Editor: Michael Wechsler
Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players
Version of Record online: 17 DEC 2011
© 2011 John Wiley & Sons A/S
Volume 67, Issue 3, pages 390–395, March 2012
How to Cite
Ansley, L., Kippelen, P., Dickinson, J. and Hull, J. H. K. (2012), Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players. Allergy, 67: 390–395. doi: 10.1111/j.1398-9995.2011.02762.x
- Issue online: 11 FEB 2012
- Version of Record online: 17 DEC 2011
- Manuscript Accepted: 11 NOV 2011
- bronchial provocation;
- eucapnic voluntary hyperpnoea;
Physicians typically rely heavily on self-reported symptoms to make a diagnosis of exercise-induced bronchoconstriction (EIB). However, in elite sport, respiratory symptoms have poor diagnostic value. In 2009, following a change in international sports regulations, all elite athletes suspected of asthma and/or EIB were required to undergo pulmonary function testing (PFT) to permit the use of inhaled β2-agonists. The aim of this study was to examine the diagnostic accuracy of physician diagnosis of asthma/EIB in English professional soccer players.
Sixty-five players with a physician diagnosis of asthma/EIB were referred for pulmonary function assessment. Medication usage and respiratory symptoms were recorded by questionnaire. A bronchial provocation test with dry air was conducted in 42 players and a mannitol challenge in 18 players. Five players with abnormal resting spirometry performed a bronchodilator test.
Of the 65 players assessed, 57 (88%) indicated regular use of asthma medication. Respiratory symptoms during exercise were reported by 57 (88%) players. Only 33 (51%) of the players tested had a positive bronchodilator or bronchial provocation test. Neither symptoms nor the use of inhaled corticosteroids were predictive of pulmonary function tests’ outcome.
A high proportion of English professional soccer players medicated for asthma/EIB (a third with reliever therapy only) do not present reversible airway obstruction or airway hyperresponsiveness to indirect stimuli. This underlines the importance of objective PFT to support a symptoms-based diagnosis of asthma/EIB in athletes.