Bronchoscopy and bronchoalveolar lavage findings in cross-country skiers with and without "ski asthma"

Bronchial hyperresponsiveness to methacholine with asthma-like symptoms ("s ki asthma") is frequent in elite cross-country skiers. To further the under standing of "ski asthma", 10 nonasthmatic, nonatopic controls and 30 adoles cent elite skiers were investigated by bronchoscopy and bronchoalveolar lav age (BAL). Nine skiers were atopic without allergy symptoms. Compared with controls, the macroscopic inflammatory index in the proximal airways in skiers was three-fold greater (median (interquartile range) 3.0 (2.0-5.0) versus 1.0 (0.8-2.3), p=0.008), In the BAL fluid, skiers had sign ificantly greater total cell (p<0.05) and percentage lymphocyte (P<0.01) an d mast cell counts (p<0.05). Neutrophil and eosinophil counts were not sign ificantly different and eosinophil cationic protein was not detected. Tumou r necrosis factor-a and myeloperoxidase were detected in 12 (40%) and six ( 20%) skiers, respectively. In skiers with ski asthma, the inflammatory inde x was greater than in nonasthmatic skiers. Lymphocyte subtypes and activati on markers, and concentration of albumin, fibronectin and hyaluronan were n ot different from those in controls. Cross-country skiers have a minor to moderate degree of macroscopic inflamm ation in the proximal airways at bronchoscopy and a bronchoalveolar lavage fluid profile which differs in several respects from healthy controls. Skie rs with ski asthma tend to show even higher degrees of bronchial inflammati on.