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Lung and Exercise in Extreme Environments

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Abstract

Changes in barometric pressure characterize both high altitude and the underwater world. These changes have a significant impact on the body’s pulmonary physiology and can affect both mountain climbers and divers. In both of these conditions, the organism must use compensatory mechanisms to adapt to the different environmental conditions. In this chapter, the environmental characteristics of altitude and underwater and their effects on the respiratory system are discussed. The body’s compensatory responses at high altitude, primarily the ventilatory response, are discussed. A section is devoted to the maladaptive response (i.e. high-altitude pulmonary oedema) and its prevention and treatment. Next, we consider the safety of high-altitude travel in patients with chronic respiratory disease, primarily chronic obstructive pulmonary disease, asthma and cystic fibrosis. In the second part of the chapter, the physiology and pathophysiology of the hyperbaric and diving environments, especially those involving the respiratory system, are described. A paragraph is dedicated to fitness for immersion, especially for the most common chronic respiratory diseases, such as asthma and COPD. In the last part of the chapter, we discuss lung interstitial oedema, its development in extreme environments or after strenuous exercise, and the diagnostic methods.

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References

  1. Bärtsch P, Saltin B. General introduction to altitude adaptation and mountain sickness. Scand J Med Sci Sports. 2008;18(Suppl 1):1–10. https://doi.org/10.1111/j.1600-0838.2008.00827.

    Article  PubMed  Google Scholar 

  2. Pollard A, Murdoch D. The high altitude medicine handbook. Abingdon: Radcliff Medical Press; 1997. p. 1–2.

    Google Scholar 

  3. West JB. Highest permanent human habitation. High Alt Med Biol. 2002;3(4):401–7.

    Article  PubMed  Google Scholar 

  4. Pomidori L, Bonardi D, Campigotto F, Fasano V, Gennari A, Valli G, Palange P, Cogo A. The hypoxic profile during trekking to the pyramid laboratory. High Alt Med Biol. 2009;10(3):233–7. https://doi.org/10.1089/ham.2008.1107.

    Article  PubMed  Google Scholar 

  5. Burtscher M, Flatz M, Faulhaber M. Prediction of susceptibility to acute mountain sickness by SaO2 values during short-term exposure to hypoxia. High Alt Med Biol. 2004;5(3):335–40.

    Article  PubMed  Google Scholar 

  6. Lorente-Aznar T, Perez-Aguilar G, García-Espot A, Benabarre-Ciria S, Mendia-Gorostidi JL, Dols Alonso D, Blasco-Romero J. Estimation of arterial oxygen saturation in relation to altitude. Med Clin (Barc). 2016;147(10):435–40. https://doi.org/10.1016/j.medcli.2016.07.025.

    Article  Google Scholar 

  7. West JB, Schoene RB, Luks AM, James S. Milledge high altitude medicine and physiology 5E. London: CRC Press; 2012.

    Book  Google Scholar 

  8. Norton EF. The fight for Everest. London: Edward Arnold; 1925.

    Google Scholar 

  9. Messner R. Everest: expedition to the ultimate, baton wicks. London: Baton Wicks; 1979.

    Google Scholar 

  10. Bernardi L, Schneider A, Pomidori L, Paolucci E, Cogo A. Hypoxic ventilatory response in successful extreme altitude climbers. Eur Respir J. 2006;27(1):165–71.

    Article  CAS  PubMed  Google Scholar 

  11. Puthon L, Bouzat P, Rupp T, Robach P, Favre-Juvin A, Verges S. Physiological characteristics of elite high-altitude climbers. Scand J Med Sci Sports. 2016;26(9):1052–9. https://doi.org/10.1111/sms.12547.

    Article  CAS  PubMed  Google Scholar 

  12. Bernardi L, Passino C, Spadacini G, Bonfichi M, Arcaini L, Malcovati L, Bandinelli G, Schneider A, Keyl C, Feil P, Greene RE, Bernasconi C. Reduced hypoxic ventilatory response with preserved blood oxygenation in yoga trainees and Himalayan Buddhist monks at altitude: evidence of a different adaptive strategy? Eur J Appl Physiol. 2007;99(5):511–8.

