Introduction and Objectives High rates of exercise induced bronchoconstriction (EIB) are consistently reported in elite endurance athletes, prompting calls to consider screening high risk groups of athletes for respiratory dysfunction.¹ There are currently no robust data examining the prevalence of respiratory symptoms and airway dysfunction (hyper-reactivity and inflammation) in elite footballers. We therefore undertook this prospective study assessing airway health and the impact of treatment in a cohort of professional footballers undergoing squad pre-season screening.

Methods Ninety-seven elite male footballers completed a respiratory assessment including measurement of airway inflammation (FeNO) and screening for EIB using an indirect bronchoprovocation challenge (Eucapnic voluntary hyperpnoea [EVH]). Players demonstrating a positive challenge result (EVH+) were prescribed appropriate standard asthma therapy directed by EIB severity and underwent repeated assessment after 9 weeks of treatment. Eight players (EVH+=3, EVH-=5) also completed a cardiopulmonary exercise test (VO₂ peak) at the initial and follow-up visits (i.e., post-treatment).

Results Twenty-seven players (29%) demonstrated EVH+. Of these, ten (37%) reported no previous history of asthma or EIB. EVH result was not predictable by respiratory symptoms. Seven (24%) of the EVH +players attended for follow-up and demonstrated a reduction in FeNO (pre=85±61 ppb, post=28±11 ppb, p=0.04) and a decrease in the fall in FEV₁ post EVH (pre=−22.9±15.4%, post=−9.0±1.6%, p=0.018). At follow-up, VO₂ peak was improved by 3.4±2.9 ml.kg^-1.min^-1 in EVH +players compared to 0.1±2.3 ml.kg^-1.min^-1 in EVH- players. Magnitude of inference analysis indicated treatment was possibly beneficial (74%) for exercise capacity.

Conclusion Elite footballers have a high EIB prevalence, which remains undetected by a symptom based approach to assessment. Treatment with appropriate standard therapy reduces EIB severity, improves airway inflammation and may improve exercise performance. Therefore, the use of objective tests to screen for EIB in this population would be beneficial.

Reference

1. Dickinson J, Whyte G, McConnell A, et al. Impact of changes in the IOC-MC asthma criteria: A British perspective. Thorax 2005;60:629–632. doi:10.1136/thx.2004.037499

• Download figure
• Open in new tab
• Download powerpoint

Abstract S107 Figure 1

Relationship between EVH result and presence of respiratory symptoms.