优秀运动员中运动诱发哮喘的机制和处理
2012/07/06
摘要
目的与方法：一些优秀运动员，特别是那些耐力运动员，常常出现哮喘。本文对当前优秀成人运动员中，运动诱发的哮喘（EIA）机制及其处理认识进行回顾性总结。
结果：目前有关EIA 的发病机制尚未完全了解，但主要有两个假说：高渗假说和温度假说。两个假说均认为炎症和肥大细胞活化对于EIA的发生至关重要，但两者在触发炎症反应的机制上存在差异。客观检测对优秀运动员EIA的诊断非常重要。EIA的处理包括药物和非药物两种手段。优秀运动员EIA治疗的主要原则是针对哮喘患者个体，采用激素吸入（ICS）治疗、β2受体激动剂治疗或白三烯拮抗剂治疗。然而，有证据显示，每日使用β2受体激动剂可能会导致耐受的出现。由于ICS具有抗炎效应，常推荐作为优秀运动员EIA治疗的主要手段。所有治疗哮喘的医生，特别是在优秀运动员的治疗时，应该对其可能导致的兴奋剂问题及时更新。优秀运动员EIA的非药物治疗包括热身，后者充分利用了EIA发作后的难治期。此外服用抗氧化剂也能降低气道炎症，是EIA非药物治疗的一个手段。佩戴热面罩，特别是针对冬天户外运动员设计的面罩，有助于保护因吸入冷和干燥空气触发的支气管收缩。
结论：优秀运动员EIA应该针对个体进行治疗，使用支气管扩张剂治疗有可能出现耐受，而且需考虑有关兴奋剂方面的问题。
（苏楠 审校）
J Asthma. 2012 Apr 20. [Epub ahead of print]
J Asthma. 2012 Apr 20. [Epub ahead of print]
Source
University of Copenhagen , Copenhagen , Denmark.
Abstract
OBJECTIVE AND METHODS： Asthma is often reported by elite athletes, especially endurance athletes. The aim of this article is to review current knowledge of mechanisms and management of exercise-induced asthma (EIA) in adult elite athletes.
RESULTS：The mechanisms underlying EIA is incompletely understood, but the two prevailing hypotheses are the hyper-osmolarity and the thermal hypothesis. Both hypotheses consider inflammation and activation of mast cells as being crucial for the development of EIA, although the assumed mechanisms triggering the inflammatory response differ. Objective testing is of utmost importance in the diagnosis of EIA in elite athletes. Management of EIA can be divided into pharmacologic and non-pharmacologic treatment. The basic principles for the treatment of EIA in elite athletes should be as for any asthmatic individual, including use of inhaled corticosteroids (ICS), β(2)-agonists, and leukotriene antagonists. However, evidence suggests that daily use of β(2)-agonists might lead to the development of tolerance. ICS therapy is, due to its anti-inflammatory effects, the recommended primary therapy for EIA also in elite athletes. All doctors treating individuals with asthma, especially elite athletes, should remain updated on doping aspects of asthma therapy. Non-pharmacologic management of EIA in elite athletes includes physical warm-up, which takes advantage of the refractory period following an attack of EIA, whereas high intake of antioxidants may reduce airway inflammation. Wearing heat masks, specially designed for outdoor winter athletes, might protect against bronchoconstriction triggered by inhalation of cold and dry air.
CONCLUSION：EIA in elite athletes should be managed as in any individual with asthma, but the risk of developing tolerance to bronchodilators as well as doping aspects should always be taken into account.
J Asthma. 2012 Apr 20. [Epub ahead of print]