    Article  PubMed  Google Scholar 

  13. Bilo G, Revera M, Bussotti M, Bonacina D, Styczkiewicz K, Caldara G, Giglio A, Faini A, Giuliano A, Lombardi C, Kawecka-Jaszcz K, Mancia G, Agostoni P, Parati G. Effects of slow deep breathing at high altitude on oxygen saturation, pulmonary and systemic hemodynamics. PLoS One. 2012;7(11):e49074. https://doi.org/10.1371/journal.pone.0049074.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Bernardi E, Pratali L, Mandolesi G, Spiridonova M, Roi GS, Cogo A. Thoraco-abdominal coordination and performance during uphill running at altitude. PLoS One. 2017;12(3):e0174927. https://doi.org/10.1371/journal.pone.0174927.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cogo A, Legnani D, Allegra L. Respiratory function at different altitudes. Respiration. 1997;64(6):416–21.

    Article  CAS  PubMed  Google Scholar 

  16. Mason NP, Barry PW, Pollard AJ, Collier DJ, Taub NA, Miller MR, Milledge JS. Serial changes in spirometry during an ascent to 5,300 m in the Nepalese Himalayas. High Alt Med Biol. 2000;1(3):185–95.

    Article  CAS  PubMed  Google Scholar 

  17. Jaeger JJ, Sylvester JT, Cymerman A, Berberich JJ, Denniston JC, Maher JT. Evidence for increased intrathoracic fluid volume in man at high altitude. J Appl Physiol Respir Environ Exerc Physiol. 1979;47(4):670–6.

    CAS  PubMed  Google Scholar 

  18. Mansell A, Powles A, Sutton J. Changes in pulmonary PV characteristics of human subjects at an altitude of 5,366 m. J Appl Physiol Respir Environ Exerc Physiol. 1980;49(1):79–83.

    CAS  PubMed  Google Scholar 

  19. Contoli M, Bousquet J, Fabbri LM, Magnussen H, Rabe KF, Siafakas NM, Hamid Q, Kraft M. The small airways and distal lung compartment. Allergy. 2010;65:141–51. https://doi.org/10.1111/j.1398-9995.2009.02242.x.

    Article  CAS  PubMed  Google Scholar 

  20. Cremona G, Asnaghi R, Baderna P, Brunetto A, Brutsaert T, Cavallaro C, Clark TM, Cogo A, Donis R, Lanfranchi P, Luks A, Novello N, Panzetta S, Perini L, Putnam M, Spagnolatti L, Wagner H, Wagner PD. Pulmonary extravascular fluid accumulation in recreational climbers: a prospective study. Lancet. 2002;359:303–9.

    Article  PubMed  Google Scholar 

  21. Senn O, Clarenbach CF, Fischler M, Thalmann R, Brunner-La Rocca H, Egger P, Maggiorini M, Bloch KE. Do changes in lung function predict high-altitude pulmonary edema at an early stage? Med Sci Sports Exerc. 2006;38(9):1565–70.

    Article  PubMed  Google Scholar 

  22. Pellegrino R, Pompilio P, Quaranta M, Aliverti A, Kayser B, Miserocchi G, Fasano V, Cogo A, Milanese M, Cornara G, Brusasco V, Dellacà R. Airway responses to methacholine and exercise at high altitude in healthy lowlanders. J Appl Physiol (1985). 2010;108(2):256–65. https://doi.org/10.1152/japplphysiol.00677.2009.

    Article  CAS  Google Scholar 

  23. Dellacà RL, Zannin E, Sancini G, Rivolta I, Leone BE, Pedotti A, Miserocchi G. Changes in the mechanical properties of the respiratory system during the development of interstitial lung edema. Respir Res. 2008;9:51. https://doi.org/10.1186/1465-9921-9-51.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Johnson MK, Birch M, Carter R, Kinsella J, Stevenson RD. Use of reactance to estimate transpulmonary resistance. Eur Respir J. 2005;25:1061–9.

