Respiratory Care for Runners: Optimizing Nasal and Pulmonary Health and Performance

Imran Özdemir, MD¹; Mustafa Yazır MD²; Cemal Cingi MD³

1.  Üsküdar University, Medical Faculty, Department of Pulmonology, Istanbul, Türkiye ORCID ID: 0000-0002-8840-9363
2. Yazır Private Otorhinolaryngology Clinic, Izmir, Türkiye ORCID ID: 0000-0003-1133-8579
3. Eskisehir Osmangazi University, Faculty of Medicine, Department of Otorhinolaryngology, Eskisehir, Türkiye ORCID ID: 0000-0003-3934-5092

OPEN ACCESS

PUBLISHED:30 November 2025

CITATION: Özdemir, I., Yazır, M., et al., 2025. Respiratory Care for Runners: Optimizing Nasal and Pulmonary Health and Performance. Research Archives, [online] 13(1).
https://doi.org/10.18103/mra.v13i1.7028

COPYRIGHT: © 2025 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted distribution, and reproduction in any medium, provided the original author and source are credited.

DOI: https://doi.org/10.18103/mra.v13i1.7028

ISSN 2375-1924

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

1. Introduction

The psychological, metabolic, and cardiovascular advantages of running make it one of the most popular forms of exercise in the world. Running puts a lot of strain on several organ systems, necessitating efficient energy usage and sustained oxygen delivery, whether you’re a recreational jogger or an expert marathoner. The respiratory system is pivotal among these systems because it facilitates oxygen intake, eliminates carbon dioxide, and helps maintain the body’s acid-base balance during exercise. When running at high intensity, a runner’s ventilatory rate may exceed 100 L/min. Although healthy people usually don’t let their lungs be the main limiting factor in endurance performance, exercise tolerance can be drastically reduced by respiratory inefficiencies, underlying airway disease, or environmental stress. There is a high prevalence of respiratory disorders in endurance athletes, including asthma, EIB, allergic rhinitis, and upper airway dysfunction.

Additional difficulties with oxygenation, breathing, and airway protection from pathogenic agents and environmental pollutants further strain the physiological demands of modern life. There is a lack of infrastructure to support running in the face of environmental factors such as pollen, mite particles, or seasonal allergies, despite running being very popular. Therefore, even experienced runners who have never smoked or been around dogs may experience persistent coughing after prolonged exertion. This is usually caused by dryness, cold, or airborne particles.

Running is incomplete without breathing; nevertheless, maintaining an inspiratory flow often takes priority over other bodily functions, such as digestion or speech. Common nasal irrigation techniques only partially remove the particulate matter that collects below the sinus cavity, which can worsen airway irritation caused by strong winds and airborne pollutants. When it comes to protecting against long-lasting particle debris, products that depend on one-way flow usually fall short. Beyond the conventional focus on integrating cardiovascular and musculoskeletal training, this work seeks to expand runners’ training ideas. It argues that optimizing aerobic fitness and respiratory function can improve long-term respiratory health by increasing volumetric oxygen capacity.

Despite its widespread promotion as a means of warding off illness and advancing age, exercise is increasingly seen as a commodity in today’s culture. Specifically, cultural frameworks that value autonomy and independence are congruent with running. Within this framework, the operational “control currencies” that define the running experience include elements like route, speed, distance, terrain, and mental concentration. In light of this background, this study examines running-specific respiratory care factors. Optimizing respiratory performance and maintaining aerobic health across the lifespan are the goals of this evidence-based guide, which summarizes the physiology of exercise ventilation, identifies common respiratory disorders affecting athletes, investigates environmental influences, and compiles prevention and management strategies.

2. Respiratory Physiology in Runners

2.1. Ventilatory Responses to Exercise

During exercise, ventilation increases linearly with metabolic demand until the ventilatory threshold is reached. Runners adapt by increasing tidal volume, respiratory muscle efficiency, and alveolar–capillary diffusion capacity. These adaptations are essential for maintaining oxygen delivery during prolonged exertion.

2.2. Running and the Nose

When it comes to runners’ respiratory health, the nose is absolutely crucial. In addition to directing airflow, it protects the lower airways from harmful substances by functioning as a warmer and humidifier, as well as a sophisticated filter. Maintaining smooth airflow while conditioning inspired air to near-body temperature and humidity becomes a challenge for the nasal passages when ventilation exceeds 100-150 L/min during running. While most of our breathing occurs through the nose when we’re at rest, we augment nasal airflow with oral breathing as the intensity of our workout increases. Although the total airflow may be limited during high-intensity efforts, the resistance created by the nasal valve area and turbinates enhances air conditioning. During submaximal exercise, rhinomanometry shows that sympathetic vasoconstriction reduces nasal resistance. Increased dryness and airway irritation can result from an early transition to mouth breathing due to anatomical abnormalities such as septal deviation or turbinate hypertrophy. To improve breathing comfort, functional rhinoplasty or septoplasty can be performed when necessary to open the nasal passageways. An important component of EIB, the nasal mucosa heats and humidifies the air to avoid the bronchial lining from becoming dehydrated. The danger of chilling and mediator release in the lower airways is increased when breathing through the mouth since this conditioning is bypassed.

