Cold air exercise screening for exercise induced bronchoconstriction in cold weather athletes

Area of Science:

• Sports Medicine
• Pulmonary Medicine
• Environmental Medicine

Background:

• Exercise Induced Bronchoconstriction (EIB) significantly impacts cold weather athletes.
• A standardized cold air exercise provocation test for EIB is currently lacking.
• Existing EIB screening methods may not accurately reflect exercise challenges in cold environments.

Purpose of the Study:

• To compare the prevalence of EIB using a novel Cold Air Test (CAT) against the Eucapnic Voluntary Hyperpnea (EVH) test in cold weather athletes.
• To evaluate the diagnostic agreement between CAT and EVH for identifying EIB.
• To identify potential predictors of EIB in this population.

Main Methods:

• Sixteen cold weather athletes underwent spirometry and Fractional Expired Nitric Oxide (FENO) measurements.
• Participants completed the EVH test followed by a 5 km outdoor running CAT at -15°C within 72 hours.
• Respiratory symptoms, atopy status, and lung function parameters (FEV1, FVC, PEF) were assessed.

Main Results:

• EIB was detected in 5 athletes using EVH and 7 athletes using CAT, with only 50% agreement between the tests.
• Post-exercise, CAT resulted in significantly prolonged FEV1 recovery and decreased Peak Expiratory Flow compared to EVH.
• Predictive factors for EIB included FENO >12 ppb, FEV1/FVC ratio <0.75, and BMI <20 kg/m².

Conclusions:

• The standard EVH test may not adequately identify all cases of EIB in cold weather athletes.
• The CAT appears more sensitive for detecting EIB triggered by cold air exercise.
• Further research is needed to establish optimal EIB screening protocols for athletes training in cold conditions.