EP 3.2 Respiratory health in Athletes
Common airway and non-airway related causes of shortness of breath
Airway related:
● Ventilation limit
● Excersise-induced arterial hypoxemia
● Sub-clinical pulmonary oedema
● Excersise-induced bronchoconstriction
● Excersise-induced laryngeal obstruction and vocal cord dysfunction
● Upper tract airway infections
● Excersise-induced hyperventilation & dysfunctional breathing
● Rhinitis
● Cough
Non airway related:
● Deconditioning
● Cardiac disease
● Iron deficiency
● Infectious disease
● Musculoskeletal causes
TLC = Total lung capacity
VC = vital capacity
Tidal volume = Per adem hoeveel lucht er binnen komt
FRC = hoeveel lucht er overblijft na een normale expiratie
RV = hoeveelheid lucht in de longen na een maximale expiratie
Ventilatie
VE = minute ventilation L/min
VE = frequentie rate * tidal volume.
FR = frequency rate
● 8-12 breaths in rust
● 20-50 breaths in exercise
VT = tidal volume
● 0,4-0,6 in rust
● 2-3,5L/min in exercise
VEpeak is MVV or FEV1 * 40
20% breathing reserve at peak excersise
,Acute exercise induced clinical oedema
Acute clinical oedema:
● Worsening dyspnoea/breathlessness
● Fatigue
● Cough
● Pink sputum
● Coughing up blood
Exercise induced bronchoconstriction
● Wheezing, cough, shortness of breath and/or chest tightness
● Generally occurring within 5 to 30 minutes after intense exercise
● Sometimes during moderate exercise
● Gradual spontaneous improvement is common after exercise
● Symptoms are mild to moderate in severity
● Impairment of athletic performance could be present
● Symptoms often not severe enough to cause significant respiratory distress
● Asthma-like symptoms in elite athletes are not necessarily associated with classic
features of asthma
● Have nonspecific complaints such as poor performance or “ feeling out of shape”,
abdominal pain, headaches, muscle cramps, fatigue and dizziness
● Expiratory dyspnea, expiratory wheezing
Exercise induced laryngeal obstruction (EILO)
● Breathing high pitched, grating
● Difficult breathing IN
● Peaks at maximum exercise
● Tightness in the throat
Asthma
● Breathing wheezing
● Difficulty breath OUT
● Peaks after exercise
● Tightness in the chest
Blood anemia
Clinical low HB levels
● < 12 g/dl women (normal 7,5 - 10 mmol)
● < 14 g/dl men (normal 8,5 - 11 mmol)
Iron
● 80% functional active
○ Hemoglobin contains 85% of functional iron
○ Myoglobin contains 12% of functional iron
● 20% stored
● Plays a role in mitochondrial function
, Normal values
Vital signs
● Heart rate: 60-100bpm
● Respiratory rate: 12-20 breaths
● Blood pressure: 120/80
● Body temperature: 37
● Oxygen saturation: > 93%
Arterial blood gas:
● pH: 7.35-7.45
● PaCO2: 35-45 mmhg
● PaO2: 80-100 mmhg
Bloed
● Hemoglobine: 12-16 gm/dl
● Hematocrit: 40-50%
● Troponin: < 0.4 ng/ml
● Brain natriuretic peptide: < 100 pg/ml
Pulmonary function
● FEV1: >80%
● FEV1/FVC: >70%
● FVC: >80%
● Diffusing capacity for carbon monoxide: 20-25ml
Ventilatie
● Tidal volume VT: =/- 0,5L
● Minute ventilation VE: 5-8L/min
● Maximum inspiratory pressure MIP: > -20 cmH20
● Maximum expiratory pressure MEP: > +40 cmH20
● Rapid shallow breathing index RSBI: < 100
● Deadspace-to-tidal-volume ratio (VD/VT): <60%
Breathing
● Normal breathing: 8-20 breaths/min
● Slow paced breathing: <10/min, mostly 5-6
● Fast paced breathing: consciously fast breathing rate > 20 /min
● Hyperventilation: Normal frequency but extra deep sighs, or high frequency > 20/min
sometimes irregular, decrease co2 tension blood
● Dysregulation: Irregular pattern, diaphragmatic/chest disturbed etc
Common airway and non-airway related causes of shortness of breath
Airway related:
● Ventilation limit
● Excersise-induced arterial hypoxemia
● Sub-clinical pulmonary oedema
● Excersise-induced bronchoconstriction
● Excersise-induced laryngeal obstruction and vocal cord dysfunction
● Upper tract airway infections
● Excersise-induced hyperventilation & dysfunctional breathing
● Rhinitis
● Cough
Non airway related:
● Deconditioning
● Cardiac disease
● Iron deficiency
● Infectious disease
● Musculoskeletal causes
TLC = Total lung capacity
VC = vital capacity
Tidal volume = Per adem hoeveel lucht er binnen komt
FRC = hoeveel lucht er overblijft na een normale expiratie
RV = hoeveelheid lucht in de longen na een maximale expiratie
Ventilatie
VE = minute ventilation L/min
VE = frequentie rate * tidal volume.
FR = frequency rate
● 8-12 breaths in rust
● 20-50 breaths in exercise
VT = tidal volume
● 0,4-0,6 in rust
● 2-3,5L/min in exercise
VEpeak is MVV or FEV1 * 40
20% breathing reserve at peak excersise
,Acute exercise induced clinical oedema
Acute clinical oedema:
● Worsening dyspnoea/breathlessness
● Fatigue
● Cough
● Pink sputum
● Coughing up blood
Exercise induced bronchoconstriction
● Wheezing, cough, shortness of breath and/or chest tightness
● Generally occurring within 5 to 30 minutes after intense exercise
● Sometimes during moderate exercise
● Gradual spontaneous improvement is common after exercise
● Symptoms are mild to moderate in severity
● Impairment of athletic performance could be present
● Symptoms often not severe enough to cause significant respiratory distress
● Asthma-like symptoms in elite athletes are not necessarily associated with classic
features of asthma
● Have nonspecific complaints such as poor performance or “ feeling out of shape”,
abdominal pain, headaches, muscle cramps, fatigue and dizziness
● Expiratory dyspnea, expiratory wheezing
Exercise induced laryngeal obstruction (EILO)
● Breathing high pitched, grating
● Difficult breathing IN
● Peaks at maximum exercise
● Tightness in the throat
Asthma
● Breathing wheezing
● Difficulty breath OUT
● Peaks after exercise
● Tightness in the chest
Blood anemia
Clinical low HB levels
● < 12 g/dl women (normal 7,5 - 10 mmol)
● < 14 g/dl men (normal 8,5 - 11 mmol)
Iron
● 80% functional active
○ Hemoglobin contains 85% of functional iron
○ Myoglobin contains 12% of functional iron
● 20% stored
● Plays a role in mitochondrial function
, Normal values
Vital signs
● Heart rate: 60-100bpm
● Respiratory rate: 12-20 breaths
● Blood pressure: 120/80
● Body temperature: 37
● Oxygen saturation: > 93%
Arterial blood gas:
● pH: 7.35-7.45
● PaCO2: 35-45 mmhg
● PaO2: 80-100 mmhg
Bloed
● Hemoglobine: 12-16 gm/dl
● Hematocrit: 40-50%
● Troponin: < 0.4 ng/ml
● Brain natriuretic peptide: < 100 pg/ml
Pulmonary function
● FEV1: >80%
● FEV1/FVC: >70%
● FVC: >80%
● Diffusing capacity for carbon monoxide: 20-25ml
Ventilatie
● Tidal volume VT: =/- 0,5L
● Minute ventilation VE: 5-8L/min
● Maximum inspiratory pressure MIP: > -20 cmH20
● Maximum expiratory pressure MEP: > +40 cmH20
● Rapid shallow breathing index RSBI: < 100
● Deadspace-to-tidal-volume ratio (VD/VT): <60%
Breathing
● Normal breathing: 8-20 breaths/min
● Slow paced breathing: <10/min, mostly 5-6
● Fast paced breathing: consciously fast breathing rate > 20 /min
● Hyperventilation: Normal frequency but extra deep sighs, or high frequency > 20/min
sometimes irregular, decrease co2 tension blood
● Dysregulation: Irregular pattern, diaphragmatic/chest disturbed etc
