James Hull

Approach to the diagnosis and management of suspected exercise-induced bronchoconstriction by primary care physicians

BackgroundExercise-related respiratory symptoms in the diagnosis of exercise-induced bronchoconstriction (EIB) have poor predictive value. The aim of this study was to evaluate how athletes presenting with these symptoms are diagnosed and managed in primary care.MethodsAn electronic survey was distributed to a random selection of family practitioners in England. The survey was designed to assess the frequency with which family practitioners encounter adults with exercise-related respiratory symptoms and how they would approach diagnostic work-up and management. The survey also evaluated awareness of and access to diagnostic tests in this setting and general knowledge of prescribing asthma treatments to competitive athletes.Results257 family practitioners completed the online survey. One-third of respondents indicated they encountered individuals with this problem at a frequency of more than one case per month. Over two-thirds of family practitioners chose investigation as an initial management strategy, while one-quarter would initiate treatment based on clinical information alone. PEFR pre- and post-exercise was the most commonly selected test for investigation (44%), followed by resting spirometry pre- and post-bronchodilator (35%). Short-acting β2-agonists were the most frequently selected choice of treatment indicated by respondents (90%).ConclusionFamily practitioners encounter individuals with exercise-related respiratory symptoms commonly and although objective testing is often employed in diagnostic work-up, the tests most frequently utilised are not the most accurate for diagnosis of EIB. This diagnostic approach may be dictated by the reported lack of access to more precise testing methods, or may reflect a lack of dissemination or awareness of current evidence. Overall the findings have implications both for the management and hence welfare of athletes presenting with this problem to family practitioners and also for the competitive athletes requiring therapeutic use exemption.

Human Tissue Act: implications for sports science

In September 2006, an Act with significant implications for sports science research conducted in the UK came into force. The Human Tissue (HT) Act replaced the previous version of 1961 and affects all scientific practice that involves human tissue sampling and storage.1nnThe HT Act was conceived in response to shortcomings revealed in a series of public inquiries into UK hospital practice over the past 25 years;2 3 in particular, to address the use of human tissue and organs without appropriate patient consent. Consequently, its purpose is to provide a new legal framework for the acquisition, analysis and storage of human tissue in England, Wales and Northern Ireland. In order to implement this Act, a special authority (the Human Tissue Authority; HTA) was also established.nnSince inception, the Act has had significant implications for both clinical and research practice in the UK.4 5 Indeed, although the Act primarily concerns pathological specimens, it affects all practice that involves human tissue sampling. This is particularly true in sports science, where collection, storage and analysis of human samples are fundamental to many studies. nn#### Categories of “relevant” human samples in the HT Actnn##### I. Specifically identified relevant materialnnThis includes material such as bodily organs and tissues, consisting largely or entirely of cells, and clearly identifiable and regarded as such. The category includes internal organs and tissues, skin and bone; and specifically the following: