title: Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools.
abstract: BACKGROUND
  Airway disorders are common in regular chlorinated swimming pool attendees, particularly competitive athletes, but the impact of intense swimming training on airway function and structure remains unclear.
  
  
  OBJECTIVE
  This study aimed to evaluate airway inflammation and remodeling in elite swimmers.
  
  
  METHODS
  Twenty-three elite swimmers were tested during off-training season. All had exhaled nitric oxide measurement, methacholine test, eucapnic voluntary hyperpnea challenge, allergy skin prick tests, and bronchoscopy with bronchial biopsies. Clinical data and tissues from 10 age-matched mild-asthmatic and 10 healthy nonallergic subjects were used for comparison.
  
  
  RESULTS
  Swimmers had increased airway mucosa eosinophil and mast cell counts than did controls (P < .05). They had more goblet cell hyperplasia and higher mucin expression than did healthy or asthmatic subjects (P < .05). A greater submucosal type I and III collagen expression and tenascin deposition was also observed in swimmers than in controls (P < .05). Neither exhaled nitric oxide nor airway responsiveness to methacholine or eucapnic voluntary hyperpnea challenge correlated with these inflammatory and remodeling changes.
  
  
  CONCLUSIONS
  Intense, long-term swimming training in indoor chlorinated swimming pools is associated with airway changes similar to those seen in mild asthma, but with higher mucin expression. These changes were independent from airway hyperresponsiveness. The long-term physiological and clinical consequences of these changes remain to be clarified.
authors.affiliation: Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada. valerie.bougault@univ-lille2.fr
authors.forename: Valérie
authors.initials: V
authors.lastname: Bougault
authors.forename: Lionel
authors.initials: L
authors.lastname: Loubaki
authors.forename: Philippe
authors.initials: P
authors.lastname: Joubert
authors.forename: Julie
authors.initials: J
authors.lastname: Turmel
authors.forename: Christian
authors.initials: C
authors.lastname: Couture
authors.forename: Michel
authors.initials: M
authors.lastname: Laviolette
authors.forename: Jamila
authors.initials: J
authors.lastname: Chakir
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Boulet
mesh_terms: D056151:Airway Remodeling / Q000276:immunology; D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D001980:Bronchi / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D002452:Cell Count; D002713:Chlorine / Q000009:adverse effects*; D004804:Eosinophils / Q000276:immunology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008407:Mast Cells / Q000276:immunology; D016210:Methacholine Chloride; D009077:Mucins / Q000378:metabolism; D009504:Neutrophils / Q000276:immunology; D009569:Nitric Oxide / Q000378:metabolism; D012882:Skin Tests; D013147:Spirometry; D013550:Swimming; D013551:Swimming Pools; D013601:T-Lymphocytes / Q000276:immunology; D055815:Young Adult
chemical_list: D000485:Allergens; D016085:Bronchoconstrictor Agents; D009077:Mucins; D016210:Methacholine Chloride; D009569:Nitric Oxide; D002713:Chlorine