Understanding the total airway response to exercise: current perspectives and future challenges

Exercise places a unique set of physiological demands on the airway tract. Historically, most work in this area has focused on the lower airway response, however it is now becoming increasingly apparent that the structural and functional behaviour of the upper airway and large central airways is equally important. Dysfunction in these sections of the airway tract can act to either hinder or modulate the exercise ventilatory response and as such lead to an increased work of breathing and the development of troublesome respiratory symptoms. This article provides an overview of the way in which the entire airway tract is challenged by the heightened ventilatory state mandated by physical activity, highlighting recent developments in our understanding of the physiology of laryngeal, large central and lower airway function during exercise.