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Screening of athletes for exercise-induced bronchoconstriction
1Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.
Summary
Diagnosing exercise-induced bronchoconstriction (EIB) in elite athletes requires objective evidence. Bronchial provocation challenge tests, like eucapnic voluntary hyperpnea (EVH), are recommended for accurate EIB diagnosis.
Area of Science:
- Sports Medicine
- Pulmonary Medicine
- Exercise Physiology
Background:
- Exercise-induced bronchoconstriction (EIB) is prevalent in elite athletes, especially endurance, winter, and swimming athletes.
- Clinical diagnosis of EIB shows moderate sensitivity and specificity.
- Objective evidence of EIB is now required for elite athletic competitions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of various bronchial provocation challenge tests for EIB in elite athletes.
- To identify the most sensitive and specific tests for diagnosing EIB in this population.
Main Methods:
- Review of recent studies on EIB diagnostic methods in elite athletes.
- Comparison of eucapnic voluntary hyperpnea (EVH) challenge, pharmacological tests (methacholine), exercise challenges (laboratory and field), and osmotic challenges (hypertonic saline, mannitol).
Main Results:
- Eucapnic voluntary hyperpnea (EVH) challenge demonstrates high sensitivity and specificity for EIB.
- Pharmacological tests have low sensitivity but high specificity, not recommended for pure EIB.
- Osmotic challenges (saline, mannitol) show high sensitivity and specificity, serving as alternatives to EVH.
Conclusions:
- Bronchial provocation challenge tests are essential for accurate EIB diagnosis in elite athletes.
- EVH and osmotic challenges are recommended due to their high sensitivity and specificity.
- Standardized field exercise tests and pharmacological tests have limitations in diagnosing EIB in elite athletes.