    Article  CAS  PubMed  Google Scholar 

  25. Cogo A, Miserocchi G. Pro: most climbers develop subclinical pulmonary interstitial edema. High Alt Med Biol. 2011;12(2):121–4. https://doi.org/10.1089/ham.2011.0004.

    Article  PubMed  Google Scholar 

  26. Maggiorini M. High altitude-induced pulmonary oedema. Cardiovasc Res. 2006;72(1):41–50.. Epub 2006 Jul 12

    Article  CAS  PubMed  Google Scholar 

  27. Swenson ER, Bärtsch P. High-altitude pulmonary edema. Compr Physiol. 2012;2(4):2753–73. https://doi.org/10.1002/cphy.c100029.

    Article  PubMed  Google Scholar 

  28. Luks AM. Physiology in medicine: a physiologic approach to prevention and treatment of acute high-altitude illnesses. J Appl Physiol (1985). 2015;118(5):509–19. https://doi.org/10.1152/japplphysiol.00955.2014.

    Article  CAS  Google Scholar 

  29. Luks AM, McIntosh SE, Grissom CK, Auerbach PS, Rodway GW, Schoene RB, Zafren K, Hackett PH, Wilderness Medical Society. Wilderness medical society consensus guidelines for the prevention and treatment of acute altitude illness. Wilderness Environ Med. 2010;21(2):146–55. https://doi.org/10.1016/j.wem.2010.03.002.

    Article  PubMed  Google Scholar 

  30. Stream JO, Luks AM, Grissom CK. Lung disease at high altitude. Expert Rev Respir Med. 2009;3(6):635–50. https://doi.org/10.1586/ers.09.51.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Seys SF, Daenen M, Dilissen E, Van Thienen R, Bullens DM, Hespel P, Dupont LJ. Effects of high altitude and cold air exposure on airway inflammation in patients with asthma. Thorax. 2013;68(10):906–13. https://doi.org/10.1136/thoraxjnl-2013-203280.

    Article  PubMed  Google Scholar 

  32. Bersuch E, Gräf F, Renner ED, Jung A, Traidl-Hoffmann C, Lauener R, Roduit C. Lung function improvement and airways inflammation reduction in asthmatic children after a rehabilitation program at moderate altitude. Pediatr Allergy Immunol. 2017;28(8):768–75. https://doi.org/10.1111/pai.12808.

    Article  PubMed  Google Scholar 

  33. Cogo A, Basnyat B, Legnani D, Allegra L. Bronchial asthma and airway hyperresponsiveness at high altitude. Respiration. 1997;64(6):444–9.

    Article  CAS  PubMed  Google Scholar 

  34. Huismans HK, Douma WR, Kerstjens HA, Renkema TE. Asthma in patients climbing to high and extreme altitudes in the Tibetan Everest region. J Asthma. 2010;47(6):614–9. https://doi.org/10.3109/02770900903573277.

    Article  PubMed  Google Scholar 

  35. Stokes S, Kalson N, Earl M, Frost H, Whitehead AG, Tyrrell-Marsh I, Davies A. Bronchial asthma on Mount Kilimanjaro is not a disadvantage. Thorax. 2008;63(10):936–7. https://doi.org/10.1136/thx.2008.102327.

    Article  CAS  PubMed  Google Scholar 

  36. Wu TY, Ding SQ, Liu JL, Yu MT, Jia JH, Chai ZC, Dai RC, Zhang SL, Li BY, Pan L, Liang BZ, Zhao JZ, Qi de T, Sun YF, Kayser B. Who should not go high: chronic disease and work at altitude during construction of the Qinghai-Tibet railroad. High Alt Med Biol. 2007;8(2):88–107.

    Article  PubMed  Google Scholar 

  37. Golan Y, Onn A, Villa Y, Avidor Y, Kivity S, Berger SA, Shapira I, Levo Y, Giladi M. Asthma in adventure travelers: a prospective study evaluating the occurrence and risk factors for acute exacerbations. Arch Intern Med. 2002;162(21):2421–6.

