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The Effect of Exercise in the Cold on Lung Function in Athletes

The prevalence rate of bronchoconstriction that is exercise-related in athletes range from 11% to 50%, and up to 90% of subjects with asthma will have exercise-induced bronchospasm (Holzer et al., 2002; restated by Parsons and Mastronarde 2005). Wilber et al. (2000) as restated by Parsons and Mastronarde (2005) found that 18% to 26% of Olympic winter sport athletes and 50% of cross-country skiers were found to have exercise-induced bronchospasm. Mannix et al. (1996) as restated by Parsons and Mastronarde (2005) studied 124 elite figure skaters in their figure-skating routines. They found out that 35% had a significant post-exercise drop in their FEV1. Also, Voy (1986) stated that the US Olympic Committee reported an 11.2% prevalence of exercise induced bronchospasm in all athletes who competed in the 1984 Summer Olympics. In Dickinson et al. (2006), the reported prevalence of exercise induced asthma in winter athletes ranges from 9% to 50%, which is higher than that of the general population (approximately 8% in the United Kingdom), but is found to be parallel with the numbers of elite summer sports athletes.

The American Academy of Allergy, Asthma, and Immunology in 2007 reported that asthma was most common among cyclists and mountain bikers in the Olympics. It is least common in athletes competing in badminton, volleyball, and other Olympic events.

Also when at rest, we normally breathe through our nose. This serves to warm and humidify the air we breathe in to make it more like the air inside the lungs. However during exercise, we breathe through our mouth, and the air that hits the lungs is colder and less humid. The difference between temperatures of air in the lungs can trigger attacks and disturb the normal function of the lungs.
 
Lastly, this literature will cover treatment, both pharmacologic and nonpharmacologic, and prevention for athletes experiencing exercise induced bronchospasm.
 
A study done by Yuan-Ching Hsieh et al. (1970) on nine patients with cold air sensitivity at rest and during treadmill supported the concept that there is marked change in the air flow resistance when breathing cold air in poorly ventilated lung areas both at rest and in exercise. Another study by Donaldson G.C. et al. (1999) investigated if falls in environmental temperature increases morbidity from chronic obstructive pulmonary disease (COPD). They found out that temperature-related lung function reduction and increase in the number of attacks may result in a high level of morbidity from chronic obstructive pulmonary disease (COPD).

The American Academy of Allergy, Asthma, and Immunology in 2007 reported that asthma was most common among cyclists and mountain bikers in the Olympics. It is least common in athletes competing in badminton, volleyball, and other Olympic events.

Also when at rest, we normally breathe through our nose. This serves to warm and humidify the air we breathe in to make it more like the air inside the lungs. However during exercise, we breathe through our mouth, and the air that hits the lungs is colder and less humid. The difference between temperatures of air in the lungs can trigger attacks and disturb the normal function of the lungs.
 
Lastly, this literature will cover treatment, both pharmacologic and nonpharmacologic, and prevention for athletes experiencing exercise induced bronchospasm.
 
A study done by Yuan-Ching Hsieh et al. (1970) on nine patients with cold air sensitivity at rest and during treadmill supported the concept that there is marked change in the air flow resistance when breathing cold air in poorly ventilated lung areas both at rest and in exercise. Another study by Donaldson G.C. et al. (1999) investigated if falls in environmental temperature increases morbidity from chronic obstructive pulmonary disease (COPD). They found out that temperature-related lung function reduction and increase in the number of attacks may result in a high level of morbidity from chronic obstructive pulmonary disease (COPD).

The origination and development of exercise induced bronchoconstriction is not completely understood and is thought to be multifactorial. The most common hypothesis for the etiology of exercise-induced bronchospasm is that breathing relatively dry air causes the tracheobronchial tree to narrow by way of evaporative loss in water in the airway surface brought about by the difference in osmotic and temperature differences (Anderson and Daviskas 2000). Large volumes of air that are often colder than the body temperature are exchanged during exercise. This large volume overwhelms the ability of the upper airway to warm the air and thus cool air reaches the distal airway. This phenomenon, the reaching of cold air into the distal airways, will
then result in airway narrowing due to reactive hyperemia of the blood vessels in the airways. Airway edema also results from increased hydrostatic pressures (Gilbert and McFadden 1992).

According to the Allergy and Asthma Disease Management Center (2003), breathing cold air often causes bronchospasm and brings about secretions in the tracheobronchial tree in patients with asthma as well as normal individuals. It was concluded that one year of daily exposure to cold environment may result in slow, but very significant, decrease in airflow rates, accompanied by bronchial hyperresponsiveness, with the effects beginning within 6 months of exposure.

Exercise induced bronchoconstriction and other respiratory symptoms brought about by cold involve many mechanisms. These are thermal or the warmth related, mechanical, as well as osmotic or dryness related acting on the tracheobronchial tree (Helenius et al. 2005). In addition to cold air affecting the tracheobronchial tree, skin stimulation in the face by the cold air also has an effect on the airway reacting quickly (Heindl S. et al. 2004). The American College of Sports Medicine, on their stand on keeping injuries during exercise, mentioned that taking in of warm, dry air in combination of the skin and facial cooling act in synergy to trigger exercised induced bronchospasm (Talus Outdoor Technologies 2008).

As mentioned, these athletes could not avoid having to perform or exercise in cold environments - not just perform and exercise but exercise and carry out their activity in the highest level.  Therefore, it is necessary that trainers, coaches, and physicians have a high index of suspicion when their perfectly conditioned and healthy athletes complain of symptoms during exercise in the cold. It is very important for trainers, coaches, athletes, and healthcare providers to have the proper education in the recognition of an impending or even an ongoing episode of exercise induced bronchospasm. Recognize the symptoms for such an episode and provide the appropriate treatment as necessary.
 
If and when exercise induced asthma/exercise induced bronchospasm happen in an otherwise healthy athlete, it is best managed when the athlete and the doctor work hand in hand in finding, getting rid of, and manage triggers. They must choose the proper medications in both preventive and maintenance, and have an asthma emergency plan.
 

According to Quinn (2007), exercise induced asthma can definitely be treated using medications that are used in managing standard asthma diagnosis. For exercise induced asthma, an athlete can be given a short-acting inhaled bronchodilator. This can be given prior to the athlete's strenuous activity to settle and loosen up the airway. Other medications that may be prescribed include inhaled or oral long acting beta-2 agonist, low dose oral steroids, and leukotriene receptor antagonists (Quinn 2007).
 
There are nonpharmacologic strategies that athletes can utilize as well to minimize the number of attacks and severity of symptoms of exercise induced bronchospasm. According to Parsons and Mastronarde (2005), wearing a face mask during activity warms and humidifies the inhaled air when outdoor conditions are cold and dry. Also, trying to inhale warm air as much as possible by breathing through the nose and not the mouth will help to improve exercise induced bronchospasm. In doing so will warm, filter, and humidify the air taken in. The end result of which will prevent airway cooling. In addition, if ever an athlete determines his or her triggers, should attempt to avoid these triggers at all times.

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