BTS clinical statement for the assessment and management of respiratory problems in athletic individuals

Exhaled and Systemic Biomarkers to Aid the Diagnosis of Bronchial Asthma in Elite Water Sports Athletes

“…Further investigations (e.g., bronchoprovocation testing and peak expiratory flow [PEF] monitoring) were performed if the baseline spirometry and reversibility results were not suggestive of airway obstruction, but the participant had a history of exercise-induced respiratory symptoms and was clinically well at the time. Based on thorough clinical history, clinical signs and symptoms, results of the investigations, and a robust evaluation of the likelihood of the diagnosis, the diagnosis of asthma/EIB was confirmed by a highly trained senior respiratory specialist with experience in sports medicine (5,14,18,19).…”

“…Pulmonary function variables were expressed as percentages of the predicted values using the Global Lung Function Initiative reference equations (28). In cases of suspected asthma, the following tests were performed according to the Global Initiative for Asthma document and international guidelines: reversibility testing after 400 μg of salbutamol inhalation (positive if FEV 1 increases >200 mL and >12% of the predicted value), indirect bronchial challenge test with hypertonic potassium chloride solution inhalation (positive if FEV 1 falls >15% of the predicted value), and/or daily and pre-and postexercise PEF measurements (positive if variability is >20% over a 2-wk period) (5,14,29).…”

“…However, it can occur in nonasthmatic individuals as well (3,4), and its exact prevalence varies according to the criteria used for the diagnosis (2). Nonetheless, asthma and EIB are very common among elite athletes and may potentially limit the athletic performance (5)(6)(7)(8)(9)(10). A recent systematic review and meta-analysis showed that the overall prevalence of lower airway dysfunction (a collective term for asthma, EIB, and airway hyperresponsiveness) is more than 20% among athletes; however, in elite athletes, it reaches almost 30%, whereas in aquatic disciplines, it is almost 40% (11).…”

“…Diagnostic tools for chronic inflammatory airway diseases involve basic (e.g., questionnaires, full blood count measurement, and spirometry with or without reversibility testing) and specific investigations (peak expiratory flow [PEF] variability measurement, direct (acting on airway smooth muscles, e.g., metacholine challenge) and indirect (acting on airway inflammatory cells, e.g., eucapnic voluntary hyperpnea) bronchial provocation tests, skin prick test, immunoglobulin E (IgE) measurement, etc.). The diagnosis of asthma is very challenging and requires specific considerations in elite aquatic athletes because they have often higher than normal lung function parameters, the symptoms are mostly present only during exertion and exercise in water, and the symptoms do not necessarily correlate with objective findings (5,12). Therefore, although clinical history and subjective symptoms are important in the diagnostic process, according to the recommendation of the International Olympic Committee, an objective test such as bronchial challenge should be performed (13).…”

Laryngeal response to high-intensity exercise in healthy athletes

“…Key symptoms of EILO are inspiratory breathing problems during high-intensity exercise, often accompanied by coarse or high-pitched inspiratory breath sounds, feeling of tightness in the throat or neck area and sometimes stridor. 3 These symptoms are associated with a paradoxical obstruction of laryngeal structures that otherwise appear normal, most often predominantly involving the supraglottic folds, but often followed by adduction also of the vocal cords. Symptoms of EILO typically resolve within minutes after exercise has ended but may also be prolonged in some cases.…”