    Article  PubMed  Google Scholar 

  38. Cogo A, Fiorenzano G. Bronchial asthma: advice for patients traveling to high altitude. High Alt Med Biol. 2009;10(2):117–21. https://doi.org/10.1089/ham.2009.1007.

    Article  PubMed  Google Scholar 

  39. Dillard TA, Moores LK, Bilello KL, Phillips YY. The preflight evaluation. A comparison of the hypoxia inhalation test with hypobaric exposure. Chest. 1995;107(2):352–7.

    Article  CAS  PubMed  Google Scholar 

  40. Edvardsen A, Akerø A, Christensen CC, Ryg M, Skjønsberg OH. Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation. Thorax. 2012;67(11):964–9. https://doi.org/10.1136/thoraxjnl-2012-201855.

    Article  PubMed  Google Scholar 

  41. Kelly PT, Swanney MP, Stanton JD, Frampton C, Peters MJ, Beckert LE. Resting and exercise response to altitude in patients with chronic obstructive pulmonary disease. Aviat Space Environ Med. 2009;80(2):102–7.

    Article  PubMed  Google Scholar 

  42. Furian M, Hartmann SE, Latshang TD, Flueck D, Murer C, Scheiwiller PM, Osmonov B, Ulrich S, Kohler M, Poulin MJ, Bloch KE. Exercise performance of lowlanders with COPD at 2,590 m: data from a randomized trial. Respiration. 2018;95(6):422–32. https://doi.org/10.1159/000486450.

    Article  PubMed  Google Scholar 

  43. Rand S, Prasad SA. Exercise as part of a cystic fibrosis therapeutic routine. Expert Rev Respir Med. 2012;6(3):341–51.; quiz 352. https://doi.org/10.1586/ers.12.19.

    Article  CAS  PubMed  Google Scholar 

  44. Fischer R, Lang SM, Brückner K, Hoyer HX, Meyer S, Griese M, Huber RM. Lung function in adults with cystic fibrosis at altitude: impact on air travel. Eur Respir J. 2005;25(4):718–24.

    Article  CAS  PubMed  Google Scholar 

  45. Blau H, Mussaffi-Georgy H, Fink G, Kaye C, Szeinberg A, Spitzer SA, Yahav J. Effects of an intensive 4-week summer camp on cystic fibrosis: pulmonary function, exercise tolerance, and nutrition. Chest. 2002;121(4):1117–22.

    Article  PubMed  Google Scholar 

  46. Ryujin DT, Mannebach SC, Samuelson WM, Marshall BC. Oxygen saturation in adult cystic fibrosis patients during exercise at high altitude. Pediatr Pulmonol. 2001;32(6):437–41.

    Article  CAS  PubMed  Google Scholar 

  47. Lynch JH, Bove AA. Diving medicine: a review of current evidence. J Am Board Fam Med. 2009;22:399–407. https://doi.org/10.3122/jabfm.2009.04.080099.

    Article  PubMed  Google Scholar 

  48. Pendergast DR, Moon RE, Krasney JJ, Held HE, Zamparo P. Human physiology in an aquatic environment. Compr Physiol. 2015;5(4):1705–50. https://doi.org/10.1002/cphy.c140018.

    Article  PubMed  Google Scholar 

  49. Tetzlaff K, Thorsen E. Breathing at depth: physiologic and clinical aspects of diving while breathing compressed gas. Clin Chest Med. 2005;26(3):355–80.

    Article  PubMed  Google Scholar 

  50. Pendergast DR, Lundgren CE. The underwater environment: cardiopulmonary, thermal, and energetic demands. J Appl Physiol. 2009;106(1):276–83. https://doi.org/10.1152/japplphysiol.90984.2008.

    Article  CAS  PubMed  Google Scholar 

  51. Bosco G, Rizzato A, Moon RE, Camporesi EM. Environmental physiology and diving medicine. Front Psychol. 2018;9:72. https://doi.org/10.3389/fpsyg.2018.00072.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ricciardi L. Modificazioni dell'apparato respiratorio in immersione. In: Rossi A, Schiavon M, editors. Apparato respiratorio e Attivita’ Subacquea. Editeam S.a.S.Gruppo Editoriale; 2000, p. 1–15.

