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Air athletes breathe: weighing benefits against harm
  1. James H Hull1,2,
  2. Michael Stephen Koehle3,4
  1. 1 Respiratory Medicine, Royal Brompton Hospital, London, UK
  2. 2 Institute of Sport, Exercise and Health (ISEH), UCL, London, UK
  3. 3 Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Division of Sports Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr James H Hull, Respiratory Medicine, Royal Brompton Hospital, London, UK; j.hull{at}

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It is well established that undertaking regular vigorous physical activity is associated with a broad range of benefits, including for cardiac, metabolic and cognitive health. Participation in sport, however, places specific demands on the respiratory system of athletic individuals and by its very nature, necessitates heightened levels of ventilation for prolonged periods of time. Indeed, individuals engaging in endurance-based sporting activity will typically inhale many thousands of litres of ambient air during a training or competition session and this ‘inhaled dose’ accumulates over the course of a season and their sporting career. There is a necessity to consider whether this exposure could be associated with any harm.

The air quality to which athletes are exposed is often poor. Athletes, who train and compete in urban environments (eg, where the major stadia are situated), are typically exposed to vehicle and industrial emissions primarily released as a product of combustion (such as oxides of nitrogen and particulate matter), or secondary pollutants such as ground-level ozone (created when ultraviolet light from the sun reacts with other pollutants). In addition to air pollutants, athletes are also exposed to allergens, infective matter and chemical by-products of disinfection which may also affect airway responsiveness. Moreover, it is estimated that over the next decade, air pollution exposure during sport …

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  • Contributors JHH and MSK contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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