Respiratory Care for Runners: Optimizing Nasal and Pulmonary Health and Performance
Main Article Content
Imran Özdemir, MD
http://orcid.org/0009-0002-8840-9363
Mustafa Yazır, MD
http://orcid.org/0000-0003-1133-8579
Cemal Cingi, MD
http://orcid.org/0000-0003-3934-5092
http://orcid.org/0009-0002-8840-9363
Mustafa Yazır, MD
http://orcid.org/0000-0003-1133-8579
Cemal Cingi, MD
http://orcid.org/0000-0003-3934-5092
Abstract
Respiratory function is crucial for runners' performance, recovery, and overall health. The unique physiological demands of endurance running subject the respiratory system to sustained high ventilatory efforts, increased exposure to environmental triggers such as allergens and pollutants, and a higher risk of exercise-induced respiratory issues, including exercise-induced bronchoconstriction and airway hyperresponsiveness. Runners often suffer from respiratory conditions such as asthma, allergic rhinitis, and exercise-induced bronchoconstriction. While cardiovascular and musculoskeletal adaptations are well-studied, the respiratory aspect often receives less attention despite its significant clinical and performance implications. This review discusses the physiological basis of respiratory health in runners, highlights common respiratory challenges, reviews evidence-based interventions, and suggests integrated strategies to optimize lung function in both competitive and recreational runners. A new section focuses on nasal physiology and care during running. Structured respiratory care—including preventive, therapeutic, and rehabilitative approaches—can improve performance, lower morbidity, and promote long-term respiratory health in runners.
Keywords:
Respiratory Care, Runners, Nasal Health, Pulmonary Health, Performance
Article Details
How to Cite
ÖZDEMIR, Imran; YAZIR, Mustafa; CINGI, Cemal.
Respiratory Care for Runners: Optimizing Nasal and Pulmonary Health and Performance.
Medical Research Archives, [S.l.], v. 13, n. 11, nov. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7028>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i11.7028.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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38. Carlsen KH, et al. Cold air inhalation and exercise-induced bronchoconstriction. Respir Med. 1998;92(5):308–315.
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2. Dempsey JA, Wagner PD. Exercise-induced arterial hypoxemia. J Appl Physiol. 1999;87(6):1997–2006.
3. Powers SK, Howley ET. Exercise Physiology: Theory and Application to Fitness and Performance. 10th ed. New York: McGraw-Hill; 2017.
4. Johnson BD, Weisman IM, Zeballos RJ, Beck KC. Pulmonary limitations to exercise performance: physiology, pathophysiology, and clinical applications. J Appl Physiol. 2000;89(1):1–24.
5. Carlsen KH, Anderson SD, Bjermer L, et al. Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis. Eur Respir J. 2008;31(4):681–689.
6. Sheel AW, Romer LM. Ventilation and respiratory mechanics in exercise. Compr Physiol. 2012;2(2):605–638.
7. Levine BD. VO₂max: what do we know, and what do we still need to know? J Physiol. 2008;586(1):25–34.
8. Hopkins SR. Exercise-induced arterial hypoxemia: the role of ventilation-perfusion inequality and diffusion limitation. Adv Exp Med Biol. 2006;588:17–30.
9. Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise performance in healthy individuals: a systematic review and meta-analysis. Sports Med. 2012;42(8):707–724.
10. Cole P. The respiratory role of the nose. Am J Rhinol. 1989;3(1):1–4.
11. Watanabe K, et al. Nasal air conditioning during exercise. J Appl Physiol. 1995;78(2):518–524.
12. Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y. Changes in airway resistance during nasal or oral breathing in humans. Respir Physiol. 1996;102(2–3):233–239.
13. Eccles R. Nasal airflow and resistance. Physiol Rev. 2000;80(3):1065–1098.
14. Cole P, Haight JS. Sympathetic nervous control of nasal vasculature. Am J Rhinol. 1988;2(1):47–52.
15. Elad D, Wolf M, Keck T. Airflow in the nasal cavity during respiration. Clin Exp Otorhinolaryngol. 2008;1(2):53–62.
16. Cingi C, Acar M, Muluk NB, et al. Functional outcomes after septoplasty in athletes. Eur Arch Otorhinolaryngol. 2011;268(6):857–861.