Mucus and cilia in the nasal mucosa further filter out allergens and dust, and this helps keep the lower airways from becoming inflamed. Respiratory vulnerability is increased due to impaired mucociliary clearance, which can be caused by chronic rhinitis or dehydration. Breathed air helps pulmonary vasodilation and oxygen absorption because nitric oxide (NO), generated in the paranasal sinuses, diffuses into the air. Hence, during running, nasal breathing provides a natural NO boost. Even though most people breathe through their mouths when they’re really pushing themselves to their limits, keeping your nasal airways open at moderate intensities can help you breathe more efficiently and with less effort. In runners, nasal mucosa inflammation can be caused by environmental irritants such as pollen, cold air, and pollution. Forty percent or more of endurance athletes may experience exercise-induced rhinitis. A prevalent ailment that might cause airflow issues and exercise-induced bronchospasm (EIB) is allergic rhinitis. Antihistamines and intranasal corticosteroids are still the main treatments available. In arid areas, mucosal dehydration can cause a dry nose and nosebleeds; to prevent this, one should hydrate well, use saline gels, and keep the environment humid. Restoring airflow may require medical or surgical intervention in cases of chronic sinusitis and nasal polyps, even though these conditions are less prevalent. Differences in breathing technique affect the amount of energy required to exhale: breathing through the nose increases resistance but improves oxygen extraction, while breathing through the mouth lowers resistance but dries out the airway. When exerting moderate effort, it is normal to breathe alternately through your nose and mouth. In addition to promoting diaphragmatic activity, nasal breathing can help delay fatigue. Improve your CO₂ tolerance and respiratory pattern with nasal-breathing exercises. It is common practice to progressively resume nasal breathing and irrigation as part of post-operative rehabilitation. Nasal blockage can cause snoring and poor oxygenation, so keeping them open is beneficial for sleep and recuperation. Procedures such as septoplasty or turbinate reduction can help alleviate discomfort and improve performance when structural abnormalities are the cause of obstruction. The nasal valve can be widened and resistance reduced with the use of non-surgical devices, such as nasal dilators. Runners should have their nasal function checked by a sports doctor regularly. Protection and performance on the field can be improved by incorporating nasal care into respiratory measures. This includes things like rhinitis management, staying hydrated, and even contemplating surgery.

3. Common Respiratory Disorders in Runners

Runners often suffer from respiratory conditions such as asthma, allergic rhinitis, and exercise-induced bronchoconstriction. A temporary airway restriction, as evidenced by decreased airflow during hyperventilation, is characteristic of exercise-induced bronchoconstriction. Spirometry and bronchoprovocation tests are utilized for diagnosis. The management procedure includes administering corticosteroids, controlling environmental conditions, and using short-acting β-agonists prior to exercise. The ability to perform at one’s best is unaffected by asthma when it is under control.

3.1. Exercise-Induced Bronchoconstriction

Fifty percent of professional endurance athletes and twenty percent of amateur runners experience Exercise-Induced Bronchoconstriction. A temporary narrowing of the airway occurs during or after activity, leading to symptoms such as wheezing, coughing, shortness of breath, or a heavy feeling in the chest. The process of hyperventilation, which cools and dries the airways, releases mast cell mediators that, in turn, promote bronchospasm. The diagnosis cannot be made without objective studies, such as bronchoprovocation trials or pre- and post-exercise spirometry. Aside from controller therapy with inhaled corticosteroids and short-acting β₂-agonists inhaled before exercise, nonpharmacological approaches include warm-up exercises and the use of face masks in cold air.

3.2. Asthma in Runners

When you have asthma, which is often associated with EIB, it can have a negative impact on your performance and quality of life. Many Olympic runners compete with asthma and find relief through medication, proving that the disease does not hinder peak performance when controlled appropriately. Key components of asthma treatment include individualized asthma management, adherence to inhaled corticosteroids, and monitoring of lung function.

3.3. Allergic Rhinitis and Upper Airway Disorders

Athletes are at increased risk of developing allergic rhinitis when constantly exposed to environmental allergens such as pollen and grass. Nasal congestion, rhinorrhea, and sneezing can significantly affect your breathing and sleep quality. Endoscopic diagnosis is necessary for upper airway dysfunctions, which can involve vocal cord dysfunction, as they cause symptoms comparable to asthma.

