exercise induced bronchoconstriction asthma airway inflammation and treatment in elite athletes n.
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Exercise-Induced Bronchoconstriction (EIB)

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  1. Exercise-Induced Bronchoconstriction, Asthma, Airway Inflammation and Treatment in Elite Athletes • Exercise-Induced Bronchoconstriction (EIB) • Acute, transient airway narrowing during and after exercise • EIB defined as a 10 % decline in FEV 1 after appropriate exercise provocation • EIB present in 50 to 90 % of asthmatics, in 10 % of nonasthmatic subjects

  2. Prevalence of EIB in athletes • range from 11-50 %

  3. Prevalence of EIB in athletes • USA Olympic Committee – 11.2 % in athletes competing in the 1984 Summer Olympics • Prevalence underestimated- athletes experience lack of awareness of symptoms suggestive of EIB • Athletes do´nt adjust to health personnel their medical problems

  4. Pathogenesis of EIB • multifactorial, not completely understood • evaporative water loss (dry air breathing) results in the release of mediators (histamine) • large volume of colder air are exchange, owerhelming upper airway ability to warm the air effectively-airway narrowing • inflammation in the airways (eosinophils, activated neutrophils) in swimmers, ice-hockey players, cross country skiers • decrease of inflammatory cells after discontinuing high-level exercise

  5. Athletic population at risk • Prevalent especially in endurance events (long-distance running, swimming, cross-county skiing) • More prevalent in winter sport athletes (increased cooling of airways) • More in high ventilation sports see table – next slide

  6. Athletic population at risk • Competition in polluted enviroment (chlorine in swimmers, chemicals in ice-resurfacing machinery, particulate matter,CO, NO) • Exposure to allergens (pollen, mites, molds)

  7. Clinical presentation Common symptoms • cough, wheezing, chest tightness, dyspnoea More subttle symptoms • fatigue, poor performance • symptoms peak 5-10 min. after exercise cease, lasting for 30-60 minutes

  8. Diagnosis

  9. Management strategies of EIB

  10. Bronchial asthma in athletes • Prevalence • in summer – sport athletes varies from 3.7 % to 22.8 % • incidence higher in long-distance runners -15.5 – 23.9 % • risk of astma associated with atopy • combination of sporting event and atopy- 42-fold risk of asthma in long distance runners,97-fold in atopic swimmers compared to nonatopic controls

  11. Treatment of asthma in athletes • the same therapy as in normal poeple • B2 agonist use according to IOC requirements (positive bronchodilation test, positive bronchial provocation test-eucapnic voluntary hyperpnea test, exercise challenge in the laboratory or in the field, hypertonic aerosol test,methacholine test)

  12. Physicians check list of common environmental factors for allergic athletes