    Google Scholar 

  53. Attivita’ subacquea e apparato respiratorio in. Criteri di valutazione pneumologia per l’idoneita’ all’attivita’ subacquea a cura di Maurizio Casasco e Annalisa Cogo. Med Sport. 2010;63(Suppl. 1 al N. 2):83–91.

    Google Scholar 

  54. Mebane GY. The coincidence of asthma and morbility or mortality in recreational scuba divers involving United Status citizens and reported to DAN. In: Elliott DH, editor. Are asthmatics fit to dive? UHMS; 1996, p. 3–5.

    Google Scholar 

  55. Di Napoli PL, Rossi A. Controindicazioni pneumologiche all'attività sportiva subacquea. In: Rossi A. e Schiavon M., editors. Apparato respiratorio e attività subacquea. Editeam sas Gruppo Editoriale; 2000, p. 25–41.

    Google Scholar 

  56. Schiavon M, Rossi A. Terapia farmacologia pneumologica: indicazioni e controindicazioni. In: Rossi A. e Schiavon M., editors. Apparato Respiratorio e attività subacquea. Editeam sas Gruppo Editoriale; 2000, p. 43–52.

    Google Scholar 

  57. British Thoracic Society Fitness to Dive Group. British Thoracic Society guidelines on respiratory aspects of fitness for diving. Thorax. 2003;58(1):3–13.

    Article  Google Scholar 

  58. Adir Y, Bove AA. Can asthmatic subjects dive? Eur Respir Rev. 2016;25(140):214–20. https://doi.org/10.1183/16000617.0006-2016.

    Article  PubMed  Google Scholar 

  59. Coop CA, Adams KE, Webb CN. SCUBA diving and asthma: clinical recommendations and safety. Clin Rev Allergy Immunol. 2016;50(1):18–22. https://doi.org/10.1007/s12016-015-8474-y.

    Article  PubMed  Google Scholar 

  60. South Pacific Underwater Medicine Society. Suggested assessment for the diver with asthma. SPUMS [Online]. 2014. www.spums.org.au/public-file-download/full-spums-medical

  61. Committee, UK Sport Diving Medical. Asthma and diving. British Sub-Aqua Club. [Online] September 16, 2014. www.bsac.com/page.asp?section=1533&sectionTitle=Respiratory+condition

  62. Elliott DH. Are asthmatics fit to dive? Kensington, MD: Undersea and Hyperbaric Medical Society; 1996.

    Google Scholar 

  63. Recreational Scuba Training Council (RSTC). Medical Statement: Guidelines for recreational scuba diver’s physical examination. https://wrstc.com/standards-dowloads/10-MedicalGuidelines. Accessed 10 June 2018.

  64. Ustrup AS, Ulrik CS. Are recreational SCUBA divers with asthma at increased risk? J Asthma. 2017;54(8):784–91. https://doi.org/10.1080/02770903.2016.1263861.

    Article  PubMed  Google Scholar 

  65. Bosco G, Paoli A, Camporesi EM. Aerobic demand and scuba diving: concerns about medical evaluation. Diving Hyperb Med. 2014;44(2):61–3.

    PubMed  Google Scholar 

  66. Mitchell SJ, Bove A. Medical screening of recreational divers for cardiovascular disease: consensus discussion at the Divers Alert Network Fatality Workshop. Undersea Hyperb Med. 2011;38:289–96.

    PubMed  Google Scholar 

  67. Ogawa S, Shreeniwas R, Brett J, Clauss M, Furie M, Stern DM. The effect of hypoxia on capillary endothelial cell function: modulation of barrier and coagulant function. Br J Haematol. 1990;75(4):517–24.

    Article  CAS  PubMed  Google Scholar 

  68. Parker JCX, Parker RE, Granger DN, Taylor AE. Vascular permeability and trans- vascular fluid and protein transport in the dog lung. Circ Res. 1981;48(4):549–61.

