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Disconnect between standardized field‐based testing and mannitol challenge in Scottish elite swimmers
Author(s) -
Clearie K. L.,
Williamson P. A.,
Vaidyanathan S.,
Short P.,
Goudie A.,
Burns P.,
Hopkinson P.,
Meldrum K.,
Howaniec L.,
Lipworth B. J.
Publication year - 2010
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/j.1365-2222.2010.03461.x
Subject(s) - mannitol , exhaled nitric oxide , bronchoconstriction , medicine , anesthesia , nitric oxide , airway , physical therapy , chemistry , biochemistry
Summary Background Elite swimmers have high rates of rhinoconjunctivitis and exercise‐induced bronchoconstriction. Moreover, exposure to chlorine and chlorine metabolites is known to induce bronchial hyper‐reactivity. Objective To assess the early and late effects of chlorine and exercise on the unified airway of elite swimmers, and to compare the response to mannitol and field‐based exercise challenge. Methods The Scottish national squad underwent exhaled tidal (FE NO ) and nasal (N NO ) nitric oxide measurement, peak nasal inspiratory flow (PNIF), and forced expiratory volume in 1 s before, immediately after, and 4–6 h post‐swimming. A sport‐specific exercise test was carried out during an intensive lactate set (8 min at 80% maximum hear rate). All swimmers underwent mannitol challenge, and completed a health questionnaire. Results N =61 swimmers were assessed: 8/59 (14%) of swimmers had a positive mannitol challenge. Nine out of 57 (16%) of swimmers had a positive exercise test. Only one swimmer was positive to both. Swimmers with a positive mannitol had a significantly higher baseline FE NO (37.3 vs. 18.0 p.p.b., P =0.03) than those with a positive exercise challenge. A significant decrease in FE NO was observed pre vs. immediate and delayed post‐chlorine exposure: mean (95% CI) 18.7 (15.9–22.0) p.p.b. vs. 15.9 (13.3–19.1) p.p.b. ( P <0.01), and 13.9 (11.5–16.7) p.p.b. ( P <0.01), respectively. There were no significant differences in N NO. Mean PNIF increased from 142.4 L/min (5.8) at baseline to 162.6 L/min (6.3) immediately post‐exposure ( P <0.01). Delayed post‐exposure PNIF was not significantly different from pre‐exposure. Conclusions No association was found between mannitol and standardized field‐based testing in elite swimmers. Mannitol was associated with a high baseline FE NO ; however, exercise/chlorine challenge was not. Thus, mannitol may identify swimmers with a ‘traditional’ inflammatory asthmatic phenotype, while field‐based exercise/chorine challenge may identify a swimmer‐specific bronchoconstrictor response. A sustained fall in FE NO following chlorine exposure suggests that a non‐cellular, perhaps neurogenic, response may be involved in this group of athletes. Cite this as: K. L. Clearie, P. A. Williamson, S. Vaidyanathan, P. Short, A. Goudie, P. Burns, P. Hopkinson, K. Meldrum, L. Howaniec and B. J. Lipworth, Clinical & Experimental Allergy , 2010 (40) 731–737.