Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: A 5-year prospective follow-up study of 42 highly trained swimmers
Open accessAbstract
Background Mild eosinophilic airway inflammation and bronchial hyperresponsiveness-ie, mild asthma-have been shown to affect a high proportion of endurance athletes. The persistence of airway inflammation, bronchial hyperresponsiveness, and asthma in this population is not known, however, inasmuch as follow-up studies of athletes' asthma have not been performed. Objective The purpose of this study was to investigate effect of finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma. Methods Forty-two elite competitive swimmers, most of them from the Finnish national team (37/42; 88%), were followed for 5 years in a prospective manner. All of the swimmers completed questionnaires and underwent resting spirometry, histamine challenge testing, and skin prick tests at baseline and at follow-up. Twenty-nine swimmers (69%) also gave induced sputum samples on both occasions. Sixteen (38%) of the swimmers had continued their competitive careers during follow-up (active swimmers), but 26 (62%) had stopped competing more than 3 months before the follow-up examination (past swimmers). Results Bronchial responsiveness was increased in 7 (44%) of the 16 active swimmers at baseline and in 8 (50%) of the 16 active swimmers at follow-up; it was increased in 8 (31%) of the 26 past swimmers at baseline and in 3 (12%) of the 26 past swimmers at follow-up (McNemar test, P =.025). The difference in the change in bronchial hyperresponsiveness between the study groups was significant (likelihood ratio test, P =.023). Current asthma (defined as bronchial hyperresponsiveness and exercise-induced bronchial symptoms monthly) was observed in 5 (31%) of the active swimmers at baseline and in 7 (44%) of the active swimmers at follow-up; of the past swimmers, it occurred in 6 (23%) at baseline and in 1 (4%) at follow-up (McNemar test, P =.025). The difference in the change in current asthma between the study groups was significant (likelihood ratio test, P =.0040). The sputum differential cell counts of eosinophils and lymphocytes increased significantly during the follow-up period in the active swimmers (Wilcoxon signed rank sum test; P =.033 and P =.0029, respectively); in the past swimmers, the sputum differential cell counts of eosinophils tended to decrease during the follow-up period (P =.17), whereas the differential cell counts of lymphocytes did not change significantly. The changes in the sputum differential cell counts of eosinophils between the study groups differed significantly (Mann-Whitney U test, P =.019). Conclusion In swimmers who had stopped high-level training, bronchial hyperresponsiveness and asthma attenuated or even disappeared. Mild eosinophilic airway inflammation was aggravated among highly trained swimmers who remained active during the 5-year follow-up. Our results suggest that athletes' asthma is partly reversible and that it may develop during and subside after an active sports career.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In that study, there was a significant difference in the change in current asthma between the groups; it occurred in 31% of active swimmers at baseline and in 44% at follow-up, corresponding numbers in past swimmers were 31% at baseline and 12% at follow-up (p = 0.004).
“There was a | significant difference in the change in current | asthma between the groups; it occurred in 31% of | active swimmers at baseline and in 44% at follow- | up, corresponding numbers in past swimmers were | 31% at baseline and 12% at follow-up (p ¼ 0.004).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Helenius et al. (2002)
In that study, mild eosinophilic airway inflammation was aggravated over time in active swimmers as reflected in the sputum eosinophil counts.
“Mild eosinophilic airway inflammation was | aggravated over time in active swimmers as | reflected in the sputum eosinophil counts”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Helenius et al. (2002)
In that study, the difference in change in bronchial hyperresponsiveness between groups was significant (p = 0.023).
“The difference | in change in bronchial hyperresponsiveness between | groups was significant (p ¼ 0.023).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Helenius et al. (2002)
In a follow-up study of Finnish competitive swimmers, bronchial responsiveness was increased in 7 (44%) and 8 (50%) of the active swimmers at baseline and at follow-up, but only in 8 (31%) of the past swimmers at baseline and 3 (12%) at follow-up.
“Bronchial responsiveness was increased in 7 (44%) and | 8 (50%) of the active swimmers at baseline and at | follow-up, but only in 8 (31%) of the past swimmers | at baseline and 3 (12%) at follow-up.”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Helenius et al. (2002)
Cites
Standardization of Spirometry — 1987 Update
Buist, A. S. (1987) · American Review of Respiratory Disease · doi:10.1164/ajrccm/136.5.1073 · Cited by 3,275 · see citing works
Induced Sputum Cell Counts in Healthy Adults
Belda, J., Leigh, R., PARAMESWARAN, K. N., O’Byrne, P. M., Sears, M. R., & HARGREAVE, F. E. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.161.2.9903097 · Cited by 390 · see citing works
Karjalainen, E.-M., Laitinen, A., Sue‐Chu, M., Altraja, A., Bjermer, L. H., & Laitinen, L. A. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.161.6.9907025 · Cited by 319 · see citing works
High prevalence of asthma in cross country skiers.
