International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections

Abstract

Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to ‘core’ members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

“…This consensus statement process took a unique approach, following key steps as detailed in Part 1. (9) In brief, subgroups of the IOC Consensus group were originally established to review the literature in the following six areas: 1) epidemiology / risk factors for ARill, 2) infective ARill, 3) non-infective ARill, 4) acute asthma/EIB and related conditions, 5) effects of ARill on exercise / sports performance, medical complications / return-to-sport, and 6) acute nasal/vocal cord dysfunction presenting as ARill. A chair, who was a "core" member of the consensus group, was identified for each subgroup.…”

“…The IOC Medical and Scientific Committee appointed a chair (MS) for this consensus group in July 2019. This consensus statement process took a unique approach, following key steps as detailed in part 1 9. In brief, subgroups of the IOC Consensus group were originally established to review the literature in the following six areas: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction (EIB) and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/RTS and (6) acute nasal/vocal cord dysfunction presenting as ARill.…”

“…The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to acute non-infective respiratory illness in athletes. This consensus document complements part 1, which focuses on ARinf 9. The specific focus of part 2 is a review of epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of illness during exercise, effects of illness on exercise/sports performance and return-to-sport (RTS) guidelines.…”

“…This consensus document complements Part 1, which focuses on ARinf. (9) The specific focus of Part 2 is a review of epidemiology, risk factors, pathology / pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of illness during exercise, effects of illness on exercise / sports performance, and return-to-sport (RTS) guidelines. This consensus group recognises that there are international guidelines for several of the respiratory conditions.…”

Exercise-induced Bronchoconstriction and its Relevance in Public Health

“…[8][9][10] In elite athletes, the diagnosis and treatment of EIB are heavily supported by documents from international institutions, including the European Respiratory Society (ERS) and the Academy of Allergy and Clinical Immunology (EAACI), 10 and are further backed by formal advice from the World Anti-Doping Agency (WADA) and the International Olympic Committee (IOC), which allow the use of inhalable corticosteroids, together with shortacting β2-agonists, medications that can be consumed with no risk of sports punishments, so long as the standard protocol for therapeutic use exemption has been followed. [10][11][12] In the context of EIB, related to the Cardiopulmonary Exercise Testing (CPET), which includes the spirometry conducted before and many times after exercise, the most relevant spirometry variable is the forced expiratory volume in the first second (FEV1), during the forced vital capacity (FVC) maneuver. In this protocol, the measurements of FEV1 should be taken before, immediately after, and at 5, 10, and 15 min of recovery.…”