Asthma in United States Olympic athletes who participated in the 1998 Olympic Winter Games

doi:10.1067/mai.2000.108605

Journal of Allergy and Clinical Immunology

Volume 106, Issue 2, August 2000, Pages 267-271

https://doi.org/10.1067/mai.2000.108605 Get rights and content

Abstract

Background: About one of every 5 athletes who participated in the 1996 Summer Olympic Games in Atlanta had a past history of asthma, had symptoms that suggested asthma, or took asthma medications. No previous study has determined the prevalence of asthma in all US athletes who participated in an Olympic Winter Games. Objectives: We sought to determine how many US athletes who participated in the 1998 Olympic Winter Games had a past history of asthma, had symptoms that suggested asthma, or indicated taking a medication used to treat asthma. Methods: We evaluated responses to questions that asked about allergic and respiratory diseases in the United States Olympic Committee Medical History Questionnaire that was completed by all 196 athletes who represented the United States at the 1998 Olympic Winter Games in Nagano, Japan. Results: Forty-three (21.9%) of the 196 athletes had a previous diagnosis of asthma, and 36 (18.4%) recorded use of an asthma medication at some time in the past. Forty-four (22.4%) reported use of an asthma medication, a diagnosis of asthma, or both (our basis for the diagnosis of asthma). Thirty-four (17.4%) of the athletes were currently taking an asthma medication at the time that they completed the questionnaire or indicated that they took these medications on a permanent or semipermanent basis and were considered to have active asthma. Athletes who participated in Nordic combined, cross-country, and short track events had the highest prevalence of having been told that they had asthma or had taken an asthma medication in the past (60.7%) in contrast with only one (2.8%) of the 36 athletes who participated in bobsled, biathlon, luge, and ski jumping. Eighteen (24%) of 75 athletes who participated in alpine, long track, figure skating, snow boarding, and curling had a previous diagnosis of asthma or recorded use of an asthma medication. Conclusions: We conclude that asthma appeared to have been more common in athletes who participated in the 1998 Winter Games than in athletes who participated in either the 1996 or 1984 Summer Games. Clearly, asthma rates vary widely among sports. This suggests that the environment in which exercise is performed is important in leading to a decrease in the amount of exercise required to trigger asthma and perhaps in causing injury to the airways. (J Allergy Clin Immunol 2000;106:267-71.)

Section snippets

Methods

All athletes who represented the United States at the 1998 Winter Games in Nagano were required to complete a medical history questionnaire that was designed by the United States Olympic Committee (USOC) Sports Medicine Division; this was the same questionnaire that was used in our previous study at the 1996 Atlanta Games.² Briefly, questionnaires were given to the athletes by USOC medical staff at team processing in Nagano within 2 weeks before participation in the Winter Games. Athletes

Results

One hundred ninety-six athletes represented the United States in Nagano, and all completed the questionnaire. Responses to the questions that asked about allergic and respiratory disease are presented in Table I. Almost 22% of the athletes had been told that they had asthma (question 5). About 16% (32/196) of the athletes listed having taken a medication specifically for asthma at some time (question 13). When we combined all questions on the questionnaire that asked athletes to list

Discussion

This study demonstrates that 44 (22.4%) of the 196 US athletes who participated in the Nagano Winter Games in 1998 had a history of asthma, took asthma medications, or both (Table I, Table II) compared with 117 (16.7%) of the 699 athletes who participated in the Atlanta Summer Games in 1996.² On the medical history questionnaire, athletes were asked the following: “Have you ever been told that you have (had) asthma or exercise-induced asthma?”; 15.3% and 21.9% recorded positive responses in

Acknowledgements

We thank Elizabeth Lawler for her assistance in the completion of this manuscript.