3.4. Lower Respiratory Tract Infections

Runners are at a higher risk of respiratory infections because their immune system may be temporarily weakened after intense exercise. Particularly dangerous are viral diseases such as influenza and COVID-19, which require stringent protocols for returning to sports. It is crucial to practice excellent hygiene and be vaccinated in order to keep one’s respiratory system healthy.

4. Elite Runners

The ability to run in various weather conditions is crucial for elite runners. Factors affecting health and performance include temperature, humidity, pollen levels, smoking, and weather. Therefore, understanding how the environment affects breathing and running is helpful to optimize recovery and boost performance. Generally, people care about their respiratory health beyond just running. To improve your health, train at an ideal intensity, eat properly, stay well-hydrated, recover quickly, and practice mindful breathing while considering your environment.

Long, intense training sessions in tough conditions are common for elite runners. If you want to perform well and avoid distractions during competitions, you need to know how to prepare for and recover from sessions, long runs, and intervals. A recovery and deloading plan is essential. While recovery processes have been well studied, techniques focused on the respiratory system have received less attention. Breathing patterns after exercise, hydration advice, sleep routines, and easing into less intense periods are all important but sometimes overlooked parts of ventilatory recovery. Any effective recovery plan should include moments to shift your focus away from breathing.

Recovery breathing is a typical technique runners use to help recover from workouts. There are many methods to make running and recovery breathing more comfortable. You can speed up healing by applying eucalyptus oil to an injured area. Staying hydrated benefits both the respiratory system and the body right after exercise, but the interval we discussed earlier is equally important. Also, timing your last meal can be beneficial. Getting enough sleep is another key factor for all elite runners. Sleep patterns can greatly influence performance, especially for those who do not run at night or juggle multiple jobs.

Make sure to keep breathing steadily as you begin the deloading phase. Building a regular maintenance routine is easier when you gradually increase the intensity and frequency of your runs. Therefore, reducing running volume while increasing effort can be part of a deload plan. Insights from studies on emergency breathing can also help in monitoring feedback.

5. Interventions and Strategies for Respiratory Care

Preventive Strategies

• Preparticipation Screening: Identifying asthma, EIB, or rhinitis through questionnaires and spirometry enhances early intervention.
• Environmental Modification: Training location and timing should minimize exposure to allergens and pollutants.
• Vaccination: Influenza and COVID-19 vaccination reduce morbidity and training interruptions.

Pharmacological Therapy

• Asthma and EIB: Inhaled corticosteroids continue to be the primary treatment, with β₂-agonists used for emergency symptoms.
• Allergic Rhinitis: Intranasal corticosteroids and antihistamines help improve nasal airflow and lessen exercise-related impairments.

Non-Pharmacological Interventions

• Warm-Up Routines: Interval warm-ups induce a refractory period that reduces EIB episodes.
• Respiratory Muscle Training (RMT): Strengthens inspiratory and expiratory muscles, improving ventilatory efficiency.
• Breathing Techniques: Diaphragmatic and nasal breathing improve efficiency and decrease airway irritation.

6. Rehabilitation and Return-to-Play

Respiratory rehabilitation, especially after infections, involves gradual return-to-play protocols, monitoring exertional dyspnea, and conducting cardiopulmonary assessments when needed. Pulmonary rehabilitation techniques used for chronic lung disease are increasingly modified for athletes recovering from respiratory illnesses.

7. Integrating Respiratory Care into Runner Health

Sports physicians should work with pulmonologists to diagnose, treat, and monitor airway disorders. Incorporating spirometry, bronchoprovocation testing, and allergy testing ensures an accurate diagnosis. Respiratory care should involve physiotherapists, allergists, and coaches. Physiotherapists can focus on breathing retraining, while allergists aim to optimize immunotherapy for individuals with sensitivities. Coaches have a role in adjusting training loads during flare-ups.

Conclusion

Among the most crucial—and often neglected—components of endurance running is keeping one’s respiratory system in good shape. Respiratory disorders and diminished pulmonary function are among the understudied chronic ailments and illnesses that might develop as a result of the training load of lengthy miles. Because of its remarkable adaptability, the human respiratory system can sustain endurance-based exercise. A myriad of dangers jeopardize the health of the nose and lungs. The nasal passages may become dry or blocked with mucus; the airway linings can be irritated by polluted air, smoke, and allergies; and getting enough sleep and reducing training load can hinder recovery. In addition to endangering the lungs, airways, and mucosa, these factors may also limit endurance performance. Runners can reap big rewards with little effort by implementing simple, low-cost field and home measures. Pre- and post-run nose and airway conditioning routines improve mucosal heat and moisture retention while minimizing discharge. During a training week, methods include lowering breathing rate in conjunction with recovery, restoration, and conditioning components to lessen the stimulation felt after a workout and encourage continuous adaptation to moderate loads and durations. On a broader scale, the quality of recovery after sessions is determined by the interaction of numerous concurrent factors.

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