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Respiratory health of elite athletes – preventing airway injury: a critical review
  1. Pascale Kippelen1,
  2. Kenneth D Fitch2,
  3. Sandra Doreen Anderson3,
  4. Valerie Bougault4,
  5. Louis-Philippe Boulet5,
  6. Kenneth William Rundell6,
  7. Malcolm Sue-Chu7,8,
  8. Donald C McKenzie9
  1. 1Centre for Sports Medicine & Human Performance, Brunel University, Uxbridge, UK
  2. 2School of Sports Science, Exercise and Health, Faculty of Life Sciences, University of Western Australia, Crawley, Western Australia, Australia
  3. 3Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  4. 4Faculté des Sciences du Sport, Université Droit et Santé de Lille 2, Lille, France
  5. 5Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Canada
  6. 6Medical Affairs, Pharmaxis, Exton, Pennsylvania, USA
  7. 7Department of Thoracic Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
  8. 8Department of Circulation and Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  9. 9Division of Sports Medicine, School of Human Kinetics, University of British Columbia, Vancouver, Canada
  1. Correspondence to Pascale Kippelen, Brunel University, Centre for Sports Medicine & Human Performance, Uxbridge UB8 3PH, UK; pascale.kippelen{at}


Elite athletes, particularly those engaged in endurance sports and those exposed chronically to airborne pollutants/irritants or allergens, are at increased risk for upper and lower airway dysfunction. Airway epithelial injury may be caused by dehydration and physical stress applied to the airways during severe exercise hyperpnoea and/or by inhalation of noxious agents. This is thought to initiate an inflammatory cascade/repair process that, ultimately, could lead to airway hyperresponsiveness (AHR) and asthma in susceptible athletes. The authors review the evidence relating to prevention or reduction of the risk of AHR/asthma development. Appropriate measures should be implemented when athletes exercise strenuously in an attempt to attenuate the dehydration stress and reduce the exposure to noxious airborne agents. Environmental interventions are the most important. Non-pharmacological strategies can assist, but currently, pharmacological measures have not been demonstrated to be effective. Whether early prevention of airway injury in elite athletes can prevent or reduce progression to AHR/asthma remains to be established.

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.