Larsson, K., Ohlsén, P., Larsson, L., Malmberg, P., Rydstrom, P. O., & Ulriksen, H. (1993) · BMJ · doi:10.1136/bmj.307.6915.1326 · Cited by 297 · see citing works
Prevalence of asthma in Finnish young men.
Haahtela, T., Lindholm, H. J., Björkstén, F., Koskenvuo, K., & Laitinen, L. A. (1990) · BMJ · doi:10.1136/bmj.301.6746.266 · Cited by 292 · see citing works
Self-citationHelenius, I. J., Tikkanen, H. O., Sarna, S., & Haahtela, T. (1998) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(98)70173-3 · Cited by 242 · see citing works
Self-citationAllergy and asthma in elite summer sport athletes
Helenius, I. J., & Haahtela, T. (2000) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2000.107749 · Cited by 224 · see citing works
Self-citationAsthma in United States Olympic athletes who participated in the 1996 Summer Games
Weiler, J. M., Layton, T. A., & Hunt, M. (1998) · Journal of Allergy and Clinical Immunology · doi:10.1016/s0091-6749(98)70010-7 · Cited by 214 · see citing works
Helenius, I. J., Rytilä, P., Metso, T., Haahtela, T., Venge, P., & Tikkanen, H. O. (1998) · Allergy · doi:10.1111/j.1398-9995.1998.tb03904.x · Cited by 201 · see citing works
Self-citationA Rapid Dosimetric Method With Controlled Tidal Breathing for Histamine Challenge
Sovijärvi, A. R. A., Malmberg, L. P., Reinikainen, K. J., Rytilä, P. H., & Poppius, H. (1993) · CHEST Journal · doi:10.1378/chest.104.1.164 · Cited by 180 · see citing works
The U.S. Olympic Committee experience with exercise-induced bronchospasm, 1984
Voy, R. O. (1986) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-198606000-00013 · Cited by 179 · see citing works
The cellular composition of induced sputum in chronic obstructive pulmonary disease
Peleman, R. A., Rytilä, P. H., KIPS, J. C., Joos, G., & Pauwels, R. (1999) · European Respiratory Journal · doi:10.1034/j.1399-3003.1999.13d24.x · Cited by 167 · see citing works
Airway Hyperresponsiveness in Elite Athletes
Langdeau, J.-B., Turcotte, H., BOWIE, D. M., Jobin, J., DESGAGNÉ, P., & Boulet, L. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.161.5.9909008 · Cited by 160 · see citing works
Association between type of training and risk of asthma in elite athletes
Helenius, I. J., Tikkanen, H. O., & Haahtela, T. (1997) · Thorax · doi:10.1136/thx.52.2.157 · Cited by 121 · see citing works
Self-citationLymphoid Aggregates in Endobronchial Biopsies from Young Elite Cross-country Skiers
Sue‐Chu, M., Karjalainen, E.-M., Altraja, A., Laitinen, A., Laitinen, L. A., SS, A. B. N., Larsson, L., & Bjermer, L. H. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.2.9711012 · Cited by 117 · see citing works
Sue‐Chu, M., Larsson, L., & Bjermer, L. H. (1996) · Respiratory Medicine · doi:10.1016/s0954-6111(96)90206-1 · Cited by 114 · see citing works
Prevalence of Bronchial Hyperresponsiveness in Highly Trained Athletes
Weiler, J. M., Metzger, W. J., Donnelly, A., Crowley, E. T., & Sharath, M. D. (1986) · CHEST Journal · doi:10.1378/chest.90.1.23 · Cited by 111 · see citing works
Increased sensitization to aeroallergens in competitive swimmers
Zwick, H., Popp, W., Budik, G., Wanke, T., & Rauscher, H. (1990) · Lung · doi:10.1007/bf02719681 · Cited by 97 · see citing works
Assessment of chlorine exposure in swimmers during training
Drobnic, F., Freixa, A., Casán, P., Sanchis, J., & Guardino, X. (1996) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199602000-00018 · Cited by 96 · see citing works
Persistent Asthma After Repeated Exposure to High Concentrations of Gases in Pulpmills
Chang-Yeung, M., Lam, S. C., Kennedy, S., & Frew, A. J. (1994) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.149.6.8004329 · Cited by 87 · see citing works
Chloroform in Alveolar Air of Individuals Attending Indoor Swimming Pools
Aggazzotti, G., Fantuzzi, G., Righi, E., Tartoni, P., Cassinadri, T. M., & Predieri, G. (1993) · Archives of Environmental Health An International Journal · doi:10.1080/00039896.1993.9940368 · Cited by 69 · see citing works
Factors Associated with Respiratory Problems in Swimmers
Potts, J. E. (1996) · Sports Medicine · doi:10.2165/00007256-199621040-00002 · Cited by 67 · see citing works
Renal function in dogs with chronic moderate unilateral ureteral obstruction
Aperia, A. C., Herin, P., Josephson, S., & Lännergren, K. (1982) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365518209168042 · Cited by 67 · see citing works
Management of allergic Olympic athletes
Fitch, K. D. (1984) · Journal of Allergy and Clinical Immunology · doi:10.1016/0091-6749(84)90314-2 · Cited by 54 · see citing works
Asthma and other pulmonary diseases in former elite athletes.