    Article  CAS  PubMed  Google Scholar 

  69. Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J. 2016;37(27):2097–104. https://doi.org/10.1093/eurheartj/ehw164.. Epub 2016 May 12

    Article  PubMed  PubMed Central  Google Scholar 

  70. Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014;12:25. https://doi.org/10.1186/1476-7120-12-25.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Pratali L, Cavana M, Sicari R, Picano E. Frequent subclinical high-altitude pulmonary edema detected by chest sonography as ultrasound lung comets in recreational climbers. Crit Care Med. 2010;38(9):1818–23. https://doi.org/10.1097/CCM.0b013e3181e8ae0e.

    Article  PubMed  Google Scholar 

  72. Pagé M, Sauvé C, Serri K, Pagé P, Yin Y, Schampaert E. Echocardiographic assessment of cardiac performance in response to high altitude and development of subclinical pulmonary edema in healthy climbers. Can J Cardiol. 2013;29(10):1277–84. https://doi.org/10.1016/j.cjca.2013.04.025.. Epub 2013 Jul 17

    Article  PubMed  Google Scholar 

  73. Bouzat P, Walther G, Rupp T, Doucende G, Payen JF, Levy P, Verges S. Time course of asymptomatic interstitial pulmonary oedema at high altitude. Respir Physiol Neurobiol. 2013;186(1):16–21. https://doi.org/10.1016/j.resp.2012.12.009.. Epub 2012 Dec 29

    Article  PubMed  Google Scholar 

  74. Zavorsky GS, Milne EN, Lavorini F, Rienzi JP, Cutrufello PT, Kumar SS, Pistolesi M. Small changes in lung function in runners with marathon-induced interstitial lung edema. Physiol Rep. 2014;2(6):e12056. https://doi.org/10.14814/phy2.12056.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Taylor BJ, Carlson AR, Miller AD, Johnson BD. Exercise-induced interstitial pulmonary edema at sea-level in young and old healthy humans. Respir Physiol Neurobiol. 2014;191:17–25. https://doi.org/10.1016/j.resp.2013.10.012.. Epub 2013 Nov 4

    Article  PubMed  Google Scholar 

  76. Nielsen HB. Arterial desaturation during exercise in man: implication for O2 uptake and work capacity. Scand J Med Sci Sports. 2003;13(6):339–58.

    Article  PubMed  Google Scholar 

  77. Pingitore A, Garbella E, Piaggi P, Menicucci D, Frassi F, Lionetti V, Piarulli A, Catapano G, Lubrano V, Passera M, Di Bella G, Castagnini C, Pellegrini S, Metelli MR, Bedini R, Gemignani A, L'Abbate A. Early subclinical increase in pulmonary water content in athletes performing sustained heavy exercise at sea level: ultrasound lung comet-tail evidence. Am J Physiol Heart Circ Physiol. 2011;301(5):H2161–7. https://doi.org/10.1152/ajpheart.00388.2011.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy

    Annalisa Cogo

  2. Physical Activity Unit—Sports Medicine, Padova, Italy

    Maurizio Schiavon

  3. Institute of Clinical Physiology, CNR, Pisa, Italy

    Lorenza Pratali

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  1. Annalisa Cogo
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  2. Maurizio Schiavon
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  3. Lorenza Pratali
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Correspondence to Annalisa Cogo .

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Editors and Affiliations

  1. Centre for Exercise and Sport Science, University of Ferrara, Ferrara, Italy

    Annalisa Cogo

  2. National Heart and Lung Institute, Imperial College London, London, UK

    Matteo Bonini

  3. Internal medicine Department, Ospedale Civile di Alghero, ASSL Sassari, ATS Sardegna, Alghero, Italy

    Paolo Onorati

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Cogo, A., Schiavon, M., Pratali, L. (2019). Lung and Exercise in Extreme Environments. In: Cogo, A., Bonini, M., Onorati, P. (eds) Exercise and Sports Pulmonology. Springer, Cham. https://doi.org/10.1007/978-3-030-05258-4_12

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