Diagnosing exercise‐induced bronchoconstriction: Over‐or under‐detection?

Jackson, Anna; Allen, Hayden; Hull, James H.; Hopker, James G.; Backhouse, Susan H.; Price, Oliver J.; Dickinson, John W.

doi:10.1111/all.14005

Cited by 7 publications

(12 citation statements)

References 10 publications

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“…This observation is in keeping with studies conducted over the past two decades that consistently reveal poor diagnostic agreement when directly comparing exercise, EVH and/or inhaled mannitol 27 33 82–84. Accordingly, while surrogate tests may reduce the risk of underdiagnosis (ie, false-negative outcome), there remains concern regarding the potential for overdiagnosis (ie, false-positive outcome) 85. Indeed, recent studies have questioned the suitability of current diagnostic thresholds when using surrogate tests in this setting.…”

Section: Discussionsupporting

confidence: 81%

“…Specifically, Price et al (86) has previously observed a greater reduction in lung function post EVH in 'healthy' (defined as entirely asymptomatic, with no prior history of asthma or inhaler medication use) elite vs. recreational athletes, indicating that the 'normative' airway response may differ according to the athletic population tested. This also presents challenges with respect to the most appropriate diagnostic 'cutoff' value according to the form of bronchial provocation challenge employed (85,86).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on ‘acute respiratory illness in the athlete’

et al. 2021

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ObjectiveTo report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups.DesignSystematic review and meta-analysis.Data sourcesPubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020).Eligibility criteriaOriginal full-text studies, including male or female athletes/physically active individuals/military personnel (aged 15–65 years) who had a prior asthma diagnosis and/or underwent screening for lower airway dysfunction via self-report (ie, patient recall or questionnaires) or objective testing (ie, direct or indirect bronchial provocation challenge).ResultsIn total, 1284 studies were identified. Of these, 64 studies (n=37 643 athletes) from over 21 countries (81.3% European and North America) were included. The prevalence of lower airway dysfunction was 21.8% (95% CI 18.8% to 25.0%) and has remained stable over the past 30 years. The highest prevalence was observed in elite endurance athletes at 25.1% (95% CI 20.0% to 30.5%) (Q=293, I2=91%), those participating in aquatic (39.9%) (95% CI 23.4% to 57.1%) and winter-based sports (29.5%) (95% CI 22.5% to 36.8%). In studies that employed objective testing, the highest prevalence was observed in studies using direct bronchial provocation (32.8%) (95% CI 19.3% to 47.2%). A high degree of heterogeneity was observed between studies (I2=98%).ConclusionLower airway dysfunction affects approximately one in five athletes, with the highest prevalence observed in those participating in elite endurance, aquatic and winter-based sporting disciplines. Further longitudinal, multicentre studies addressing causality (ie, training status/dose–response relationship) and evaluating preventative strategies to mitigate against the development of lower airway dysfunction remain an important priority for future research.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on ‘acute respiratory illness in the athlete’

et al. 2021

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“…has previously been reported to increase the risk of misdiagnosis and unnecessary inhaler therapy which likely contributes to the widespread perception of medication misuse (14,34). Likewise, the challenges associated with screening and detection may also add to the belief that it is possible to falsify a diagnosis and abuse the TUE system.…”

Section: Distrustmentioning

confidence: 99%

“…Following approval from the local Research Ethics Committee, purposive sampling was employed to recruit ten athletes (five athletes with a physician diagnosis of asthma prescribed inhaler therapy and five without asthma) involved in previous research studies of the Clinical Exercise and Respiratory Physiology Research Group, Leeds Beckett University (14,15). Purposive sampling describes the inclusion of individuals that provide a rich and detailed insight into the research question (16).…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Asthma medication in athletes: a qualitative investigation of adherence, avoidance and misuse in competitive sport

et al. 2021

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Objectives:The purpose of this qualitative study was to utilize the Capability, Opportunity, Motivation -Behavior model (COM-B) to: (1) evaluate athlete knowledge and understanding of current asthma-related anti-doping regulations, (2) explore the impact of environmental and societal influences on athletes with asthma, and (3) examine athlete perception of asthma medication use in competitive sport. Methods: Semi-structured interviews were conducted with ten competitive endurance athletes (five athletes with asthma and five without asthma). Interviews were guided by the COM-B model and transcripts were analyzed inductively and deductively using reflexive thematic analysis. Results: Mapping the experiences and perceptions of athletes against an established behavioral framework identified that: (1) athletes' possess limited knowledge and understanding of the World Anti-Doping Agency (WADA) Prohibited List and Therapeutic use exemption (TUE) policy with respect to asthma medication; (2) the use of sub-optimal diagnostic methods is commonplace and increases the risk of misdiagnosis and unnecessary inhaler therapy; (3) negative media portrayal of high-profile asthma-related doping allegations impacts public opinion and contributes to the perception of wrongdoing within the sporting community. Conclusion:The novel application of behavioral science highlights several factors that may contribute to asthma medication avoidance and promote misuse in competitive sport. The findings from this study provide a foundation for the development and implementation of targeted education programmes, and it is hoped that employing this approach will ultimately improve overall perceptions of asthma treatment in athletes, which is necessary to maintain respiratory health, optimize performance and protect the integrity of sport.

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“…2 In secondary care, debate remains regarding the optimal diagnostic protocol. 3 Further, it is unclear which diagnostic tests are commonly utilized and, importantly, the extent to which practitioners adhere to bronchial provocation guidelines in secondary care.…”

Section: Exercise-induced Bronchoconstriction: a Survey Of Diagnosticmentioning

confidence: 99%

Exercise‐induced bronchoconstriction: A survey of diagnostic practice in secondary care across the United Kingdom

Simpson

Drake

Fowler

2020

Allergy

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Diagnosing exercise‐induced bronchoconstriction: Over‐or under‐detection?

Cited by 7 publications

References 10 publications

Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on ‘acute respiratory illness in the athlete’

Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on ‘acute respiratory illness in the athlete’

Asthma medication in athletes: a qualitative investigation of adherence, avoidance and misuse in competitive sport

Exercise‐induced bronchoconstriction: A survey of diagnostic practice in secondary care across the United Kingdom

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