17. Anderson SD, Daviskas E. The mechanism of exercise-induced asthma. J Allergy Clin Immunol. 2000;106(3):453–459.
18. Kuehni CE, Strippoli MP, Low N, Silverman M. Air pollution and airway inflammation in runners. Eur Respir J. 2002;20(5):1032–1038.
19. Thomas PS, et al. Mucociliary clearance in athletes. Clin Physiol Funct Imaging. 2001;21(5):422–426.
20. Lundberg JO, et al. Nitric oxide and the nasal airways. Am J Respir Crit Care Med. 1994;150(2):545–549.
21. Morton AR, King K, Goodman C, et al. Nasal vs oral breathing during exercise: effects on ventilation and endurance. Eur J Appl Physiol. 2017;117(12):2435–2445.
22. Bonini S, Bonini M, Bousquet J, et al. Exercise-induced rhinitis: pathophysiological mechanisms and management. Allergy. 1996;51(9):680–683.
23. Bonini M, Lapucci G, et al. Allergic rhinitis and exercise performance: a clinical perspective. Allergy Asthma Proc. 2009;30(1):96–103.
24. Dykewicz MS, Hamilos DL. Chronic rhinitis and nosebleeds in athletes. J Allergy Clin Immunol. 2010;125(2 Suppl):S2–S7.
25. Fokkens WJ, et al. Chronic rhinosinusitis in athletes. Rhinology. 2016;54(3):217–223.
26. Rodenstein DO, Dooms G, Thomas Y, et al. Nasal vs oral breathing effects on ventilation efficiency. J Appl Physiol. 1985;58(3):708–712.
27. McKeown P. The Oxygen Advantage. New York: Harper Wave; 2015.
28. Cingi C, Muluk NB, Acar M. Rehabilitation after nasal surgery in athletes. Sports Med Health Sci. 2020;2(3):139–145.
29. Bonsignore MR, Marrone O, Fanfulla F. Sleep-disordered breathing and athletic performance. Eur Respir Rev. 2018;27(149):170110.
30. Cakmak O, Coskun M, Celik H. Exercise tolerance after nasal surgery. Am J Rhinol. 2004;18(5):363–367.
31. O’Kroy JA, James MA. The effect of nasal dilator strips on exercise performance. Clin J Sport Med. 2003;13(4):209–213.
32. Cingi C, et al. ENT evaluation in sports medicine: the nasal component. J Sports Med Phys Fitness. 2019;59(10):1785–1792.
33. Parsons JP, Hallstrand TS, Mastronarde JG, et al. Exercise-induced bronchoconstriction: diagnosis and management. Am Fam Physician. 2013;87(6):427–434.
34. Anderson SD, Kippelen P. Airway injury as a mechanism for exercise-induced bronchoconstriction. Chest. 2008;133(2):547–555.
35. Weiler JM, et al. Practice parameter: pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction. Ann Allergy Asthma Immunol. 2010;105(6 Suppl):S1–S47.
36. Fitch KD. Asthma and airway hyperresponsiveness in Olympic athletes: epidemiology and implications. Br J Sports Med. 2012;46(6):413–416.
37. Rundell KW, et al. Air pollution and exercise-induced airway dysfunction. Exerc Sport Sci Rev. 2002;30(2):59–64.
38. Carlsen KH, et al. Cold air inhalation and exercise-induced bronchoconstriction. Respir Med. 1998;92(5):308–315.
39. Chapman RF, Karlsen T, Ge RL, et al. Altitude training considerations for elite endurance athletes: a consensus statement. Br J Sports Med. 2014;48(2):97–111.
40. Bernard A. Chlorination products: emerging links with allergic diseases. Curr Med Chem. 2007;14(16):1771–1782.
41. Haahtela T, et al. Patient education and self-management in asthma. Eur Respir J. 1994;7(7):1391–1397.
42. Wilson MG, Hull JH, Rogers J, et al. Cardiopulmonary considerations for return-to-play in elite athletes after COVID-19 infection. J Sci Med Sport. 2020;23(7): 639–644.
43. Passfield L, Hopker J, Jobson SA, et al. Monitoring training and performance in athletes using wearable technology. Br J Sports Med. 2017;51(6):418–420.
44. Mickleborough TD. Omega-3 polyunsaturated fatty acids in physical performance optimization. Int J Sport Nutr Exerc Metab. 2013;23(1):83–96.