Exercise-Induced Respiratory Conditions in Athletes

Athletes may experience a spectrum of respiratory responses triggered or exacerbated by vigorous physical activity. Exercise-induced bronchoconstriction manifests as a transient narrowing of the airways, with or without underlying asthma, leading to cough, wheeze and breathlessness. In some individuals, exercise precipitates systemic allergic reactions, characterised by urticaria, hypotension and respiratory compromise. Mechanisms include rapid airway cooling and osmotic shifts that provoke mediator release, airway inflammation and neural reflexes. Prevalence is elevated in endurance disciplines and cold-air sports, where repeated hyperventilation and environmental irritants augment epithelial stress. Under-recognition remains a challenge, impacting performance and quality of life. Diagnosis relies on objective testing—spirometry before and after exercise or surrogate bronchoprovocation challenges—supplemented by symptom questionnaires. Management combines non-pharmacological measures (warm-up routines, modified training environments) with targeted pharmacotherapy, notably inhaled β2-agonists and corticosteroids. A nuanced understanding of phenotypes and endotypes is driving personalised approaches, with implications for anti-doping regulations, athlete health surveillance and public-health promotion of safe exercise.

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Exercise-Induced Respiratory Conditions in Athletes publication trend

The graph below shows the total number of articles in exercise-induced respiratory conditions in athletes across all publications each year (not limited to Nature Index journals).

Technical terms

Exercise-induced bronchoconstriction (EIB): Transient reduction in airway calibre induced by physical exertion, evident as a fall in forced expiratory volume.

Exercise-induced anaphylaxis (EIA): Systemic allergic reaction precipitated by exercise, often requiring additional co-factors to elicit symptoms.

Airway hyperresponsiveness (AHR): Exaggerated narrowing of airways in response to stimuli, assessed by provocation tests.

Spirometry: Lung-function test measuring volumes and flow rates, notably forced expiratory volume in one second (FEV₁).

References

1. Getting in Shape: Updates in Exercise Anaphylaxis. Current Allergy and Asthma Reports (2024).
2. Evaluating serum periostin and YKL-40 as biomarkers for airway remodeling and hyperresponsiveness in pediatric asthma. World Allergy Organization Journal (2024).
3. Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. npj Primary Care Respiratory Medicine (2018).
4. Asthma in Competitive Cross-Country Skiers: A Systematic Review and Meta-analysis. Sports Medicine (2020).