The Interaction Between Respiratory Function and Exhaled Nitric Oxide in Exercise-Induced Bronchoconstriction in Sportsmen

The aim of the investigation was to study the features of exercise-induced bronchospasm revealed by laboratory tests under intensive training, to assess the relationship between this phenomenon and the level of expiratory NO fraction (FeNO) in asymptomatic winter sports athletes without asthma diagnosis.

Materials and Methods. Skiers and biathletes aged from 13 to 26 years were examined in two stages: stage 1 — standard laboratory treadmill test (n=52); stage 2 — outdoor exercise challenge test at subfreezing temperature (n=78). The FeNO level was measured before and after exercise at both stages.

Results. The prevalence of exercise-induced bronchospasm (EIB) in laboratory treadmill testing and outdoor exercise testing was 21 and 6.4% respectively. In these individuals no significant differences in baseline spirometry parameters were found compared to non-EIB athletes. The laboratory testing revealed significantly higher baseline FeNO levels in males compared to female athletes. We recorded the positive correlation of baseline spirometric parameters and FeNO, post-exercise FeNO and forced expiratory volume in 1 s after 1 and 5 minutes of the test, and the negative correlation of FeNO after the exercise and peak expiratory flow 5 minutes after the exercise.

Conclusion. EIB has low prevalence among winter sports athletes. However, the obtained results suggest that the excess NO production in respiratory ways of sportsmen can exacerbate the intensity of bronchial obstruction or is associated with the obstruction somehow.

1. Parsons J.P., Mastronarde J.G. Exercise-induced bronchoconstriction in athletes. Chest 2005; 128: 3966–3974.
2. Weiler J.M., Anderson S.D., Randolph C., et al. American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter.?Ann Allergy Asthma Immunol 2010; 105(6 Suppl): S1–S47.
3. Anderson S.D., Kippelen P. Assessment and prevention of exercise-induced bronchoconstriction. Br J Sports Med 2012; 46(6): 391–396.
4. Scollo M., Zanconato S., Ongaro R., et al. Exhaled nitric oxide and exercise-induced bronchoconstriction in asthmatic children. Am J?Respir Crit Care Med 2000; 161: 1047–1050.
5. El Halawani S.M., Ly N.T., Mahon R.T., et al. Exhaled nitric oxide as a predictor of exercise-induced bronchoconstriction. Chest 2003; 124: 639–643.
6. Feitosa L.A., Dornelas de Andrade A., Reinaux C.M., Britto M.C. Diagnostic accuracy of exhaled nitric oxide in exercise-induced bronchospasm: Systematic review. Rev Port Pneumol 2012; 18(4): 198–204.
7. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005; 171: 912–930.
8. Wilber R.L., Rundell K.W., Szmedra L., Jenkinson D.M., Im J., Drake S.D. Incidence of exercise-induced bronchospasm in Olympic winter sport athletes. Med Sci Sports Exerc 2000; 32(4): 732–737.
9. Parsons J.P., Cosmar D., Phillips G., Kaeding C., Best T.M., Mastronarde J.G. Screening for exercise-induced bronchoconstriction in college athletes. J Asthma 2012; 49(2): 153–157.
10. Chinellato I., Piazza M., Peroni D., Sandri M., Chiorazzo?F., Boner A.L., Piacentini G. Bronchial and alveolar nitric oxide in exercise-induced bronchoconstriction in asthmatic children. Clin Exp Allergy 2012; 42(8): 1190–1196.
11. Grzelewski T., Grzelewska A., Majak P., Stelmach W., Kowalska A., Stelmach R., Janas A., Stelmach I. Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma. Nitric Oxide 2012; 27(2): 82–87.
12. Ciprandi G., Tosca M.A., Castellazzi A.M., Cairello F., Salpietro C., Arrigo T., Miraglia Del Giudice M. FEF (25–75) might be a predictive factor for bronchial inflammation and bronchial hyperreactivity in adolescents with allergic rhinitis. Int J Immunopathol Pharmacol 2011; 24(4): 17–20.
13. Sugiura H., Ichinose M. Nitrative stress in inflammatory lung diseases. Nitric Oxide 2011; 25: 138–144.
14. Belda J., Ricart S., Casan P., et al. Airway inflammation in the elite athlete and type of sport. Br J Sports Med 2008; 42: 244–248.
15. Soodaeva S.K., Klimanov I.A. Narusheniya okislitel’nogo metabolizma pri zabolevaniyakh respiratornogo trakta i sovremennye podkhody k antioksidantnoy terapii [Oxidative metabolic imbalance in respiratory diseases and modern approaches to anti-oxidant therapy]. Atmosfera. Pul’monologiya i allergologiya — Atmosphere. Pulmonology and Allergology 2009; 1: 34–38.
16. Kasimay Ö., Yildirim A., Ünal M., Kaçar O., Bilsel S., Kurtel H. The involvement of nitric oxide and endothelin-1 in exercise-induced bronchospasm in young soccer players. Clin J Sport Med 2011; 21(3): 237–242.

Nikitina L.Yu., Soodaeva S.К., Petrovsky F.I., Kotlyarova V.N., Koynosov А.P., Shashkova Т.V., Petrovskaya Yu.А., Gasymova S.Sh., Chuchalin А.G. The Interaction Between Respiratory Function and Exhaled Nitric Oxide in Exercise-Induced Bronchoconstriction in Sportsmen. Sovremennye tehnologii v medicine 2013; 5(3): 45