Kujala, U. M., Sarna, S., Kaprio, J., & Koskenvuo, M. (1996) · Thorax · doi:10.1136/thx.51.3.288 · Cited by 44 · see citing works
Self-citationCan early asthma be confirmed by laboratory tests?
Metso, T., Kilpiö, K., Björkstén, F., Kiviranta, K., & Haahtela, T. (1996) · Allergy · doi:10.1111/j.1398-9995.1996.tb04597.x · Cited by 23 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Carlsen, K. ‐., Anderson, S. D., Bjermer, L. H., Bonini, S., Brusasco, V., Canonica, G. W., Cummiskey, J. M., Delgado, L., Giacco, S. R. D., Drobnic, F., et al. (2008) · Allergy · doi:10.1111/j.1398-9995.2008.01662.x · Cited by 316 · see citing works
Self-citationAmerican Academy of Allergy, Asthma & Immunology Work Group Report: Exercise-induced asthma
Weiler, J. M., Bonini, S., Coifman, R. E., Craig, T., Delgado, L., Capão-Filipe, M., Passàli, D., RANDOLPH, C. C., & Storms, W. W. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.02.041 · Cited by 238 · see citing works
Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes
Anderson, S. D., & Kippelen, P. (2008) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2008.05.001 · Cited by 237 · see citing works
Weiler, J. M., Anderson, S. D., RANDOLPH, C. C., Bonini, S., Craig, T., Pearlman, D. S., Rundell, K. W., Silvers, W. S., Storms, W. W., Bernstein, D. I., et al. (2010) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2010.09.021 · Cited by 221 · see citing works
Cold air-provoked respiratory symptoms: the mechanisms and management
Koskela, H. O. (2007) · International Journal of Circumpolar Health · doi:10.3402/ijch.v66i2.18237 · Cited by 213 · see citing works
Fitch, K. D., Sue‐Chu, M., Anderson, S. D., Boulet, L., Hancox, R. J., McKenzie, D. C., Backer, V., Rundell, K. W., Alonso, J. M., Kippelen, P., et al. (2008) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2008.07.003 · Cited by 197 · see citing works
Asthma, Airway Inflammation and Epithelial Damage in Swimmers and Cold-Air Athletes
Bougault, V., Turmel, J., St-Laurent, J., Bertrand, M., & Boulet, L.-P. (2009) · European Respiratory Journal · doi:10.1183/09031936.00117708 · Cited by 170 · see citing works
Health effects of disinfection by-products in chlorinated swimming pools
Florentin, A., Hautemanière, A., & Hartemann, P. (2011) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2011.07.012 · Cited by 165 · see citing works
An overview of asthma and airway hyper-responsiveness in Olympic athletes
Fitch, K. D. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090814 · Cited by 156 · see citing works
Weisel, C. P., Richardson, S. D., Nemery, B., Aggazzotti, G., Baraldi, E., Blatchley, E. R., Blount, B. C., Carlsen, K.-H., Eggleston, P. A., Frimmel, F. H., et al. (2009) · Environmental Health Perspectives · doi:10.1289/ehp.11513 · Cited by 153 · see citing works
Exercise and asthma: an overview
Giacco, S. R. D., Firinu, D., Bjermer, L. H., & Carlsen, K. (2015) · European Clinical Respiratory Journal · doi:10.3402/ecrj.v2.27984 · Cited by 146 · see citing works
Physical training does not increase allergic inflammation in asthmatic children
