Reviews and Feature Articles
Exercise in elite summer athletes: Challenges for diagnosis,☆☆

https://doi.org/10.1067/mai.2002.127784Get rights and content

Abstract

Background: There is a high prevalence of asthma and exercise-induced bronchoconstriction (EIB) in elite athletes when the diagnosis is based on symptoms and medication use. Objective measurements are now required by some sporting bodies to support a diagnosis of asthma or EIB to justify use of β-agonists. Such measurements could include bronchial provocation with methacholine, with eucapnic voluntary hyperpnea (EVH) of dry air (a surrogate for exercise), or both. Objective: The aim of the study was to investigate the relationship between asthma symptoms and responses to methacholine and the EVH challenge in a group of unselected elite summer-sport athletes. The outcome would be to inform practitioners of a suitable objective approach to identifying those with asthma and EIB. Methods: Fifty elite summer-sport athletes with or without asthma were recruited from sporting teams and sports medicine centers throughout Melbourne, Australia. All subjects completed a respiratory questionnaire and, on separate days, underwent a bronchoprovocation challenge test with methacholine and EVH. Results: Forty-two subjects reported one or more respiratory symptoms in the past year, 9 had positive methacholine challenge results (mean PD20 of 1.69 ± 2.05 μmol), and 25 had positive EVH challenge results (mean fall in FEV1 of 25.4% ± 15%). Although all subjects with positive methacholine challenge results had positive EVH challenge results, methacholine had a negative predictive value of only 61% and a sensitivity of 36% for identifying those responsive to EVH. Conclusion: These findings suggest that the pathogenesis of EIB in elite athletes might be different from that of asthma, and as such, neither symptoms nor the methacholine challenge test should be used exclusively for identifying EIB. (J Allergy Clin Immunol 2002;110:374-80.)

Section snippets

Patients

Fifty elite-level athletes, defined as state level or above in their primary sport, were recruited from sports medicine centers and sporting teams throughout Melbourne, Australia. The subjects were unselected for previous respiratory problems. The subjects were asked to attend the laboratory for challenge on 3 occasions, having refrained from both caffeine and exercise on the day of testing. Those taking pulmonary medications were asked to withhold those medications as follows: short-acting

Subjects

All 50 of the athletes recruited (15 male and 35 female patients; median age, 21 years; age range, 16-42 years) completed the questionnaire and each challenge test. Twenty-seven subjects had a previous diagnosis of asthma made by a clinician. Thirteen of the subjects were using prophylactic medications, of which 5 were taking only inhaled corticosteroids on a twice daily basis, 4 were taking only mast cell stabilizers (sodium cromoglycate or nedocromil sodium) before exercise, and 4 were taking

Discussion

This study contained a significant proportion of athletes competing at an international level, thus placing it in an international context. The results of this study in elite summer-sport athletes showed that respiratory symptoms are not highly sensitive for predicting bronchoconstriction to dry air hyperpnea or methacholine. In this group of elite summer-sport athletes, the EVH challenge test determined a prevalence of bronchial hyperresponsiveness (BHR) of 50%, comprising 60% of those who

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    The Victorian Asthma Foundation provided funding for the cost of the equipment and consumables. The Foundation was in no way involved in any stage of the research study. The Alfred Postgraduate Research Trust provided a full-time research scholarship for the main researcher and primary author of this article.

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    Reprint requests: Karen Holzer, MBBS, FACSM, Department of Allergy, Asthma & Clinical Immunology, Alfred Hospital, Prahran VIC 3181, Australia.

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