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      Increased levels of alveolar and airway exhaled nitric oxide in runners

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          Abstract

          Aim

          The objective of this study was to apply extended NO analysis for measurements of NO dynamics in the lung, divided into alveolar and airway contribution, in amateur runners and marathoners.

          Methods

          The athletes participated in either a marathon or a half marathon. The athletes self-reported their age, weight, height, training distance per week, competing distance, cardio-pulmonary health, atopic status, and use of tobacco. Measurements of exhaled NO (F ENO) with estimation of alveolar NO (C ANO) and airway flux (J awNO), ventilation, pulse oximetry, and peak flow were performed before, immediately after, and 1 hour after completing the race.

          Results

          At baseline the alveolar NO was higher in amateur runners, 2.9 ± 1.1 ppb ( p = 0.041), and marathoners, 3.6 ± 1.9 ppb ( p = 0.002), than in control subjects, 1.4 ± 0.5 ppb. J awNO was higher in marathoners, 0.90 ± 0.02 nL s −1 ( p = 0.044), compared with controls, 0.36 ± 0.02 nL s −1, whereas the increase in amateur runners, 0.56 ± 0.02 nL s −1, did not attain statistical significance ( p = 0.165). Immediately after the race there was a decrease in F ENO in both amateur runners and marathoners, whereas C ANO and J awNO were decreased in marathoners only.

          Conclusion

          Our results support the view that there is an adaptation of the lung to exercise. Thus strenuous exercise increased both airway and alveolar NO, and this might in turn facilitate oxygen uptake.

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          Most cited references31

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          A European Respiratory Society technical standard: exhaled biomarkers in lung disease.

          Breath tests cover the fraction of nitric oxide in expired gas (FeNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FeNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FeNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.
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            Inhaled nitric oxide for the adult respiratory distress syndrome.

            The adult respiratory distress syndrome is characterized by pulmonary hypertension and right-to-left shunting of venous blood. We investigated whether inhaling nitric oxide gas would cause selective vasodilation of ventilated lung regions, thereby reducing pulmonary hypertension and improving gas exchange. Nine of 10 consecutive patients with severe adult respiratory distress syndrome inhaled nitric oxide in two concentrations for 40 minutes each. Hemodynamic variables, gas exchange, and ventilation-perfusion distributions were measured by means of multiple inert-gas-elimination techniques during nitric oxide inhalation; the results were compared with those obtained during intravenous infusion of prostacyclin. Seven patients were treated with continuous inhalation of nitric oxide in a concentration of 5 to 20 parts per million (ppm) for 3 to 53 days. Inhalation of nitric oxide in a concentration of 18 ppm reduced the mean (+/- SE) pulmonary-artery pressure from 37 +/- 3 mm Hg to 30 +/- 2 mm Hg (P = 0.008) and decreased intrapulmonary shunting from 36 +/- 5 percent to 31 +/- 5 percent (P = 0.028). The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2), an index of the efficiency of arterial oxygenation, increased during nitric oxide administration from 152 +/- 15 mm Hg to 199 +/- 23 mm Hg (P = 0.008), although the mean arterial pressure and cardiac output were unchanged. Infusion of prostacyclin reduced pulmonary-artery pressure but increased intrapulmonary shunting and reduced the PaO2/FiO2 and systemic arterial pressure. Continuous nitric oxide inhalation consistently lowered the pulmonary-artery pressure and augmented the PaO2/FiO2 for 3 to 53 days. Inhalation of nitric oxide by patients with severe adult respiratory distress syndrome reduces the pulmonary-artery pressure and increases arterial oxygenation by improving the matching of ventilation with perfusion, without producing systemic vasodilation. Randomized, blinded trials will be required to determine whether inhaled nitric oxide will improve outcome.
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              Infectious episodes in runners before and after the Los Angeles Marathon.

              An epidemiologic study of Los Angeles Marathon (LAM) applicants was conducted to investigate the relationship between self-reported infectious episodes (IE), training data, and LAM participation. Eight days before the LAM, 4926 of 12,200 applicants were randomly selected, and sent a pilot-tested four page questionnaire, which was received 7 days after the LAM. The 2311 respondents were found to be 2.0 yr older and 7.6 min faster than other LAM finishers (p less than .01). Univariate and multivariate analyses (logistic regression) were conducted to test the relationship between IE and km/wk of running (6 total categories). The final model tested controlled for age, marital status, reported sickness in other members of the runner's home, perceived feelings of stress in response to personal training regimens, and the suppressive effect of sickness on regular training. In runners training greater than or equal to 97 vs less than 32 km/wk, the odds ratio (OR) for IE during the 2 month period prior to the LAM was 2.0 (95% confidence interval (CI) 1.2-3.4). A test for trend showed an increase in OR with increase in km/wk category (p = .04) which was largely explained by the increased odds of reported sickness in the greater than or equal to 97 km/wk category. Of the 1828 LAM participants without IE before the LAM, 236 (12.9%) reported IE during the week following the LAM vs 3 of 134 (2.2%) similarly experienced runners who did not participate, OR = 5.9 (95% CI 1.9-18.8). These data suggest that runners may experience increased odds for IE during heavy training or following a marathon race.
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                Author and article information

                Journal
                Ups J Med Sci
                Ups. J. Med. Sci
                IUPS
                Upsala Journal of Medical Sciences
                Taylor & Francis
                0300-9734
                2000-1967
                June 2017
                08 May 2017
                : 122
                : 2
                : 85-91
                Affiliations
                [a ]Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden;
                [b ]Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden;
                [c ]Department of Medicine, Huddinge, Karolinska Institute, Sweden;
                [d ]Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden;
                [e ]Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
                Author notes
                CONTACT Marieann Högman marieann.hogman@ 123456medsci.uu.se Department of Medical Sciences, University Hospital, 751 85 Uppsala, Sweden
                Article
                iups-122-85
                10.1080/03009734.2017.1317886
                5441377
                28481126
                04107cf7-155d-4bca-8809-6bf48359341a
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 January 2017
                : 03 April 2017
                : 06 April 2017
                Funding
                Funded by: Swedish National Centre
                Award ID: ; nr 22
                Funded by: Swedish National Centre for Research in Sports 10.13039/501100005350
                Award ID: 1998; nr 22
                This study was supported in part by a grant of the Swedish National Centre for Research in Sports [1998; nr 22].
                Categories
                Original Articles

                Medicine
                athletes,biomarkers,exhaled nitric oxide,pulmonary gas exchange
                Medicine
                athletes, biomarkers, exhaled nitric oxide, pulmonary gas exchange

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