April 4, 2023
Evidence-based guidance for the clinical diagnostic approach to lower airway dysfunction
Lower airway dysfunction is a term used to describe asthma-related issues in athletes, including exercise-induced asthma, exercise-induced bronchoconstriction and/or airway hyperresponsiveness. Together these conditions represent the most common reason athletes seek medical attention. The diagnostic precision related to lower airway dysfunction is however limited, and requires an objective measure. The IOC consensus subgroup on ‘acute respiratory illness in the athlete’, of which UP SEMLI researchers are a part, recently published a review comparing the performance of various diagnostic bronchoprovocation tests in the assessment of lower airway dysfunction in athletes in order to inform best clinical practice.
Their review of the literature and meta-analysis found that studies describing the use of bronchial provocation tests in the diagnosis of lower airway dysfunction in athletes were varied in terms of the application of protocols and cut-off values. They report that both the eucapnic voluntary hyperpnoea and field-based sport-specific exercise challenge tests exhibit moderate specificity for the detection of lower airway dysfunction in athletes reporting symptoms. In addition, field-based sport-specific exercise challenge tests performed in dry environments and at high intensities, resulted in greater test performance compared to eucapnic voluntary hyperpnoea in this context.Based on the best and current available data researchers provided evidence-based guidance for the clinical diagnosis of lower airway dysfunction. That is, for the assessment of lower airway dysfunction in athletes, eucapnic voluntary hyperpnoea and field-based exercise challenge tests offer similar and moderate diagnostic performance. Field-based sport-specific exercise challenge tests in dry air conditions may be more sensitive. Direct methacholine bronchoprovocation tests appear to have lower overall test performance in the assessment of lower airway dysfunction in symptomatic athletes.
Reference for this summary:
Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’. Tonje Reier-Nilsen, Nicola Sewry, Bruno Chenuel, Vibeke Backer, Kjell Larsson, Oliver J Price, Lars Pedersen, Valerie Bougault, Martin Schwellnus, James H Hull. Br J Sports Med Epub ahead of print: doi:10.1136/ bjsports-2022-106059.