Risk factors associated with acute respiratory illnesses in athletes: a systematic review by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

Derman, Wayne; Badenhorst, Marelise; Eken, Maaike M.; Gomez-Ezeiza, Josu; Fitzpatrick, Jane; Gleeson, Maree; Kunorozva, Lovemore; Mjøsund, Katja; Mountjoy, Margo; Sewry, Nicola; Schwellnus, Martin

doi:10.1136/bjsports-2021-104795

Cited by 14 publications

(12 citation statements)

References 96 publications

(108 reference statements)

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“…In one of these studies, there was a Streptococcal outbreak in 23 athletes over 15 days (IR of 40.6/1000 athlete days) 63. In another study, seven clusters of different respiratory viral infections were recorded, with a ‘common cold’ in 44 athletes over 21 days, resulting in an IR of 26.7/1000 athlete days,64 which could have been caused by different risk factors such as the competition, international air travel and time difference 65. A large outbreak of infections from one pathogen in a small number of athletes is unusual and contrasts to the other study in this group 66…”

Section: Discussionmentioning

confidence: 94%

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

et al. 2022

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ObjectiveTo determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons.DesignSystematic review and meta-analysis.Data sourcesElectronic databases: PubMed-Medline, EbscoHost and Web of Science.Eligibility criteriaOriginal research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15–65 years.ResultsAcross all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3).Summary/conclusionsThese findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported.PROSPERO registration numberCRD42020160472.

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Section: Discussionmentioning

confidence: 94%

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

et al. 2022

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“…A comprehensive review of the risk factors and biomarkers for both suspected and confirmed ARinf (n=24 studies) has been published by an IOC consensus subgroup 63. This review included 48 studies (19 390 athletes) and the majority (71%) of studies were self-reported ARill in athletes.…”

Section: Risk Factors Associated With Arinf In Athletesmentioning

confidence: 99%

“…A comprehensive review of the risk factors and biomarkers for both suspected and confirmed ARinf (n=24 studies) has been published by an IOC consensus subgroup. (63) • Vitamin D deficiency cannot be diagnosed by typical symptoms and clinical signs (clinical syndrome) alone, and laboratory tests are required for formal identification.…”

Section: Risk Factors Associated With Acute Respiratory Infections In...mentioning

confidence: 99%

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

Schwellnus

Adami²,

Bougault

et al. 2022

Br J Sports Med

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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.

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“…In a real-life situation, HA may be combined with additional stressors such as travel, poor nutrition, and sleep deprivation, which could elevate the neuroendocrine response and thereby increase the risk for immunosuppression [ 2 ]. On the other hand, HA is mainly performed by elite athletes and highly trained military personnel, who may be less vulnerable to exercise-induced immunosuppression than our recreationally active participants [ 10 , 22 , 49 ]. Based on our findings, HA can be used to successfully induce heat adaptations in the weeks leading up to athletic competition or military deployment, without negatively affecting s-IgA availability, URTS risk and wellness.…”

Section: Practical Implicationsmentioning

confidence: 99%

“…Salivary immunoglobulin-A (s-IgA) has been studied extensively and research suggests that s-IgA availability diminishes with intensified training periods, resulting in elevated URTS risk [ 12 , 13 ]. Indeed, a recent systematic review identified both increased training intensity and reduced s-IgA as risk factors for the development of clinically diagnosed upper respiratory tract infection [ 10 ]. It should be noted, however, that URTS do not necessarily have an infective origin, but can also result from factors such as allergies or asthma [ 14 ], clouding the relationship between s-IgA and URTS.…”

Section: Introductionmentioning

confidence: 99%

Heat acclimation does not negatively affect salivary immunoglobulin-A and self-reported illness symptoms and wellness in recreational athletes

et al. 2022

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Heat acclimation (HA) protocols repeatedly expose individuals to heat stress. As HA is typically performed close to the pinnacle event, it is essential that the protocol does not compromise immune status, health, or wellbeing. The purpose of this study was to examine the effect of HA on resting salivary immunoglobulin-A (s-IgA) and salivary cortisol (s-cortisol), self-reported upper-respiratory tract symptoms, and self-reported wellness parameters. Seventeen participants (peak oxygen uptake 53.2 ± 9.0 mL·kg −1 ·min −1 ) completed a 10-day controlled-hyperthermia HA protocol, and a heat stress test both before (HST1) and after (HST2) HA (33°C, 65% relative humidity). Resting saliva samples were collected at HST1, day 3 and 7 of the HA protocol, HST2, and at 5 ± 1 days post-HA. Upper-respiratory tract symptom data were collected weekly from one week prior to HA until three weeks post HA, and wellness ratings were reported daily throughout HA. HA successfully induced physiological adaptations, with a lower end-exercise rectal temperature and heart rate and higher whole-body sweat rate at HST2 compared to HST1. In contrast, resting saliva flow rate, s-IgA concentration, s-cortisol concentration, and s-cortisol secretion rate remained unchanged (n = 11–14, P = 0.10–0.48). Resting s-IgA secretion rate increased by 39% from HST1 to HST2 (n = 14, P = 0.03). No changes were observed in self-reported upper respiratory tract symptoms and wellness ratings. In conclusion, controlled-hyperthermia HA did not negatively affect resting s-IgA and s-cortisol, self-reported upper-respiratory tract symptoms, and self-reported wellness parameters in recreational athletes.

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Risk factors associated with acute respiratory illnesses in athletes: a systematic review by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

Cited by 14 publications

References 96 publications

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

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

Heat acclimation does not negatively affect salivary immunoglobulin-A and self-reported illness symptoms and wellness in recreational athletes

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