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Asthma and the elite athlete: Summary of the International Olympic Committee's Consensus Conference, Lausanne, Switzerland, January 22-24, 2008

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Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled β2-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to β2-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale β2-agonists will continue.

Section snippets

Does the athlete have asthma?

Asthma is a syndrome with many clinical phenotypes.4 Exercise-induced asthma is the occurrence of a transient narrowing of the airways after exercise that is reversible by inhalation of a β2-agonist in an individual with asthma. When narrowing of the airways occurs only with exercise, this phenomenon is best described as EIB.5 The term EIB is self-explanatory and is used throughout this article.

Sports activities at an elite level are often associated with symptoms that may be suggestive of

Optimal management of asthma in athletes

The goal of asthma treatment is to reduce or prevent respiratory symptoms and to optimize pulmonary function.40 Management of asthma in athletes should be similar to management in nonathletes, with attention to patient education (which is often deficient in athletes),41 reduction of relevant environmental exposures, treatment of associated comorbid conditions, individualized pharmacotherapy, prevention of exacerbations, and regular follow-up (Fig 1). Athletes should also be advised to avoid

β2-Agonists experience at Olympic Games

In 2004, requiring Olympic athletes to demonstrate evidence of asthma or AHR to inhale β2-agonists resulted in a 27% reduction in their use from the 2000 Olympics, when notification only was accepted.2 Identified in 2001, the markedly skewed prevalence of β2-agonist notifications was confirmed after use of β2-agonists had to be approved in 2002. A higher percentage of β2-agonist notifications/approved applications was observed in summer sports with a major endurance component in competition

Environmental aspects of asthma in elite athletes

Airway function can be affected by exposure to seasonal and perennial allergens in sensitized individuals, dry/cold air, and poor quality air containing pollutants such as chlorine derivatives in swimming pools, ozone and oxides of nitrogen, and fine and ultrafine PM derived from combustion.69 The effects may be greater in subjects with asthma than without asthma. Because of the high minute ventilation during exercise, the effects of these exposures may be more marked in athletes than in

Training as a cause of asthma

The prevalences of asthma, EIB, and AHR are increased in elite athletes.6, 47, 83 For swimmers, this has been attributed to the frequent recommendation for patients with asthma to engage in this sport. However, the proportion of elite swimmers who commence swimming because of asthma compared with those who develop asthma and/or AHR after years of intense training is unknown. Several studies in the last decade have suggested that long-term intense endurance training may promote the development

Why are patients with asthma successful at the Olympic Games?

Athletes who notified β2-agonist use in Sydney and were approved to inhale β2-agonists in Salt Lake City, Athens, and Torino won more individual Olympic medals than their counterparts without asthma at each Games (see this article's Fig E3 in the Online Repository at www.jacionline.org).

The differences were greater in winter athletes than in summer athletes because a greater percentage of winter competitions can be classed as endurance events. Of the 28 summer sports, 6—boxing, wrestling,

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    Consensus Conference supported by the International Olympic Committee.

    Disclosure of potential conflict of interest: K. D. Fitch is a member of the International Olympic Committee (IOC) Medical Commission and chair of the IOC Independent Asthma Panel. M. Sue-Chu is on the Advisory Board of Novartis and GlaxoSmithKline, has delivered lectures funded by AstraZeneca, has participated in a clinical trial funded by Novartis, and is a member of the IOC Independent Asthma Panel. S. D. Anderson invented the mannitol test for Pharmaxis Ltd and is a member of the IOC Independent Asthma Panel. L.-P. Boulet has received sponsorship or funding from AstraZeneca, GlaxoSmithKline, Merck Frosst, Schering-Plough, Novartis, Alexion, AsthmaTx, Boehringer-Ingelheim, Ception, Genentech, IVAX, MedImmune, Topigen, and Wyeth. D. C. McKenzie has received research funding from the World Anti-Doping Agency and is a member of the IOC Independent Asthma Panel. V. Backer has received research funding from Pharmaxis Ltd and the Danish Lung Association and is a member of the Advisory Board of MSD, Novartis, ALK-Abelló, AstraZeneca, and GlaxoSmithKline. K. W. Rundell has delivered lectures sponsored by Merck and has received research funding from the World Anti-Doping Agency, Pharmaxis, SkyPharma, and Forest Research. P. Kippelen has received research funding from the British Olympic Association and is a member of the IOC Independent Asthma Panel. The rest of the authors have declared that they have no conflict of interest.

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