Mechanisms and Biomarkers of Exercise-Induced Bronchoconstriction - 09/04/18

Doi : 10.1016/j.iac.2018.01.008

Pascale Kippelen, PhD ^a, Sandra D. Anderson, PhD, DSc ^b,^⁎ , Teal S. Hallstrand, MD, MPH ^c
^a Department of Life Sciences, Division of Sport, Health and Exercise Sciences, Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Kingston Lane, Uxbridge UB8 3PH, UK
^b Central Clinical School, Sydney Medical School, University of Sydney, Parramatta Road, Sydney New South Wales 2006, Australia
^c Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Center for Lung Biology, University of Washington, Box 358052, 850 Republican Street, Seattle, WA 98109-4714, USA

^∗Corresponding author. PO Box 87, Balmain, New South Wales 2041, Australia.PO Box 87BalmainNew South Wales2041Australia

Résumé

Exercise is a common trigger of bronchoconstriction. In recent years, there has been increased understanding of the pathophysiology of exercise-induced bronchoconstriction. Although evaporative water loss and thermal changes have been recognized stimuli for exercise-induced bronchoconstriction, accumulating evidence points toward a pivotal role for the airway epithelium in orchestrating the inflammatory response linked to exercise-induced bronchoconstriction. Overproduction of inflammatory mediators, underproduction of protective lipid mediators, and infiltration of the airways with eosinophils and mast cells are all established contributors to exercise-induced bronchoconstriction. Sensory nerve activation and release of neuropeptides maybe important in exercise-induced bronchoconstriction, but further research is warranted.

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Keywords : Hyperpnea, Water loss, Osmolarity, Epithelium, Mast cells, Eosinophils, Eicosanoids, Sensory nerves

Plan

Key points

Introduction

Conditioning the air inspired during exercise

Heat Loss as a Stimulus to Airway Narrowing

Water Loss as a Stimulus to Airway Narrowing

Temperature as a Modulator of Time Course and Severity of Exercise-Induced Bronchoconstriction

Epithelial dysfunction in exercise-induced bronchoconstriction

Breaking Through the Epithelial Barrier

Disturbance of the Airway Surface Liquid

Mucus Dysfunction

Epithelial Damage Restitution

Leukocyte activation as a fundamental mechanism of exercise-induced bronchoconstriction

The Acute Response

The Cellular and Molecular Phenotype Associated with Exercise-Induced Bronchoconstriction

Refractoriness to Repeated Exercise

Neurogenic factors and exercise-induced bronchoconstriction

Sensory Nerve Activation

The role of regional alterations in the airways and the development of exercise-induced bronchoconstriction

Summary and future considerations

Disclosure Statement: Dr S.D. Anderson is the inventor of the mannitol test used for the diagnosis of bronchial hyperresponsiveness and receives a share of the royalties from the sale of Aridol and Osmohale paid to Royal Prince Alfred Hospital by Pharmaxis Ltd. Drs P. Kippelen and T.S. Hallstrand have no conflict of interest.