Oliver J. Price

Airway dysfunction in elite athletes – an occupational lung disease?

Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athletes respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.

The Impact of Exercise-Induced Bronchoconstriction on Athletic Performance: A Systematic Review

BackgroundExercise-induced bronchoconstriction (EIB) describes the phenomenon of transient airway narrowing in association with physical activity. Although it may seem likely that EIB would have a detrimental impact on athletic performance, this has yet to be established.ObjectivesThe aim of this review is to provide a systematic appraisal of the current status of knowledge regarding EIB and exercise performance and to highlight potential mechanisms by which performance may be compromised by EIB.Data Sources and Study SelectionPubMed/Medline and EBSCO databases were searched up to May 2014 using the search parameter: [(‘exercise’ OR ‘athlete’) AND (‘asthma’ OR ‘bronchoconstriction’ OR ‘hypersensitivity’) AND ‘performance’]. This search string returned 243 citations. After systematically reviewing all of the abstracts, 101 duplicate papers were removed, with 132 papers excluded for not including an exercise performance outcome measure.ResultsThe remaining ten studies that met the initial criteria were included in this review; six evaluated the performance of physically active individuals with asthma and/or EIB while four assessed the effects of medication on performance in a comparable population.ConclusionThe evidence concludes that whilst it is reasonable to suspect that EIB does impact athletic performance, there is currently insufficient evidence to provide a definitive answer.

Advances in the diagnosis of exercise-induced bronchoconstriction.

Exercise-induced bronchoconstriction (EIB) describes the post exercise phenomenon of acute airway narrowing in association with physical activity. A high prevalence of EIB is reported in both athletic and recreationally active populations. Without treatment, EIB has the potential to impact upon both health and performance. It is now acknowledged that clinical assessment alone is insufficient as a sole means of diagnosing airway dysfunction due to the poor predictive value of symptoms. Furthermore, a broad differential diagnosis has been established for EIB, prompting the requirement of objective evidence of airway narrowing to secure an accurate diagnosis. This article provides an appraisal of recent advances in available methodologies, with the principle aim of optimising diagnostic assessment, treatment and overall clinical care.

Asthma in Elite Athletes: Who Cares?

Asthma or exercise-induced bronchoconstriction is highly prevalent in athletes and if untreated has the potential to impact on their health and performance. The condition can be diagnosed and managed effectively yet there is concern that the care afforded to elite athletes with this condition is often suboptimal. In this respect, it is apparent that more could be done to protect athletes from developing airway dysfunction (eg, by reducing exposure to irritant environments); that the diagnosis of asthma in athletes is often made without secure objective evidence and that athletes may be advised to reduce activity levels in order to improve symptoms. Moreover there appears to be poor surveillance of airway health in athletes when a diagnosis of asthma has been made. Overall this raises the question of who cares about athletes with asthma? The article that follows present the case of why this is an important clinical area for physicians. The review provides an overview of asthma in athletes with the overall aim of ensuring that respiratory health in this unique population is optimized.

Reply: Reevaluating the Diagnostic Threshold for Eucapnic Voluntary Hyperpnea Testing in Athletes

1. Price OJ, Ansley L, Levai IK, Molphy J, Cullinan P, Dickinson JW, Hull JH. Eucapnic voluntary hyperpnea testing in asymptomatic athletes [letter]. Am J Respir Crit Care Med 2016;193:1178–1180. 2. Parsons JP, Hallstrand TS, Mastronarde JG, Kaminsky DA, Rundell KW, Hull JH, Storms WW, Weiler JM, Cheek FM, Wilson KC, et al.; American Thoracic Society Subcommittee on Exercise-induced Bronchoconstriction. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med 2013;187:1016–1027. 3. Parsons JP, Cosmar D, Phillips G, Kaeding C, Best TM, Mastronarde JG. Screening for exercise-induced bronchoconstriction in college athletes. J Asthma 2012;49:153–157.