title: Evidence of airway inflammation and remodeling in ski athletes with and without bronchial hyperresponsiveness to methacholine.
abstract: Asthma-like symptoms, methacholine hyperresponsiveness, and use of asthma medication are prevalent in elite cross-country skiers. We quantitated mucosal inflammatory cell infiltration and tenascin expression in the subepithelial basement membrane in endobronchial biopsy specimens of the proximal airways from 40 elite, competitive skiers (mean: 17.5; range: 16 to 20 yr) without a diagnosis of asthma, in 12 subjects with mild asthma, and in 12 healthy controls, through immunohistochemistry and indirect immunofluorescence, respectively. All of the subjects were nonsmokers. T-lymphocyte, macrophage, and eosinophil counts were, respectively, greater by 43-fold (p < 0.001), 26-fold (p < 0.001), and twofold (p < 0.001) in skiers, and by 70-fold (p < 0.001), 63-fold (p < 0.001), and eightfold (p < 0.001) in asthmatic subjects than in controls. In skiers, neutrophil counts were more than twofold greater than in asthmatic subjects, and mast cell counts were not significantly different than in controls. Tenascin expression (as measured through the thickness of the tenascin-specific immunoreactivity band in the basement membrane) was increased in skiers (median: 6.7 microm; interquartile range [IQR]: 5.3 to 8.5 microm, p < 0.001) and asthmatic subjects (mean: 8.8 microm; IQR: 7.2 to 10.8 microm, p < 0. 001) compared with controls (mean: 0.8 microm; IQR: 0 to 3.1 microm) and did not correlate with inflammatory cell counts. Inflammatory changes were present irrespective of asthmalike symptoms, hyperresponsiveness, or atopy. Prolonged repeated exposure of the airways to inadequately conditioned air may induce inflammation and remodeling in competitive skiers.
authors.affiliation: Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: E M
authors.initials: EM
authors.lastname: Karjalainen
authors.forename: A
authors.initials: A
authors.lastname: Laitinen
authors.forename: M
authors.initials: M
authors.lastname: Sue-Chu
authors.forename: A
authors.initials: A
authors.lastname: Altraja
authors.forename: L
authors.initials: L
authors.lastname: Bjermer
authors.forename: L A
authors.initials: LA
authors.lastname: Laitinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000403:Airway Resistance / Q000276:immunology; D001250:Asthma, Exercise-Induced / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D001706:Biopsy; D001980:Bronchi / Q000276:immunology / Q000473:pathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D001985:Bronchial Provocation Tests; D004804:Eosinophils / Q000276:immunology / Q000473:pathology; D006801:Humans; D007958:Leukocyte Count; D008264:Macrophages / Q000276:immunology / Q000473:pathology; D008297:Male; D008407:Mast Cells / Q000276:immunology / Q000473:pathology; D020545:Respiratory Mucosa / Q000276:immunology / Q000473:pathology; D012865:Skiing / Q000502:physiology*; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D019063:Tenascin / Q000378:metabolism
chemical_list: D019063:Tenascin