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Sport and sporting competitions play an important role in our society, with high-level athletes frequently being held up as role models. Physical exercise is a classic triggering factor for asthma and regular physical activity is essential to maintain a good quality of life during the course of chronic diseases such as asthma and allergies. Several epidemiological surveys have revealed an abnormally high prevalence of asthma and allergies in individuals involved in competitive sports compared with the general population. The risk of asthma varies in accordance with the type of sport practised. High-level athletes, particularly Olympic athletes, practising endurance sports such as swimming, running and winter sports, are at high risk for asthma and allergies. However, sportsmen regularly practising physical activities at a less intense level are also subject to risk. Allergic rhinitis occurs around twice as frequently in elite sportsmen. The author reviews the physiopathological mechanisms of asthma and rhinitis in athletes and the treatment thereof, particularly in competitive athletes. In this population, a certain number of medicines ordinarily used by normal subjects with asthma and allergic rhinitis are in fact on the list of banned substances. On 29 September 2016, the World Anti-Doping Agency (WADA) issued a list of these substances for 2017. Since their creation in 2007, therapeutic use exemptions (TUE) have enabled athletes to follow treatments containing such banned substances. However, certain observers, including some athletes, consider this practice to be a form of disguised doping.
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Citation Excerpt :
In conclusion, there was no association between the competition season and the asthma outcomes considered. So far, there has been only one other study published which compared the prevalence of asthma in elite winter and summer athletes of different sport disciplines [15]. This study is in contrast to our findings.
Prevalence of asthma in elite athletes shows very wide ranges. It remains unclear to what extent this is influenced by the competition season (winter vs. summer) or the ventilation rate achieved during competition. The aim of this study was to evaluate prevalence of asthma in German elite winter and summer athletes from a wide range of sport disciplines and to identify high risk groups.
In total, 265 German elite winter athletes (response 77%) and 283 German elite summer athletes (response 64%) answered validated respiratory questionnaires. Using logistic regression, the asthma risks associated with competition season and ventilation rate during competition, respectively, were investigated. A subset of winter athletes was also examined for their FE_NO-levels and lung function.
With respect to all asthma outcomes, no association was found with the competition season. Regarding the ventilation rate, athletes in high ventilation sports were at increased risk of asthma, as compared to athletes in low ventilation sports (doctors' diagnosed asthma: OR 2.32, 95% CI 1.19–4.53; use of asthma medication: OR 4.46, 95% CI 1.52–13.10; current wheeze or use of asthma medication: OR 2.78, 95% CI 1.34–5.76). Athletes with doctors' diagnosed asthma were at an approximate four-fold risk of elevated FE_NO-values.
The clinically relevant finding of this study is that athletes' asthma seems to be more common in sports with high ventilation during competition, whereas the summer or winter season had no impact on the frequency of the disease. Among winter athletes, elevated FE_NO suggested suboptimal control of asthma.
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These findings reflect reports in humans that showed exercise improved cardiorespiratory fitness in individuals with asthma [204], and that individuals who trained at moderate intensity were more likely to demonstrate improvements in their asthma symptoms than those who exercised at a low intensity [205–210]. Based upon these data, it seems reasonable to suggest that athletes would have a lower incidence of asthma compared to the general public; however, in reality, the opposite may be true [211–214]. While there could be several factors to explain this, strenuous exercise increases the levels of T helper 2 (Th2) cytokines [215–218] along with other factors that also impact airway remodeling.
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^☆: Reprint requests: John M. Weiler, MD, T307 GH, 200 Hawkins Dr, University of Iowa, Iowa City, IA 52242.

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Asthma, rhinitis, other respiratory diseasesAsthma in United States Olympic athletes who participated in the 1998 Olympic Winter Games☆

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

J Allergy Clin Immunol

Chest

Chest

Chest

Respir Med

Respir Med

Epidemiology of asthma: the year in review

Curr Opin Pulm Med

Exertional asthma in Swiss top-ranking athletes

Schweiz Med Wochenschr

The U.S. Olympic Committee experience with exercise-induced bronchospasm, 1984

Med Sci Sports Exerc

Unrecognized exercise-induced bronchospasm in adolescent athletes

Am J Dis Child

Asthma, rhinitis, other respiratory diseases
Asthma in United States Olympic athletes who participated in the 1998 Olympic Winter Games☆