Moreira, A. M., Delgado, L., Haahtela, T., Fonseca, J., Moreira, P. A. M., Lopes, C. M. M., Mota, J. A. P. S., Santos, M. P., Rytilä, P. H., & Castel-Branco, M. G. (2008) · European Respiratory Journal · doi:10.1183/09031936.00171707 · Cited by 128 · see citing works
Self-citationImpact of Chlorinated Swimming Pool Attendance on the Respiratory Health of Adolescents
Bernard, A., Nickmilder, M., Voisin, C., & Sardella, A. (2009) · Pediatrics · doi:10.1542/peds.2009-0032 · Cited by 126 · see citing works
Respiratory health of elite athletes – preventing airway injury: a critical review
Kippelen, P., Fitch, K. D., Anderson, S. D., Bougault, V., Boulet, L., Rundell, K. W., Sue‐Chu, M., & McKenzie, D. C. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2012-091056 · Cited by 126 · see citing works
Rhinitis and asthma in athletes: an ARIA document in collaboration with GA2LEN
Bonini, S., Bonini, M., Bousquet, J., Brusasco, V., Canonica, G. W., Carlsen, K. ‐., Corbetta, L., Cummiskey, J. M., Delgado, L., Giacco, S. R. D., et al. (2006) · Allergy · doi:10.1111/j.1398-9995.2006.01080.x · Cited by 109 · see citing works
Self-citationOutdoor swimming pools and the risks of asthma and allergies during adolescence
Bernard, A., Nickmilder, M., & Voisin, C. (2008) · European Respiratory Journal · doi:10.1183/09031936.00114807 · Cited by 100 · see citing works
Winter sports athletes: long-term effects of cold air exposure
Sue‐Chu, M. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090822 · Cited by 100 · see citing works
Asthma, Airway Inflammation and Treatment in Elite Athletes
Helenius, I. J., Lumme, A., & Haahtela, T. (2005) · Sports Medicine · doi:10.2165/00007256-200535070-00002 · Cited by 96 · see citing works
Self-citationAirway inflammation, bronchial hyperresponsiveness and asthma in elite ice hockey players
Lumme, A., Haahtela, T., Öunap, J., Rytilä, P. H., Obase, Y., Helenius, M., Remes, V., & Helenius, I. J. (2003) · European Respiratory Journal · doi:10.1183/09031936.03.00112403 · Cited by 95 · see citing works
Self-citationIncreased airway inflammatory cells in endurance athletes: what do they mean?
Bonsignore, M. R., Morici, G., Vignola, A. M., Riccobono, L., Bonanno, A., Profita, M., Abate, P., Scichilone, N., Amato, G. M., Bellia, V., et al. (2003) · Clinical & Experimental Allergy · doi:10.1046/j.1365-2222.2003.01557.x · Cited by 94 · see citing works
Emerging Environmental and Weather Challenges in Outdoor Sports
Brocherie, F., Girard, O., & Millet, G. P. (2015) · Climate · doi:10.3390/cli3030492 · Cited by 96 · see citing works
Mechanisms of asthma in Olympic athletes – practical implications
Haahtela, T., Malmberg, P., & Moreira, A. M. (2008) · Allergy · doi:10.1111/j.1398-9995.2008.01686.x · Cited by 93 · see citing works
Self-citation(2012) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/mer125 · Cited by 84 · see citing works
Carlsen, K. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2012-091292 · Cited by 82 · see citing works
Airway inflammation and upper respiratory tract infection in athletes: is there a link?
