and systemic inflammation in asthmatics: a retrospective cohort study in a secondary care centre. BMJ Open. 2017; 7(11):e018186. PMC: 5719334. DOI: 10.1136/bmjopen-2017-018186. View

11.

Price O, Sewry N, Schwellnus M, Backer V, Reier-Nilsen T, Bougault V . Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on 'acute respiratory illness in the athlete'. Br J Sports Med. 2021; 56(4):213-222. DOI: 10.1136/bjsports-2021-104601. View

12.

Button B, Picher M, Boucher R . Differential effects of cyclic and constant stress on ATP release and mucociliary transport by human airway epithelia. J Physiol. 2007; 580(Pt. 2):577-92. PMC: 2075559. DOI: 10.1113/jphysiol.2006.126086. View

13.

Weiler J, Bonini S, Coifman R, Craig T, Delgado L, Capao-Filipe M . American Academy of Allergy, Asthma & Immunology Work Group report: exercise-induced asthma. J Allergy Clin Immunol. 2007; 119(6):1349-58. DOI: 10.1016/j.jaci.2007.02.041. View

14.

Price O, Walsted E, Bonini M, Brannan J, Bougault V, Carlsen K . Diagnosis and management of allergy and respiratory disorders in sport: An EAACI task force position paper. Allergy. 2022; 77(10):2909-2923. PMC: 9796481. DOI: 10.1111/all.15431. View

15.

Bonini M, Gramiccioni C, Fioretti D, Ruckert B, Rinaldi M, Akdis C . Asthma, allergy and the Olympics: a 12-year survey in elite athletes. Curr Opin Allergy Clin Immunol. 2015; 15(2):184-92. DOI: 10.1097/ACI.0000000000000149. View

16.

Boulet L, Turmel J . Cough in exercise and athletes. Pulm Pharmacol Ther. 2019; 55:67-74. DOI: 10.1016/j.pupt.2019.02.003. View

17.

Anderson S, Kippelen P . Exercise-induced bronchoconstriction: pathogenesis. Curr Allergy Asthma Rep. 2005; 5(2):116-22. DOI: 10.1007/s11882-005-0084-y. View

18.

Hancox R, Subbarao P, Kamada D, Watson R, Hargreave F, Inman M . Beta2-agonist tolerance and exercise-induced bronchospasm. Am J Respir Crit Care Med. 2002; 165(8):1068-70. DOI: 10.1164/ajrccm.165.8.200111-091bc. View

19.

Maki-Heikkila R, Karjalainen J, Parkkari J, Valtonen M, Lehtimaki L . Asthma in Competitive Cross-Country Skiers: A Systematic Review and Meta-analysis. Sports Med. 2020; 50(11):1963-1981. PMC: 7575483. DOI: 10.1007/s40279-020-01334-4. View

20.

Skloot G . Asthma phenotypes and endotypes: a personalized approach to treatment. Curr Opin Pulm Med. 2015; 22(1):3-9. DOI: 10.1097/MCP.0000000000000225. View