Main Text:
1. Introduction
For elite athletes an optimal health state is indispensable in order to deliver their best athletic performances. Athletes who undertake intense aerobic exercise meet metabolic demands by significantly increasing minute ventilation, making the airways one of their most important organ systems. The link between strenuous exercise and asthma has been a long-standing source of research and debate, but more recently, interest in the upper airways of athletes has gained more attention. Although it has been demonstrated that the nasal airway contributes only for 10 % of minute ventilation at maximal exercise intensity 1, the nose plays an important role in respiratory physiology due to its position at the entry of the airways. The most important functions of the nasal mucosa is to humidify and heat up the inhaled air, however, it is also the first barrier to encounter and respond to environmental particles such as allergens, pathogens or irritants 2.
Athletes seem to suffer more frequently from nasal symptoms compared to the non-sporting population 3 and some data in literature suggest that factors related to the excessive ventilation and/or environmental exposures might be a causal factor for upper airway dysfunction 4, 5.
Up till now, very little data exists on the difficulties that may arise while choosing the adequate treatment strategy for this patient group that presents with specific demands related to their occupation.
The aim of this review is to give an overview on what is currently known on the relevance and causes of the different types of nasal dysfunction in athletes. Additionally, the different treatment options with their place within the anti-doping regulations as well as the open questions and unmet needs for the management of this patient group are discussed with an outlook towards further research necessities.