Bermon, S. (2026) · PubMed · doi:10.22029/eir.2007.1627 · Cited by 82 · see citing works
The determinants of prevalence of health complaints among young competitive swimmers
Lévesque, B., Duchesne, J.-F., Gingras, S., Lavoie, R., Prud’Homme, D., Bernard, E., Boulet, L.-P., & Ernst, P. (2006) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-006-0100-0 · Cited by 80 · see citing works
Health risks of early swimming pool attendance
Schoefer, Y., Zutavern, A., Brockow, I., Schäfer, T., Krämer, U., Schaaf, B., Herbarth, O., von Berg, A., Wichmann, H.-E., & Heinrich, J. (2008) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2007.08.001 · Cited by 80 · see citing works
Dempsey, J. A., Gerche, A. L., & Hull, J. H. (2020) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00444.2020 · Cited by 79 · see citing works
Airway injury during high-level exercise
Kippelen, P., & Anderson, S. D. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090819 · Cited by 79 · see citing works
Asthma, allergy and the Olympics: a 12-year survey in elite athletes
Bonini, M., Gramiccioni, C., Fioretti, D., Ruckert, B., Rinaldi, M., Akdis, C., Todaro, A., Palange, P., Carlsen, K.-H., Pelliccia, A., et al. (2015) · Current Opinion in Allergy & Clinical Immunology · doi:10.1097/aci.0000000000000149 · Cited by 76 · see citing works
Airway responsiveness and inflammation in adolescent elite swimmers
Pedersen, L., Lund, T. K., Barnes, P. J., Kharitonov, S. A., & Backer, V. (2008) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2008.04.041 · Cited by 75 · see citing works
Li, G., Cao, X., Meng, N., Huang, Y.-M., Wang, X., Gao, Y., Li, X., Yang, T., Li, B.-L., Zhang, Y., et al. (2021) · Chemical Engineering Journal · doi:10.1016/j.cej.2021.133595 · Cited by 69 · see citing works
Exercise-Induced Bronchoconstriction
Bonini, M., & Silvers, W. S. (2018) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2018.01.007 · Cited by 67 · see citing works
Airway dysfunction in swimmers: Table 1
Bougault, V., & Boulet, L. (2012) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090821 · Cited by 66 · see citing works
Prevalence and characteristics of asthma in the aquatic disciplines
Mountjoy, M. L., Fitch, K. D., Boulet, L., Bougault, V., van Mechelen, W., & Verhagen, E. A. L. M. (2015) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2015.01.041 · Cited by 63 · see citing works
Bonini, M., Lapucci, G., Petrelli, G., Todaro, A., Pamich, T., Rasi, G., & Bonini, S. (2007) · Allergy · doi:10.1111/j.1398-9995.2007.01503.x · Cited by 61 · see citing works
No effect of montelukast on asthma‐like symptoms in elite ice hockey players
Helenius, I. J., Lumme, A., Öunap, J., Obase, Y., Rytilä, P. H., Sarna, S. J., Alaranta, A., Remes, V., & Haahtela, T. (2003) · Allergy · doi:10.1046/j.1398-9995.2003.00353.x · Cited by 60 · see citing works
Self-citationExercise-induced bronchoconstriction: new evidence in pathogenesis, diagnosis and treatment
Bonini, M., & Palange, P. (2015) · Asthma Research and Practice · doi:10.1186/s40733-015-0004-4 · Cited by 59 · see citing works
Price, O. J., Sewry, N. A., Schwellnus, M. P., Backer, V., Reier‐Nilsen, T., Bougault, V., Pedersen, L., Chenuel, B. J., Larsson, K., & Hull, J. H. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104601 · Cited by 56 · see citing works
Exercise but not mannitol provocation increases urinary Clara cell protein (CC16) in elite swimmers
Romberg, K., Bjermer, L. H., & Tufvesson, E. (2010) · Respiratory Medicine · doi:10.1016/j.rmed.2010.07.012 · Cited by 54 · see citing works
Moreira, A., Kekkonen, R., Korpela, R., Delgado, L., & Haahtela, T. (2007) · Respiratory Medicine · doi:10.1016/j.rmed.2006.11.015 · Cited by 53 · see citing works
Self-citationAirway inflammation in the elite athlete and type of sport
Belda, J., Ricart, S., Casan, P., Giner, J., Bellido-Casado, J., Torrejon, M., Margarit, G., & Drobnic, F. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2007.036335 · Cited by 52 · see citing works
Côté, A., Turmel, J., & Boulet, L. (2018) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0037-1606215 · Cited by 52 · see citing works
Endurance Exercise Diverts the Balance between Th17 Cells and Regulatory T Cells
Perry, C., Pick, M., Bdolach, N., Hazan‐Halevy, I., Kay, S., Berr, I., Reches, A., Harishanu, Y., & Grisaru, D. (2013) · PLoS ONE · doi:10.1371/journal.pone.0074722 · Cited by 51 · see citing works
Gatterer, H., Dünnwald, T., Turner, R., Csapo, R., Schobersberger, W., Burtscher, M., Faulhaber, M., & Kennedy, M. D. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189700 · Cited by 50 · see citing works
Vergès, S., Flore, P., Rousseaux‐Blanchi, M., & Wuyam, B. (2004) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/j.1600-0838.2004.00383.x · Cited by 49 · see citing works
Thomas, S., Wolfarth, B., Wittmer, C., Nowak, D., Radon, K., & GA2LEN-Olympic study-Team (2010) · Allergy Asthma and Clinical Immunology · doi:10.1186/1710-1492-6-31 · Cited by 46 · see citing works
Circulating T-Regulatory Cells, Exercise and the Elite Adolescent Swimmer
Wilson, L. D., Zaldivar, F. P., Schwindt, C. D., Wang‐Rodriguez, J., & Cooper, D. M. (2009) · Pediatric Exercise Science · doi:10.1123/pes.21.3.305 · Cited by 44 · see citing works
