Hyperpnoea-induced bronchoconstriction: prevalence in athletes, novel measure of airway inflammation, & treatment with the prebiotic Bimuno-Galactooligosaccharide

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Needham, R, 2020. Hyperpnoea-induced bronchoconstriction: prevalence in athletes, novel measure of airway inflammation, & treatment with the prebiotic Bimuno-Galactooligosaccharide. PhD, Nottingham Trent University.

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Abstract

Asthma affects ~5,300,000 people in the UK. It is a significance public health burden costing the NHS an estimated one billion pounds per year. Approximately 50% of asthma patients suffer from hyperpnoea-induced bronchoconstriction (HIB), defined as a transient narrowing of the airway following hyperpnoea. HIB affects ~10% of the general population but is very prevalent in athletes, affecting approximately 35% of athletes and is severely under diagnosed and undertreated. Both asthma and HIB can be treated through pharmacological therapies, but these are neither curative nor preventative and chronic use can cause significant side-effects. The purpose of this thesis was to further understand the prevalence of HIB in athletes, and assess the effect of the dietary prebiotic, Bimuno-Galactooligosaccharide (B-GOS), supplementation on asthma and HIB. To establish the effect of B-GOS we first sort to evaluate the efficacy of a novel method to measure airway inflammation.

Consequently, this thesis investigated: (i) the prevalence of HIB in university field hockey athletes and assessed the effect of sex and diagnostic criteria on prevalence rates. Additionally, the thesis assessed the relationship between symptoms of dyspnoea and HIB in situ; (ii) the efficacy of the RTube device to collect exhaled breath condensate (EBC) with measurable cytokine concentrations; (iii) the effect of B-GOS supplementation on HIB severity, asthma control, and markers of airway inflammation in asthma participants with HIB.

The prevalence of HIB in university field hockey players was found to be 19% with a higher prevalence in males (30%) than females (5%). Diagnostic criteria influenced prevalence rates by 19% suggesting that less stringent criteria overestimate HIB prevalence. Symptoms of dyspnoea namely the “unpleasantness or discomfort of breathing” and the intensity of sensory dimensions (IPDS) were higher in HIB+ than HIB- athletes, correlated with HIB severity, and were highly sensitive and specific in predicting HIB (A1: Sensitivity = 100%; Specificity = 63%; IPDS: Sensitivity = 89%; Specificity = 66%). This is the first time respiratory symptoms and HIB have been assessed in situ, and one of the few reports to find an associate between symptoms and HIB.

This thesis found that IL-13, TSLP, IL-5, and TNF-ɑ could not be detected in EBC samples collected with the RTube device in participants with HIB and/or asthma, or healthy controls. Device material and protein adsorption was suspected in the poor recovery of biomarkers. Attempts to reduce biomarker adsorption by coating the RTube in 1% bovine serum albumin and 0.01% Tween20, alongside an 8-fold sample concentration did not results in the detection of biomarkers. As such, future work should use alternative methods of measuring airway inflammation to assess the effect of B-GOS supplementation on airway inflammation in participants with asthma and HIB.

It was found that 21 days supplementation with 3.65g/d of B-GOS did not affect HIB severity, asthma control and systemic markers of airway inflammation. These findings contrasted previous work (Williams et al, 2016) and sheds doubt on the efficacy of B-GOS to attenuate HIB. GOS dosage, however, was noted as a potential influencing factor, as such, future work should look to confirm the efficacy of B-GOS using a B-GOS dosage providing ≥5.28g/d of GOS in a larger sample size and taking direct measures of airway inflammation.

Item Type:	Thesis
Description:	Abridged version
Creators:	Needham, R.
Date:	September 2020
Rights:	This work is the intellectual property of the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed in the owner(s) of the Intellectual Property Rights.
Divisions:	Schools > School of Science and Technology
Record created by:	Linda Sullivan
Date Added:	08 Jun 2021 15:51
Last Modified:	08 Jun 2021 15:51
URI:	https://irep.ntu.ac.uk/id/eprint/43030