title: Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players.
abstract: BACKGROUND
  Physicians typically rely heavily on self-reported symptoms to make a diagnosis of exercise-induced bronchoconstriction (EIB). However, in elite sport, respiratory symptoms have poor diagnostic value. In 2009, following a change in international sports regulations, all elite athletes suspected of asthma and/or EIB were required to undergo pulmonary function testing (PFT) to permit the use of inhaled β(2)-agonists. The aim of this study was to examine the diagnostic accuracy of physician diagnosis of asthma/EIB in English professional soccer players.
  
  
  METHODS
  Sixty-five players with a physician diagnosis of asthma/EIB were referred for pulmonary function assessment. Medication usage and respiratory symptoms were recorded by questionnaire. A bronchial provocation test with dry air was conducted in 42 players and a mannitol challenge in 18 players. Five players with abnormal resting spirometry performed a bronchodilator test.
  
  
  RESULTS
  Of the 65 players assessed, 57 (88%) indicated regular use of asthma medication. Respiratory symptoms during exercise were reported by 57 (88%) players. Only 33 (51%) of the players tested had a positive bronchodilator or bronchial provocation test. Neither symptoms nor the use of inhaled corticosteroids were predictive of pulmonary function tests' outcome.
  
  
  CONCLUSIONS
  A high proportion of English professional soccer players medicated for asthma/EIB (a third with reliever therapy only) do not present reversible airway obstruction or airway hyperresponsiveness to indirect stimuli. This underlines the importance of objective PFT to support a symptoms-based diagnosis of asthma/EIB in athletes.
authors.affiliation: Department of Sport and Exercise Sciences, University of Northumbria, Newcastle, UK. les.ansley@northumbria.ac.uk
authors.forename: L
authors.initials: L
authors.lastname: Ansley
authors.forename: P
authors.initials: P
authors.lastname: Kippelen
authors.forename: J
authors.initials: J
authors.lastname: Dickinson
authors.forename: J H K
authors.initials: JH
authors.lastname: Hull
mesh_terms: D000293:Adolescent; D000328:Adult; D001250:Asthma, Exercise-Induced / Q000175:diagnosis* / Q000453:epidemiology; D056352:Athletes; D001985:Bronchial Provocation Tests / Q000379:methods; D016084:Bronchoconstriction / Q000502:physiology*; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003951:Diagnostic Errors; D004739:England / Q000453:epidemiology; D006801:Humans; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D012129:Respiratory Function Tests; D012916:Soccer; D013147:Spirometry; D055815:Young Adult
chemical_list: D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D008353:Mannitol