Non-invasive evaluation of lower airway inflammation in hyper-responsive elite cross-country skiers and asthmatics

Respir Med. 1999 Oct;93(10):719-25. doi: 10.1016/s0954-6111(99)90039-2.


Asthma-like symptoms and bronchial hyper-responsiveness (BHR) to methacholine are prevalent in competitive cross-country skiers. Whether these symptoms (ski asthma) in these athletes are caused by asthma remains uncertain. Bronchial responsiveness to adenosine 5'-monophosphate (AMP) and nitric oxide (NO) concentration in exhaled air, both indirect markers of asthmatic airway inflammation, were investigated in two non-smoking study populations of skiers and asthmatics. Of 18 skiers with ski asthma, 15 non-steroid and 14 steroid-treated asthmatics, BHR to AMP was present in five (28%), six (40%) and 10 (71%) subjects respectively. Although the groups were not significantly different in responsiveness to methacholine, responsiveness to AMP increased in order of magnitude from ski asthma < non-steroid-treated < steroid-treated asthma. Exhaled NO in 44 (nine with ski asthma) skiers was not significantly different from 82 healthy non-atopic controls [median [interquartile range (IQR)] 6.5 (4.1-9.9) vs. 5.2 (4.2-6.5) ppb]. Exhaled NO in 29 subjects with mild intermittent asthma was three-fold greater [median (IQR) 19.2 (5.1-25.6) ppb, P < 0.01] than in skiers. Exhaled NO was two- and four-fold greater in atopic than non-atopic subjects in the skier (P < 0.001) and asthmatic (P < 0.01) groups, respectively, and was correlated to methacholine responsiveness in atopic asthmatics (n = 22, rho = 0.55, P < 0.01). Exhaled NO was not elevated in ski asthma and may be more useful as a marker of atopic status than inflammation in the lower airway in skiers. Few skiers were hyper-responsive to AMP, indicating that pre-activated mucosal mast cells are not a predominant feature in ski asthma.

Publication types

  • Comparative Study

MeSH terms

  • Adenosine Monophosphate
  • Adolescent
  • Adult
  • Analysis of Variance
  • Asthma / physiopathology*
  • Biomarkers / analysis
  • Breath Tests
  • Bronchial Hyperreactivity
  • Bronchoconstrictor Agents
  • Case-Control Studies
  • Female
  • Humans
  • Lung / physiopathology*
  • Male
  • Methacholine Chloride
  • Middle Aged
  • Nitric Oxide / analysis
  • Skiing / physiology*
  • Statistics, Nonparametric


  • Biomarkers
  • Bronchoconstrictor Agents
  • Methacholine Chloride
  • Nitric Oxide
  • Adenosine Monophosphate