title: Airway hyperresponsiveness to methacholine, adenosine 5-monophosphate, mannitol, eucapnic voluntary hyperpnoea and field exercise challenge in elite cross-country skiers.
abstract: BACKGROUND
  Methacholine hyperresponsiveness is prevalent in elite athletes. Comparative studies have hitherto been limited to methacholine, eucapnic voluntary hyperpnoea and exercise. This study investigated airway responsiveness to these stimuli as well as to adenosine 5'-monophosphate (AMP) and mannitol, in 58 cross-country ski athletes.
  
  
  METHODS
  Exhaled nitric oxide concentration (F(E)NO), spirometry and bronchial challenge in random order with methacholine, AMP and mannitol were consecutively performed on three study days in the autumn. Specific IgE to eight aeroallergens and a self-completed questionnaire about respiratory symptoms, allergy and asthmatic medication were also performed on day 1. Eucapnic voluntary hyperventilation (EVH) and field exercise tests were randomly performed in 33 of the skiers on two study days in the following winter.
  
  
  RESULTS
  Of 25 (43%) skiers with airway hyperresponsiveness (AHR), 23, five and three skiers were hyperresponsive to methacholine, AMP and mannitol, respectively. Methacholine hyperresponsiveness was more prevalent in subjects without asthma-like symptoms. The F(E)NO was not significantly different in skiers with and without methacholine hyperresponsiveness. Four of 14 skiers with and four of 19 skiers without methacholine hyperresponsiveness were hyperresponsive to EVH or exercise challenge. AHR to any stimulus was present in 16 asymptomatic and nine symptomatic skiers. Asthma-like symptoms were not correlated with AHR to any stimulus.
  
  
  CONCLUSIONS
  Methacholine hyperresponsiveness is more common in asymptomatic skiers and is a poor predictor of hyperresponsiveness to mannitol and hyperpnoea. The low prevalence of hyperresponsiveness to indirect stimuli may suggest differences in the pathogenesis of methacholine hyperresponsiveness in elite skiers and non-athletes.
authors.affiliation: Department of Lung Medicine, St Olavs Hospital, University Hospital of Trondheim, N-7006 Trondheim, Norway. msuechu@online.no
authors.forename: Malcolm
authors.initials: M
authors.lastname: Sue-Chu
authors.forename: John D
authors.initials: JD
authors.lastname: Brannan
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Anderson
authors.forename: Nora
authors.initials: N
authors.lastname: Chew
authors.forename: Leif
authors.initials: L
authors.lastname: Bjermer
mesh_terms: D000249:Adenosine Monophosphate / Q000494:pharmacology; D000293:Adolescent; D001980:Bronchi / Q000187:drug effects*; D016535:Bronchial Hyperreactivity / Q000175:diagnosis; D001985:Bronchial Provocation Tests / Q000379:methods; D016085:Bronchoconstrictor Agents / Q000494:pharmacology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D008297:Male; D008353:Mannitol / Q000494:pharmacology; D016210:Methacholine Chloride / Q000494:pharmacology; D009569:Nitric Oxide / Q000032:analysis; D012865:Skiing / Q000502:physiology*
chemical_list: D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride; D009569:Nitric Oxide; D008353:Mannitol; D000249:Adenosine Monophosphate
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