BREATHING FOR PERFORMANCE: NASAL FUNCTION, OBSTRUCTION, AND THERAPEUTIC INTERVENTIONS IN COMPETITIVE ATHLETES

Background: nasal respiration is the only true physiological breathing mechanism, providing essential ventilation, air conditioning, and defensive filtration for the lower airways. For professional athletes, rhinosinusal health is one of the determinants of performance, yet sport-specific environments often disrupt this homeostasis, leading to a clinical state often described as the “athlete’s nose”. Purpose: to evaluate the pathophysiology of exercise-induced rhinosinusal alterations across various sport categories and to synthesize evidence-based management strategies - incorporating mechanical, surgical, and pharmacological interventions - to optimize athletic performance and cardiovascular safety. Methods: a structured literature review was conducted with reference to PRISMA guidelines for search transparency. Data were synthesized from clinical studies involving professional athletes (swimmers, skiers, runners, and boxers) and compared against established assessment protocols, including, the International Consensus Statement on Rhinosinusistis (ICAR-RS 2021), EPOS 2020, and the SARAH assessment framework. Findings were narratively synthesized by sport-specific pathophysiology. Results: significant alterations in nasal physiology were identified. Swimmers showed the most severe deviations, with a mean mucociliary transport time (MCTt) of 27.4±4.97 min compared with the 13-minute norm (p<0.0001), linked to chlorine-induced neurogenic inflammation and elevated Substance P. Nasal breathing was found to enhance physical endurance and may protect against cardiac fibrosis by reducing sympathetic drive. Interventions, including internal nasal dilators, septoplasty, and post-operative topical furosemide, showed significant benefits for performance and symptom control. Conclusions: rhinosinusal disruptions are sport-specific and significantly impair physical capacity. Multimodal management and systematic screening are essential for maintaining competitive fitness.