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BTS clinical statement for the assessment and management of respiratory problems in athletic individuals
  1. James H Hull1,2,
  2. Paul Burns3,
  3. Jane Carre4,
  4. Jemma Haines5,6,
  5. Claire Hepworth7,
  6. Steve Holmes8,
  7. Nigel Jones9,
  8. Alison MacKenzie10,
  9. James Y Paton11,
  10. William Martin Ricketts12,13,
  11. Luke S Howard14
  1. 1 Respiratory Medicine, Royal Brompton Hospital, London, UK
  2. 2 Institute of Sport, Exercise and Health, UCL, London, UK
  3. 3 Respiratory and sleep physiology, Royal Hospital for Children, Glasgow, UK
  4. 4 British Swimming, University of Bath, Bath, UK
  5. 5 Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester, UK
  6. 6 Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
  7. 7 Paediatric Physiotherapy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  8. 8 Primary Care, The Park Medical Practice, Shepton Mallet, Somerset, UK
  9. 9 UK Sports Medicine, British Cycling, Manchester, UK
  10. 10 Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK
  11. 11 School of Medicine, University of Glasgow, Glasgow, UK
  12. 12 Respiratory Medicine, St Bartholomew's Hospital, London, UK
  13. 13 Sports Medicine, AFC Wimbledon Football Club, London, UK
  14. 14 National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, London, UK
  1. Correspondence to Dr James H Hull, Respiratory Medicine, Royal Brompton Hospital, London, UK; j.hull{at}

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This British Thoracic Society (BTS) Clinical Statement addresses the diagnosis, evaluation and management of respiratory problems in athletic individuals. The overall recommendations issued in this document are built on a synthesis of the best available published evidence, where available and appropriate, but are largely based on expert opinion, with emphasis on providing readers with pragmatic clinical advice, when faced with respiratory problems in exercising individuals.

Participation in vigorous exercise or sport plays an important role in many people’s lifestyle and is associated with a broad range of benefits, including for cardiovascular, metabolic and mental health. For some individuals, however, the ability to participate in and enjoy sporting activities may be curtailed by the presence of respiratory symptoms. Indeed, it is estimated that at least one in four individuals report troublesome exercise-related respiratory issues, such as breathlessness, cough and/or wheeze.1 Moreover, in competitive athletes, asthma is the most prevalent medical condition and encountered in approximately a quarter of those partaking in endurance sport.2 3

Although athletic individuals can develop any cardiorespiratory illness and thus general clinical guideline documents are broadly applicable, studies over the past three decades have highlighted issues that are particularly relevant when assessing respiratory problems in athletic individuals or in certain sporting scenarios. For example, in the sports medicine world, it is now widely accepted that a clinical-based diagnosis of exercise-induced bronchoconstriction (EIB) in athletic individuals is often inaccurate and that symptoms of EIB poorly relate to objective test findings, such as from bronchoprovocation testing.4 5 This may be explained by the presence of ‘sport-specific’ differential diagnoses, including highly prevalent conditions, such as exercise-induced laryngeal obstruction (EILO) and breathing pattern disorder (BPD). This highlights the need for a modified approach to ensure a robust and accurate diagnosis and thus appropriate treatment.

There are also some …

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  • Contributors JH was the lead author responsible for the final document. All authors agreed on the outline and content of the document and authored sections of the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer A Clinical Statement reflects the expert views of a group of specialists who are well versed on the topic concerned, and who carefully examine the available evidence in relation to their own clinical practice. A Clinical Statement does not involve a formal evidence review and is not developed in accordance with clinical practice guideline methodology. Clinical Statements are not intended as legal documents or a primary source of detailed technical information. Readers are encouraged to consider the information presented and reach their own conclusions.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.