Health effects of exposure to chlorination by‐products in swimming pools
Couto, M., Bernard, A., Delgado, L., Drobnic, F., Kurowski, M. M., Moreira, A. M., Alves, R. R., Rukhadze, M., Seys, S., Wiszniewska, M., et al. (2021) · Allergy · doi:10.1111/all.15014 · Cited by 42 · see citing works
Seys, S. F., Feyen, L., Keirsbilck, S., Adams, E., Dupont, L. J., & Nemery, B. (2015) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2015.03.001 · Cited by 37 · see citing works
Exercise-induced bronchoconstriction in elite or endurance athletes:
Atchley, T. J., & Smith, D. M. (2020) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2020.01.023 · Cited by 35 · see citing works
Upper Respiratory Tract Diseases in Athletes in Different Sports Disciplines
Gałązka-Franta, A., Jura-Szołtys, E., Smółka, W., & Gawlik, R. (2016) · Journal of Human Kinetics · doi:10.1515/hukin-2016-0014 · Cited by 34 · see citing works
Westerlund, J., Bryngelsson, I.-L., Löfstedt, H., Eriksson, K., Westberg, H., & Graff, P. (2019) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459624.2018.1536825 · Cited by 33 · see citing works
Bernard, A., Voisin, C., & Sardella, A. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201008-1306ed · Cited by 31 · see citing works
High incidence of exercise-induced bronchoconstriction in triathletes of the Swiss national team
Knöpfli, B. H., Luke‐Zeitoun, M., von DUVILLARD, S. P., Burki, A., Bachlechner, C., & Keller, H. (2007) · British Journal of Sports Medicine · doi:10.1136/bjsm.2006.030569 · Cited by 32 · see citing works
Wastensson, G., & Eriksson, K. (2020) · Critical Reviews in Toxicology · doi:10.1080/10408444.2020.1744514 · Cited by 30 · see citing works
Attendance at chlorinated indoor pools and risk of asthma in adult recreational swimmers
Ferrari, M., Schenk, K., Mantovani, W., Papadopoulou, C., Posenato, C., Ferrari, P., Poli, A., & Tardivo, S. (2011) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2010.12.006 · Cited by 28 · see citing works
Update on the Mechanisms of Pulmonary Inflammation and Oxidative Imbalance Induced by Exercise
Araneda, O. F., Carbonell, T., & Tuesta, M. (2016) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2016/4868536 · Cited by 30 · see citing works
Swimming pool attendance and exhaled nitric oxide in children
Carraro, S., Pasquale, M. F., Frè, M. D., Rusconi, F., Bonetto, G., Zanconato, S., & Baraldi, E. (2006) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2006.07.016 · Cited by 29 · see citing works
Diagnosis of asthma and permitted use of inhaled β2‐agonists in athletes
Bonini, S., Brusasco, V., Carlsen, K. ‐., Delgado, L., Giacco, S. D., Haahtela, T., Rasi, G., & Cauwenberge, P. B. V. (2003) · Allergy · doi:10.1046/j.1398-9995.2003.00355.x · Cited by 29 · see citing works
Self-citationManagement of Exercise-Induced Bronchoconstriction in Athletes
Koya, T., Ueno, H., Hasegawa, T., Arakawa, M., & Kikuchi, T. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.03.011 · Cited by 28 · see citing works
Australian Association for Exercise and Sports Science position statement on exercise and asthma
Morton, A. R., & Fitch, K. D. (2011) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2011.02.009 · Cited by 28 · see citing works
Exercise-Induced Asthma: Managing Respiratory Issues in Athletes
Ora, J., Marco, P. D., Gabriele, M., Cazzola, M., & Rogliani, P. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9010015 · Cited by 27 · see citing works
Air Quality and Exercise-Induced Bronchoconstriction in Elite Athletes
Rundell, K. W., & Sue‐Chu, M. (2013) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2013.02.009 · Cited by 27 · see citing works
Asthma, outdoor air quality and the Olympic Games
McKenzie, D. C., & Boulet, L. (2008) · Canadian Medical Association Journal · doi:10.1503/cmaj.080982 · Cited by 27 · see citing works
Sheth, K. K. (2003) · Pediatric Clinics of North America · doi:10.1016/s0031-3955(03)00039-7 · Cited by 26 · see citing works
Exercise-induced bronchoconstriction
Pongdee, T., & Li, J. T. (2013) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2013.02.002 · Cited by 24 · see citing works
The environment, the airway, and the athlete
Sacha, J. J., & Quinn, J. M. (2010) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2010.06.004 · Cited by 24 · see citing works
Comparison of tracheal aspirates before and after high‐speed treadmill exercise in racehorses
Malikides, N., Hughes, K., & Hodgson, J. L. (2007) · Australian Veterinary Journal · doi:10.1111/j.1751-0813.2007.00167.x · Cited by 23 · see citing works
Inflammation in allergic asthma: Initiating events, immunological response and risk factors
Ferreira, M. A. R. (2004) · Respirology · doi:10.1111/j.1440-1843.2003.00516.x · Cited by 23 · see citing works
Pulmonary function and airway responsiveness in young competitive swimmers
Silvestri, M., Crimi, E., Oliva, S., Senarega, D., Tosca, M. A., Rossi, G. A., & Brusasco, V. (2012) · Pediatric Pulmonology · doi:10.1002/ppul.22542 · Cited by 21 · see citing works
The World Anti-Doping Code: can you have asthma and still be an elite athlete?
Fitch, K. D. (2016) · Breathe · doi:10.1183/20734735.004116 · Cited by 21 · see citing works
Recent developments in occupational asthma
Burge, P. S. (2010) · Swiss Medical Weekly · doi:10.4414/smw.2010.12883 · Cited by 20 · see citing works
Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment
Grandinetti, R., Mussi, N., Rossi, A., Zambelli, G., Masetti, M., Giudice, A., Pilloni, S., Deolmi, M., Caffarelli, C., Esposito, S., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13154558 · Cited by 20 · see citing works
Respiratory disorders in endurance athletes – how much do they really have to endure?
Bussotti, M., Marchese, G., & Marco, S. D. (2014) · Open Access Journal of Sports Medicine · doi:10.2147/oajsm.s57828 · Cited by 19 · see citing works
Thirty years of longitudinal talent development research: a systematic review and meta-aggregation
Dunn, E., Lawrence, G. P., Gottwald, V. M., Hardy, J., Holliss, B., Oliver, S. J., Roberts, R., & Woodman, T. (2024) · International Review of Sport and Exercise Psychology · doi:10.1080/1750984x.2024.2309623 · Cited by 17 · see citing works
Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools
Löfstedt, H., Westerlund, J., Graff, P., Bryngelsson, I.-L., Mölleby, G., Olin, A.-C., Eriksson, K., & Westberg, H. (2016) · Journal of Occupational & Environmental Medicine · doi:10.1097/jom.0000000000000883 · Cited by 16 · see citing works
Airways Disorders and the Swimming Pool
Bougault, V., & Boulet, L. (2013) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2013.02.008 · Cited by 16 · see citing works
Extended diagnostic criteria used for indirect challenge testing in elite asthmatic swimmers
Romberg, K., Tufvesson, E., & Bjermer, L. H. (2011) · Respiratory Medicine · doi:10.1016/j.rmed.2011.09.011 · Cited by 15 · see citing works
Swinarew, A. S., Stanula, A., Gabor, J., Raif, P., Paluch, J., Karpiński, J., Kubik, K., Okła, H., Ostrowski, A., Tkacz, E., et al. (2020) · Respiratory Research · doi:10.1186/s12931-020-01350-y · Cited by 15 · see citing works
Airway dysfunction in elite swimmers: prevalence, impact, and challenges
Lomax, M. (2016) · Open Access Journal of Sports Medicine · doi:10.2147/oajsm.s88339 · Cited by 15 · see citing works
Stimulus and mechanisms of exercise-induced bronchoconstriction
Anderson, S. D., & Kippelen, P. (2010) · Breathe · doi:10.1183/18106838.0701.025 · Cited by 15 · see citing works
The Effect of Different Training Loads on the Lung Health of Competitive Youth Swimmers
Davies, R., Parent, É., Steinback, C. D., & Kennedy, M. D. (2018) · International journal of exercise science · doi:10.70252/wqbr8294 · Cited by 14 · see citing works
Exhaled nitric oxide indicates poorly athlete's asthma
Voutilainen, M., Malmberg, L. P., Vasankari, T. J., & Haahtela, T. (2013) · The Clinical Respiratory Journal · doi:10.1111/crj.12014 · Cited by 14 · see citing works
Self-citationSeasonal Fluctuations in Airway Responsiveness in Elite Endurance Athletes
Hemingson, H. B., Davis, B. E., & Cockcroft, D. W. (2004) · Canadian Respiratory Journal · doi:10.1155/2004/601014 · Cited by 14 · see citing works
Chlorine, Chlorination By-Products and Their Allergic and Respiratory Health Effects
Kohlhammer, Y., & Heinrich, J. (2007) · Current Respiratory Medicine Reviews · doi:10.2174/157339807779941839 · Cited by 13 · see citing works
Romberg, K., Tufvesson, E., & Bjermer, L. H. (2017) · Journal of Asthma and Allergy · doi:10.2147/jaa.s134794 · Cited by 13 · see citing works
Päivinen, M. K., Keskinen, K. L., Putus, T., Kujala, U. M., Kalliokoski, P., & Tikkanen, H. O. (2021) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-021-00349-2 · Cited by 13 · see citing works
Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers
Kotsiou, O. S., Peletidou, S., Vavougios, G. D., Karetsi, E., Stavrou, V. T., Zakynthinos, G. Ε., Gourgoulianis, K. I., & Daniil, Z. D. (2019) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2019.06.008 · Cited by 13 · see citing works
Effects of lifestyle intervention on neck, shoulder, elbow and wrist symptoms
Mattila, R., Malmivaara, A. O. V., Kastarinen, M. J., Kivelä, S., & Nissinen, A. M. (2004) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.779 · Cited by 13 · see citing works
Asthma and swimming: weighing the benefits and the risks
Bernard, A. (2010) · Jornal de Pediatria · doi:10.2223/jped.2029 · Cited by 13 · see citing works
Ventilation and Respiratory Mechanics
Sheel, A. W., & Romer, L. M. (2012) · Comprehensive physiology · doi:10.1002/j.2040-4603.2012.tb00417.x · Cited by 12 · see citing works
Management of Intermittent and Persistent Asthma in Adolescent and High School Athletes
Giacco, S. D., Couto, M., Firinu, D., & García-Larsen, V. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.05.003 · Cited by 12 · see citing works
Poussel, M., & Chenuel, B. J. (2010) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2010.08.004 · Cited by 11 · see citing works
Pharmacologic Strategies for Exercise-Induced Bronchospasm with a Focus on Athletes
Backer, V., & Mastronarde, J. G. (2018) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2018.01.011 · Cited by 11 · see citing works
Prevalence of Asthma among Norwegian Elite Athletes
Melsom, H. S., Randa, A., Hisdal, J., Stang, J. S., & Stensrud, T. (2022) · Translational Sports Medicine · doi:10.1155/2022/3887471 · Cited by 10 · see citing works
Respiratory impact of a grand tour: insight from professional cycling
Allen, H., Price, O. J., Greenwell, J., & Hull, J. H. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-020-04587-z · Cited by 9 · see citing works
Exercise-Induced Bronchoconstriction
Godfrey, S., & Fitch, K. D. (2013) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2013.02.001 · Cited by 9 · see citing works
Rasmussen, S. M., Hansen, E., & Backer, V. (2022) · Frontiers in Allergy · doi:10.3389/falgy.2022.973004 · Cited by 8 · see citing works
Exercise‐induced asthma, respiratory and allergic disorders in elite athletes
Burge, P. S., & Robertson, A. S. (2008) · Allergy · doi:10.1111/j.1398-9995.2008.01769.x · Cited by 8 · see citing works
- Authors
- Helenius, I., Rytil[auml ], P., Sarna, S., Lumme, A., Helenius, M., Remes, V., & Haahtela, T.
- Affiliations
- Helsinki University Hospital (FI)
- University of Helsinki (FI)
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2002-06
- Volume
- 109
- Issue
- 6
- Pages
- 0962-0968
- ISSN
- 0091-6749 (ISSN-L)
- OpenAlex
- W2165744221
- Cited by
- 217
- References
- 26
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 1 · 2022: 4 · 2021: 8 · 2020: 9 · 2019: 4 · 2018: 10 · 2017: 6 · 2016: 10 · 2015: 13 · 2014: 8 · 2013: 13 · 2012: 16
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory and Cough-Related Research
- Keywords
- airway hyperresponsiveness, airway inflammation, elite swimmers, endurance athletes, eosinophilic airway inflammation, induced sputum, long-term follow-up, histamine challenge, asthma risk factors
- MeSH terms
- Adult, Asthma, Bronchial Provocation Tests, Female, Follow-Up Studies, Humans, Inflammation, Male, Physical Fitness, Prospective Studies, Skin Tests, Spirometry, Swimming, Bronchial Hyperreactivity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
