Disconnect between standardized field‐based testing and mannitol challenge in Scottish elite swimmers

Abstract

No association was found between mannitol and standardized field-based testing in elite swimmers. Mannitol was associated with a high baseline FE(NO); however, exercise/chlorine challenge was not. Thus, mannitol may identify swimmers with a 'traditional' inflammatory asthmatic phenotype, while field-based exercise/chlorine challenge may identify a swimmer-specific bronchoconstrictor response. A sustained fall in FE(NO) following chlorine exposure suggests that a non-cellular, perhaps neurogenic, response may be involved in this group of athletes.

An open-label study examining the effect of pharmacological treatment on mannitol- and exercise-induced airway hyperresponsiveness in asthmatic children and adolescents with exercise-induced bronchoconstriction

“…Our study supports the findings of Anderson et al who found a low sensitivity and specificity (59% and 65% respectively) of MCT to identify exercise induced bronchoconstriction in 509 children and adults [19]. This is in accordance with a recent study in elite swimmers where Clearie and co-workers could not demonstrate an association between the outcome of MCT and a sport specific exercise test [20]. …”

Alternatives to exercise challenge for the objective assessment of exercise-induced bronchospasm: eucapnic voluntary hyperpnoea and the osmotic challenge tests

“…The sensitivity was reduced to 84% when a cutoff of a 15% decrease for mannitol was used. By contrast, a recent study of elite swimmers found little concordance between the mannitol test result and a swimming exercise test result; of the 14% responding to mannitol and the 16% responding to swimming exercise, only one swimmer responded to both tests [52]. Likewise, a study of cross-country skiers found that out of 23 subjects responding to methacholine, only two had a positive response to mannitol [53].…”

Exercise-Induced Lung Disease: Too Much of a Good Thing?

“…142 Swimming in chlorinated pools, especially indoor facilities, has been linked to lung epithelial injury and airways inflammation and hyperresponsiveness in elite athletes. 32,40,79,80,84,143 In adolescent swimmers, the prevalence of EIB by cardiopulmonary testing was 36%. 79 In induced sputum, swimmers have elevated levels of neutrophils, epithelial cells, and, also, eosinophils.…”

“…While studies focus on athletes 18-20 years, they do include older adolescents (16-18 years). Cold-weather athletes, [17][18][19][20] ice rink athletes, [21][22][23][24][25]78 and swimmers 32,40,79,80 have a particularly high prevalence of EIB. EIB in endurance athletes develops relatively late and occurs during their sports careers.…”