Bronchoconstriction during cross-country skiing: Is there really a refractory period?

Purpose: The asthmatic airway responds to exercise by bronchodilation (BD) during and bronchoconstriction (BC) after exercise. A refractory period induced by an initial exercise challenge that provides protection against BC during a subsequent exercise bout has also been observed. However, no studies examining during-exercise response or refractoriness during long-duration field exercise by elite athletes have been performed. This study examined airway response and refractoriness during similar to42-min cross-country ski time trial preceded by a 6- to 9-min 2.5-km high-intensity warm-up ski. Methods: Eighteen elite athletes cross-country skied seven successive 2.5-km loops. Spirometry was performed pre- and at 5, 10, and 15 min post loop 1; loops 2-7 were treated as a race (XCR) with maneuvers performed within 20 s after loops 2-6 and serially for 15 min after lap 7. Results: Nine of 18 subjects demonstrated a greater than or equal to10% fall from baseline in FEV, (EIB+): five after lap 1 and four during or after laps 2-7. FEV1 for EIB+ athletes during XCR was not different from post lap 1 FEV1. Only one EIB + subject demonstrated significant reftactoriness. Four EIB + athletes had a less than 10% fall in FEV1 after the initial 2.5-km exercise challenge but developed EIB ( 10% fall) during the subsequent 6 X 2.5 km XCR exercise challenge. FEF25-75 falls mirrored FEV1, but demonstrated greater BD during XCR. Conclusion: Bronchoconstriction occurs in athletes during prolonged exercise and may thus influence performance. Variability in bronchial hyperresponsiveness onset and the lack of significant refractoriness in our study cohort of athletes is consistent with an exercise bronchoconstrictive dysfunction that is different than frank asthma and is yet to be clearly defined.