Aru credits nose surgery as factor in Tour de France form

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Fabio Aru (Astana) has long been a devotee of nasal strips of the kind made famous by the footballer Robbie Fowler in the 1990s and later employed in the professional peloton by Andreas Klöden, but this past winter, he took another, more permanent step towards improving his breathing.

In January of this year, Aru underwent a nose operation in Bergamo that he has credited as part of the reason for his startling form in recent weeks. The Italian champion continued his recent run on Wednesday, winning stage 5 of the Tour de France atop La Planche des Belles Filles.

"I'm reborn and that’s thanks to Professor Antonio Cassisi," Aru said after winning the Italian Championships in Ivrea last month. "Before, I couldn't get a breath of air through my nose, but now I can breathe."

In an interview in Thursday's edition of La Gazzetta dello Sport, Professor Cassisi offered a more detailed account of the surgery he performed on Aru at the beginning of the year to correct the hypertrophy of his nasal turbinates, which are ridges on the inside of the nose. Turbinates warm and moisturize air as it flows through the nose, but enlarged turbinates can block airflow.

"Fabio was suffering from a very significant hypertrophy of the lower turbinates," Professor Cassisi told La Gazzetta. "We decided on a very conservative and not very invasive surgery because removing them altogether would have been an error."

Cassisi said that Aru's previous, open-mouthed breathing was a symptom of his condition, which forces one to breathe through the mouth rather than the nose. As well as reducing snoring and thus aiding sleep, he said that the surgery also lowered the risk of contracting infections of the throat and lungs.

"Do you remember the pictures of Fabio when he was making big efforts? He always had his mouth wide open, but that's changed now," Cassisi said. "The problem when you breathe with your mouth open is that you don't have a filter, so you are also inhaling the dust particles present in the air into your lungs. This exposes you to a greater risk of illness, such as bronchitis."

Record time on La Planche des Belles Filles

Aru produced a fierce acceleration less than three kilometres from the summit of La Planche des Belles Filles on Wednesday to claim the first mountaintop finish of this Tour, beating Dan Martin (Quick-Step Floors) by 16 seconds and Chris Froome (Team Sky) by 20 seconds.

In the overall standings, Aru is now in third place, just 14 seconds down on Froome. After a disappointing Tour debut a year ago, the 2015 Vuelta a España winner has marked himself out as one of Froome's chief rivals this time around.

Aru's victory was all the more remarkable considering his truncated spring campaign, as he didn't race at all between the middle of March, when he abandoned Tirreno-Adriatico due to bronchitis, and early June, when he returned to action at the Critérium du Dauphiné. In the intervening period, Aru had to forgo the Giro d'Italia, his stated target for the season, when he injured his knee in a training crash in early April.

After impressing at the Dauphiné and soloing to the Italian national road race title in Ivrea, Aru is continuing his rich vein of form at the Tour.

According to the Ammattipyöräily Twitter account, which collates information on power output and climbing times, Aru's time of 16:12 up the final, 5.8km ascent of La Planche des Belles on Wednesday was some 33 seconds quicker than Vincenzo Nibali's time on the same ascent three years ago. It was also 8 seconds faster than Froome's previous record from 2012.

Of course the stages were very diffierent with this year's climb to the finish the only real difficulty of the stage.