Exercise in elite summer athletes: Challenges for diagnosis.
BACKGROUND
There is a high prevalence of asthma and exercise-induced bronchoconstriction (EIB) in elite athletes when the diagnosis is based on symptoms and medication use. Objective measurements are now required by some sporting bodies to support a diagnosis of asthma or EIB to justify use of beta-agonists. Such measurements could include bronchial provocation with methacholine, with eucapnic voluntary hyperpnea (EVH) of dry air (a surrogate for exercise), or both.


OBJECTIVE
The aim of the study was to investigate the relationship between asthma symptoms and responses to methacholine and the EVH challenge in a group of unselected elite summer-sport athletes. The outcome would be to inform practitioners of a suitable objective approach to identifying those with asthma and EIB.


METHODS
Fifty elite summer-sport athletes with or without asthma were recruited from sporting teams and sports medicine centers throughout Melbourne, Australia. All subjects completed a respiratory questionnaire and, on separate days, underwent a bronchoprovocation challenge test with methacholine and EVH.


RESULTS
Forty-two subjects reported one or more respiratory symptoms in the past year, 9 had positive methacholine challenge results (mean PD(20) of 1.69 +/- 2.05 micromol), and 25 had positive EVH challenge results (mean fall in FEV(1) of 25.4% +/- 15%). Although all subjects with positive methacholine challenge results had positive EVH challenge results, methacholine had a negative predictive value of only 61% and a sensitivity of 36% for identifying those responsive to EVH.


CONCLUSIONS
These findings suggest that the pathogenesis of EIB in elite athletes might be different from that of asthma, and as such, neither symptoms nor the methacholine challenge test should be used exclusively for identifying EIB.
Department of Allergy, Asthma and Clinical Immunology, Alfred Hospital and Monash University, Prahran, Australia.
Karen
K
Holzer
Sandra D
SD
Anderson
Jo
J
Douglass
D000293:Adolescent; D000328:Adult; D001250:Asthma, Exercise-Induced / Q000175:diagnosis*; D001985:Bronchial Provocation Tests; D016084:Bronchoconstriction; D016085:Bronchoconstrictor Agents; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D011237:Predictive Value of Tests; D012621:Seasons; D012680:Sensitivity and Specificity; D013177:Sports; D011795:Surveys and Questionnaires
D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride