Summary • Training and competing in an air-polluted environment can present significant challenges to the endurance athlete. • In large urban areas it is not unusual to see relatively high levels of major pollutants such as carbon monoxide, nitrogen dioxide, sulfur dioxide, ozone and particulate matter. These pollutants, either individually or synergistically, can impair general health and the capacity to train and compete in endurance sport (Table 27.1). • The primary negative effect of most air pollutants centers on the pulmonary system, where lung function is impaired via inflammation of the epithelial layer. • Athletes with a history of asthma or exercise-induced asthma are at a higher risk of being negatively affected by air pollution than non-asthmatic athletes. • Given that many endurance athletes will be forced to train (or compete) either regularly or occasionally in an air-polluted environment, we have offered several practical recommendations to athletes, coaches and medical staff for the purpose of minimizing the potential negative effects of air pollution on general health and performance. • Like air pollution, athletes who train in chlorinated swimming pools are exposed to an unhealthy environment. • Chlorine reacts with water-borne contaminants to produce volatile chemicals (trialomethanes, chloramines, haloacetic acids), which swimmers are exposed to via pool water ingestion, inhalation of air at the pool surface, and direct exposure to eyes and skin (Figure 27.3). • The most profound effect of swimming pool chlorine on general health and endurance performance is on the respiratory system. • It is believed that swimming pool chlorine affects upper and lower airway function via two mechanisms: inflammation of the lung epithelium, and airway remodeling. • Training in a chlorinated swimming pool is a fact of life for most swimmers. As such, we have offered several practical recommendations to athletes, coaches and medical staff for the purpose of minimizing the potential negative effects of swimming pool chlorine on general health and performance. • One of our practical recommendations for endurance athletes who are forced to train in air-polluted environments or chlorinated aquatic environments is to undergo evaluation of pulmonary function by a certified medical professional for the purpose of determining asthmatic response and/or susceptibility to airway hyper-reactivity. • The final section of this chapter outlined the specific tests by which athletes can have their pulmonary function evaluated (Table 27.2). Among those tests, it is recommended that endurance athletes complete an exercise challenge (EC) for the purpose of simulating sport-specific and environment-specific (air pollution, swimming pool chlorine) conditions. • Athletes, coaches and medical staff at the Olympic level are strongly encouraged to be diligent in staying current on modifications to the annual WADA Prohibited List regarding the use of asthma medications, particularly ß2-agonists.
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