Source: Annual Congress 2010 - Occupational asthma
Disease area: Airway diseases

Abstract

Exercise-induced asthma (EIA) describes narrowing of the airways that occurs in conjunction with exercise. Self-reported symptoms are known to correlate poorly with changes in airway patency. In January 2009 the World-Anti Doping Agency required athletes to provide objective evidence of airway obstruction in order to use asthma relievers; eucapnic voluntary hyperpnea (EVH) is the bronchoprovocation challenge recommended by the International Olympic Committee (IOC). 35 professional athletes (30 male; 5 female) with normal resting spirometry and a previous symptom diagnosis of asthma (31) and/or EIA (25) underwent an EVH challenge. 29 (83%) athletes were taking asthma medication. The athletes competed in a variety of sports: football (21), rugby (8), swimming (3), cricket (2), biathlon (1). Athletes were required to withhold SABA for 24 hours, LABA for 48 hours and ICS for 72 hours prior to testing. According to IOC guidelines a positive diagnosis for EIA was made when a post-challenge drop in FEV1 ≥10% occurred at 2 successive time points. During the 6-min EVH challenge athletes maintained (mean(s)) 88(8)% of target ventilation. Only 18 (51%) athletes achieved a positive test for EIA.

EIA Diagnosis

Treatment	+ve	-ve
Beta-2 only	7 (54%)	6 (46%)
ICS	8 (50%)	8 (50%)
None	3 (50%)	3 (50%)

FEV1 fell by 23(13)% in the positive tests and 6(3)% in the negative tests. A symptom diagnosis for EIA was only supported by objective evidence in 50% of cases. These results indicate an overdiagnosis of asthma in symptomatic athletes and suggest that a significant proportion of elite athletes are regularly using unnecessary medication, which may have long-term health implications.

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Citations should be made in the following way:
L. Ansley, J. Hull (Newcastle, United Kingdom). Overdiagnosis of exercise-induced asthma in symptomatic athletes. Eur Respir J 2010; 36: Suppl. 54, 1458

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