Asthma, Rhinitis, Other Respiratory Diseases
Responses to bronchial challenge submitted for approval to use inhaled β2-agonists before an event at the 2002 winter olympics,☆☆

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Abstract

Background: There has been an increase in the number and percentage of athletes competing in Olympic Games notifying use of β2-agonists, from 1.7% at Los Angeles (1984) to 5.5% at Sydney (2000). For Salt Lake City (2002), the International Olympic Committee requested objective evidence to use β2-agonists for asthma or exercise-induced asthma (EIA). Objective: The objective of this study was to evaluate the evidence submitted for approval to use a β2-agonist. Methods: Objective evidence for asthma or EIA included (1) an increase of 12% or more of the predicted FEV1 in response to bronchodilator, (2) a reduction in FEV1 of 10% or greater from baseline in response to exercise or eucapnic voluntary hyperpnea, (3) a PD20 FEV1 to methacholine or histamine at a dose of less than 200 μg (2 mg/mL) or less than 1320 μg (13.2 mg/mL) for those taking inhaled corticosteroids for 3 months. Results: There were 165 applications. Of these, 147 (89%) included evidence of a challenge, bronchodilator response, or both, and 163 test results were submitted. One hundred thirty (5.2%) applications were approved. For those with positive responses, the median value (1) was 16.2% of predicted FEV1 for response to a bronchodilator (n = 13), (2) was a 15.9% decrease in FEV1 for response to a physical challenge (n = 36), and, (3) for PD20 FEV1, was 173 μg for response to a pharmacologic challenge (n = 45). Conclusion: The analysis demonstrated that it is feasible to request objective evidence to justify use of β2-agonists on the medical grounds of asthma or EIA. (J Allergy Clin Immunol 2003;111:45-50.)

Section snippets

Methods

References were provided for methodologies to perform the various bronchial provocation tests.18, 19, 21, 22, 23, 26, 28, 29 The actual measurements of FEV1 before and after challenge and after bronchodilator use had to be provided to the panel with the source of the predicted values used.

Comparisons between the groups who had positive and negative results to each test were made by using the F test or the variance ratio test.30

Results

There were 2517 athletes at Salt Lake City, and of these, 36.3% were women. There were 165 individual applications for use of IBAs (6.6% of all participants), and these included 105 men and 60 (36.7%) women. Of these 165, 147 (89%) athletes submitted sufficient data to permit inclusion in the analysis of challenge tests. Some athletes submitted more than one result (ie, the results of methacholine and exercise or the results of methacholine and bronchodilator challenge), and in all, 163 tests

Discussion

The majority (89%) of applicants were able to meet the requirements of performing or providing test results for a bronchial challenge with 3 months' notice.

Although the response to a bronchodilator would normally be the simplest challenge to confirm the AHR of asthma, only 17% of the applicants submitted an acute response to a bronchodilator. No athlete was unfairly excluded from using IBAs because the value of 12% or more of predicted FEV1 was used for a positive bronchodilator test result

Acknowledgements

We thank Dr Patrick Schamasch of the IOC-MC for his help and guidance during the course of this project.

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  • Cited by (0)

    Supported by the Medical Commission of the International Olympic Committee.

    ☆☆

    Reprint requests: Sandra Anderson, PhD, DSc, Department of Respiratory Medicine, E11S, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia.

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