BRONCHODILATORS & RESPIRATORY ANTI-INFLAMS

Chapter 5

Overview
Airway basics

Respiratory drugs
Impact of exercise on respiratory drugs Impact of respiratory drugs on exercisers

Impact of respiratory drugs on performance

Potential complications

Airway Basics
Bronchial tree
Trachea
Bronchi Bronchioles Alveoli

Airway Basics
Cellular respiration
Gas exchange that

occurs at alveoli
Ventilation
Movement of air in &

out of the lungs

Upper respiratory tract
Conditions air

(temperature & particulate filtration)

Airway Basics
Autonomic nervous

system
Controls rate and depth

through smooth muscle contraction/relaxation Acetylcholine (cholinergic receptors) Norepinephrine (adrenergic receptors)

Airway Basics
Cholinergic receptors
Medicinal blockers used for allergies & colds
Cause decreased salivation, dry mouth, and gastric

activity
Adrenergic receptors
Alpha (alpha-1 & alpha-2): peripheral blood vessels Beta (beta-1 & beta-2): cardiac/smooth mm and

respiratory tract respectively Alpha-1 & beta-1 receptors typically excitatory Alpha-2 & beta-2 receptors typically induce relaxation

Airway Basics
In cases of asthma and

bronchoconstriction, passages become constricted May be congenital May be allergy or pollutant related Worldwide asthma pharmaceutical market > $7 billion

Airway Basics

Airway Basics

Normal

Acute Fatal Asthma

Chronic Severe Asthma

Airway Basics
Effects worsened in cold,

dry air Exercise-induced bronchoconstriction (EIB)

AKA:
Exercise-induced asthma Exercise-induce

bronchospasm Postexercise bronchoconstriction Thermally induced asthma

Airway Basics
Asthma
Bronchoconstriction & inflammation of the

respiratory tract
Exercise-induced asthma (EIA)
Bronchoconstriction & inflammation of the

respiratory tract triggered by physical activity

Exercise-induced bronchospasm (EIB)
No inflammation

Airway Basics
Asthma attacks may be triggered by

inflammatory response (mucus production to rid irritant) and/or bronchospasm (bronchiole constriction to limit irritant) Typically managed medicinally
Control meds vs. rescue meds Metered Dose Inhaler (MDI)

Respiratory Drugs
Bronchodilators
Used to combat bronchoconstriction

Anti-inflammatories
Steroidal Non-steroidal

Medicine type
Oral More consistent, but slower MDI Faster acting, but often used improperly

Respiratory Drugs
Beta-2 agonists classified according to duration of

action
Short acting Used prn Proventil, Ventolin

Long lasting Controlling drugs Serevent

OTC asthma meds may affect cardiac function

Respiratory Drugs
Refractory period
50% of athletes w/ EIB experience symptom-free

period for 1-2 hours after asthma exacerbation Athletes with known refractory period may use it to their advantage

Respiratory Drugs
Sympathomimetics
Albuterol (Proventil, Ventolin

tablet, syrup Rx)

Use ~ 15 min. before exercise for

EIB
Salmeterol Xinafoate (Serevent

aerosol Rx)
Use ~ 30-60 min. before exercise

for EIB

Respiratory Drugs
Bronchodilators: Xanthines
Relax smooth muscle around bronchioles of lung,

resulting in wider airway which makes breathing easier Used to treat bronchial asthma, but not in an acute attack Theophylline (Theobid, Theo-Dur Rx)
Many side effects similar to sympathomimetics; caffeine may

increase these

Respiratory Drugs
Corticosteroid Inhalants
Either prevent narrowing or relax smooth muscle of

lung; NOT used for acute asthma Used to prevent or reduce frequency of chronic bronchial asthma attacks (when not controlled by bronchodilators or non-steroid medications)

Respiratory Drugs
Common

Corticosteroid Inhalants
Beclomethasone

Diproprionate (Beclovent Rx) Flunisolide (AeroBid Rx) Side Effects: Dry mouth, hoarseness, wheezing, rash

Respiratory Drugs
Intranasal Steroids
Work by shrinking swollen

nasal tissue and reducing inflammation Used for seasonal allergies or hay fever involving inflammation of mucous membranes of nasal passages

Respiratory Drugs
Common Intranasal

Steroids
Beclomethasone

Diproprionate (Beconase, Vancenase Rx) Fluticasone Proprionate (Flonase aerosol Rx)

Impact of Exercise on Respiratory Drugs

May hinder effects of histamine receptor

antagonists Normal training response is bronchodilation

Exercise may augment effects of bronchodilators

Many respiratory drugs are flow-limited

Dexamethasone, theophilline, terbutaline Unlikely that increased duration of action is clinically

relevant
Long-term impact unclear due to common prn

nature of administration

Impact of Respiratory Drugs on Exercisers

Beta agonists and anti-inflammatory agents have

little to no impact on exercise HR Bronchodilators have minimal impact on exercise HR Some studies have actually demonstrated decreases in FEV and VO2

Impact of Respiratory Drugs on Performance

Exercise limiters
Cardiac output & VO2
Not ventilation, alveolar gas diffusion, or other lung

functions

Little to no effects with localized dosing as used to

treat respiratory conditions

Findings relatively consistent among both trained and

untrained participants Isolated studies have indicated increases in exercise duration at maximum intensity

Impact of Respiratory Drugs on Performance

No change in RPE

Increases in mm strength have been noted with

albuterol and clenbuterol Theophilline effects similar to caffeine in many respects

Increases in strength and power have been noted

Psychological effect?
98% of triathletes claimed to be asthmatic in 1999

Potential Complications
Side effects
Nervousness
Restlessness Dizziness Sleeplessness Dry mouth Appetite changes Throat irritation

Rebound vasodilation (nasal sprays)

Potential Complications
Theophylline shows greatest riskmost others

considered extremely safe Decreased BMD in women and children who use chronically
Can be offset with ability to exercise

NCAA allows inhalation use (banned systemically) USOC/IOC allow use with written permission

Can clear system in 2-3 days