Is there a unifying hypothesis for exercise-induced asthma?

https://doi.org/10.1016/0091-6749(84)90301-4Get rights and content

Abstract

We believe that it is the loss of water per se and not heat loss that is the most important stimulus to exercise-induced asthma (EIA). The evidence to support this concept comes from a number of observations. First, EIA may occur when expired air temperature during exercise is close to body temperature and higher than that normally observed at rest. This suggests that EIA is not always associated with cooling of the airways. Second, there is evidence to show that the temperature of the inspired air is less critical than was previously thought. Providing that the water loss is the same, the airway response is reproducible even though the heat loss may vary because of differences in the temperature of the inspired air. Because expired water concentration is relatively constant, the airway response relates well to the water concentration of the inspired air. We believe that evaporative water loss from the airway mucosa induces a transient change in osmolarity in the epithelial fluid and that this change is a more potent stimulus to bronchoconstriction than is airway cooling. We believe this hypothesis accounts for many known facts about EIA and should merit further investigation by which it may be proved or disproved.

References (43)

  • SR Malik et al.

    Alterations in airway dynamics following inhalation of ultrasonic mist

    Chest

    (1972)
  • WY Chen et al.

    Heat and water loss from the airways and exercise-induced asthma

    Respiration

    (1977)
  • EC Deal et al.

    Hyperpnea and heat flux: Initial reaction sequence in exercise-induced asthma

    J Appl Physiol

    (1979)
  • RH Strauss et al.

    Enhancement of exercise-induced asthma by cold air

    N Engl J Med

    (1977)
  • RH Strauss et al.

    Influence of heat and humidity on the airway obstruction induced by exercise in asthma

    J Clin Invest

    (1978)
  • EC Deal et al.

    Role of respiratory heat exchange in production of exercise-induced asthma

    J Appl Physiol

    (1979)
  • ER McFadden et al.

    Direct recordings of the temperatures in the tracheobronchial tree in normal man

    J Clin Invest

    (1982)
  • RE Weinstein et al.

    Effects of humidification on exercise-induced asthma (EIA)

    J Allergy Clin Immunol(abstr)

    (1976)
  • EC Deal et al.

    Esophageal temperature during exercise in asthmatic and non-asthmatic subjects

    J Appl Physiol

    (1979)
  • SD Anderson et al.

    Sensitivity to heat and water loss at rest and during exercise in asthmatic patients

    Eur J Respir Dis

    (1982)
  • SD Anderson et al.

    Respiratory heat and water loss during exercise in patients with asthma: Effect of repeated exercise challenge

    Eur J Respir Dis

    (1982)
  • SD Anderson et al.

    Exercise-induced asthma without airway cooling?

    Am Rev Respir Dis (abstr)

    (1983)
  • Anderson SD, Hahn AG, Black JL, Morton A, Fitch K: Reinterpretation of the effect of inspired air temperature on...
  • SD Anderson

    Current concepts of exercise-induced asthma

    Allergy

    (1983)
  • RE Schoeffel et al.

    Bronchial hyperreactivity in response to inhalation of ultrasonically nebulised solutions of distilled water and saline

    Br Med J

    (1981)
  • AD Resnick et al.

    A critical assessment of the mechanism by which hyperoxia attenuates exercise-induced asthma

    J Clin Invest

    (1979)
  • PM O'Byrne et al.

    Asthma induced by cold air and its relation to nonspecific bronchial responsiveness to methacholine

    Am Rev Respir Dis

    (1982)
  • M Chatham et al.

    A comparison of histamine, methacholine, and exercise airway reactivity in normal and asthmatic subjects

    Am Rev Respir Dis

    (1982)
  • JW Mitchell et al.

    Respiratory weight losses during exercise

    J Appl Physiol

    (1972)
  • L Ferris et al.

    Respiratory water loss

    Respir Physiol

    (1980)
  • ER Weibel

    Morphometrics of the lung

    • Cited by (192)

    • Subfreezing air as a cough trigger and multiple triggers are strongly associated with the presence of asthma in chronic cough

      2019, Respiratory Medicine

    • Repurposing excipients as active inhalation agents: The mannitol story

      2018, Advanced Drug Delivery Reviews

    • Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction

      2018, Immunology and Allergy Clinics of North America

    • Pathogenesis of Exercise-Induced Bronchoconstriction

      2013, Immunology and Allergy Clinics of North America

    • Refractoriness to Exercise Challenge. A Review of the Mechanisms Old and New.

      2013, Immunology and Allergy Clinics of North America
      Citation Excerpt :

      The evaporation of water is associated with heat loss and dehydration of the airway surface liquid (ASL). The ASL is 5 to 7 μm in depth; over the first 10 generations of airways, its total volume is estimated to be less than 1 mL.14 There are 2 major theories for the mechanism whereby respiratory water loss causes bronchoconstriction.

    • Air Quality and Exercise-Induced Bronchoconstriction in Elite Athletes

      2013, Immunology and Allergy Clinics of North America
      Citation Excerpt :

      Exercise-induced bronchoconstriction (EIB) is the transient narrowing of the airways usually occurring within 20 minutes after exercise, but can occur during the exercise, and spontaneously resolves within 30 to 60 minutes. Theories for pathogenesis of EIB include the hyperosmolar hypothesis, which postulates hyperpnea-induced drying of the airways with subsequent increase in cell osmolarity and release of bronchoconstricting mediators from inflammatory cells.1 The airway-cooling hypothesis is based on a reduction of intra-airway temperature during exercise and development of a reactive hyperemia after exercise in response to airway cooling.2

    View all citing articles on Scopus
    View full text
    Copyright © 1984 Published by Mosby, Inc.