Asthma and increased bronchial responsiveness in elite athletes: Atopy and sport event as risk factors,☆☆,,★★

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Abstract

Background: High prevalence of bronchial hyperresponsiveness and asthma has been found in cross-country skiers. There is limited evidence that asthma and bronchial responsiveness would be common also in athletes with summer events. Objectives: The objective of this study was to investigate occurrence of and risk factors for increased bronchial responsiveness and asthma in elite athletes with summer events and to compare their results with those of control subjects. Methods: Forty-nine speed and power athletes (mean age 21.1 years, range 16 to 31), 71 long-distance runners (mean age 26.6 years, range 16 to 39), 42 swimmers (mean age 18.6 years, range 14 to 25), and 45 control subjects (mean age 26.7 years, range 21 to 37) were studied. The subjects answered questionnaires and were given a resting spirometric examination, a skin prick test, and a histamine challenge test. Results: Current asthma (current asthmatic symptoms and increased bronchial responsiveness) was observed in 14% (22 of 162) of the athletes and in 2% (1 of 45) of the control subjects (p = 0.041). Total asthma (current asthmatic symptoms and increased bronchial responsiveness or physician-diagnosed asthma) occurred in 23% (37 of 162) of the athletes and in 4% (2 of 45) of the control subjects (p = 0.0048). Atopy according to skin prick test results was found in 48% (77 of 162) of the athletes and in 36% (16 of 45) of the control subjects (not significant). Clinical pollen allergy (positive skin test reaction to pollen and symptoms of rhinoconjunctivitis) was significantly (p  = 0.037) more common in athletes than in control subjects. Atopic athletes showed significantly more often increased bronchial responsiveness, current asthma, and total asthma than nonatopic athletes (p = 0.011, p = 0.0049, and p < 0.0001, respectively), and the odds ratios of increased bronchial responsiveness and asthma increased with the number of positive skin test reactions. After adjustment for confounding factors, the odds ratio for the occurrence of current asthma was 5.49 (95% confidence interval 0.56 to 53.7) in speed and power athletes, 2.88 (0.30 to 27.7) in long-distance runners, and 10.8 (1.10 to 106.0) in swimmers compared with control subjects. The adjusted odds ratios for the occurrence of total asthma were 3.56 (0.62 to 20.5) in speed and power athletes, 6.01 (1.19 to 30.2) in long-distance runners, and 5.89 (1.00 to 34.5) in swimmers. Conclusions: Asthma is more common in highly trained athletes than in control subjects. Asthma is especially common in elite swimmers, but the risk of asthma is increased also in long-distance runners. Increased bronchial responsiveness and asthma are strongly associated with atopic disposition and its severity in elite athletes.(J Allergy Clin Immunol 1998;101:646-52.)

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Subjects

One hundred sixty-two athletes and 45 control subjects volunteered to participate. All subjects gave their written informed consent, and the study protocol was approved by the local ethics committee. The athletes were divided into three groups according to their type of training12 and training environment: speed and power track and field athletes (n = 49), long-distance runners (n = 71), and swimmers (n = 42). The main events of speed and power athletes were sprinting (100 to 400 meters,

Results

The mean time from the beginning of active competition sports to the physician diagnosed asthma was 4 years (range, 2 to 6 years) in the two-speed and power athletes, 7.3 years (range, 3 to 14 years) in the 12 long-distance runners, and 5.7 years (range, 2 to 10 years) in the six swimmers who had asthma diagnosed during their sports career (Fig. 1).

. Individual time intervals from start of active competitive sports to physician-diagnosed asthma in athletes who had asthma diagnosed during their

Discussion

The subjects of this study were selected by using our previous respiratory symptom questionnaire for elite athletes4 in which willingness for further investigations was questioned. Self-selection may have occurred, with healthier or symptom-free subjects less likely to take part. However, such selection should have occurred in control subjects with equal extent. The results of our previous study compared with this one does not support any significant selection bias. A similar prevalence rate

Acknowledgements

We thank Mrs. Leena Petman, Mrs. Alli Tallqvist, and Mrs. Anne Bruce for technical help.

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From athe Department of Allergology, Helsinki University Central Hospital; bResearch Institute for Olympic Sports, Jyväskylä; and cthe Department of Public Health, University of Helsinki.

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Supported by Finnish Olympic Committee, Finnish Allergy Research Foundation, Finnish Sports Research Foundation, Finnish Medicine Foundation, Ida Montin Foundation, and The Finnish Anti-Tuberculosis Association Foundation.

Reprint requests: Ilkka J. Helenius, Department of Allergology, Helsinki University Central Hospital, FIN-00250, Helsinki, Finland.

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