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  • Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

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Systematic review
Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’
  1. Tonje Reier-Nilsen1,2,
  2. Nicola Sewry3,4,
  3. Bruno Chenuel5,6,
  4. Vibeke Backer7,8,
  5. Kjell Larsson9,
  6. Oliver J Price10,11,
  7. Lars Pedersen12,
  8. Valerie Bougault13,
  9. Martin Schwellnus3,4,
  10. James H Hull14,15
  1. 1 The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
  2. 2 Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3 Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  4. 4 International Olympic Committee (IOC) Research Centre of South Africa, University of Pretoria, Pretoria, South Africa
  5. 5 Centre Hospitalier Régional Universitaire de Nancy, Department of Lung function and Exercise Physiology - University Center of Sports Medicine and Adapted Physical Activity, Université de Lorraine, Nancy, France
  6. 6 Université de Lorraine, DevAH, Nancy, France
  7. 7 Department of ENT, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
  8. 8 CFAS, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
  9. 9 Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  10. 10 School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
  11. 11 Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK
  12. 12 Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
  13. 13 Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d’Azur, Nice, France
  14. 14 Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  15. 15 Institute of Sport, Exercise and Health (ISEH), Division of surgery and Interventional science, University College London, London, UK
  1. Correspondence to Dr Tonje Reier-Nilsen, The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo 0806, Norway; tonjereiernilsen{at}icloud.com

Abstract

Objectives To compare the performance of various diagnostic bronchoprovocation tests (BPT) in the assessment of lower airway dysfunction (LAD) in athletes and inform best clinical practice.

Design Systematic review with sensitivity and specificity meta-analyses.

Data sources PubMed, EBSCOhost and Web of Science (1 January 1990–31 December 2021).

Eligibility criteria Original full-text studies, including athletes/physically active individuals (15–65 years) who underwent assessment for LAD by symptom-based questionnaires/history and/or direct and/or indirect BPTs.

Results In 26 studies containing data for quantitative meta-analyses on BPT diagnostic performance (n=2624 participants; 33% female); 22% had physician diagnosed asthma and 51% reported LAD symptoms. In athletes with symptoms of LAD, eucapnic voluntary hyperpnoea (EVH) and exercise challenge tests (ECTs) confirmed the diagnosis with a 46% sensitivity and 74% specificity, and 51% sensitivity and 84% specificity, respectively, while methacholine BPTs were 55% sensitive and 56% specific. If EVH was the reference standard, the presence of LAD symptoms was 78% sensitive and 45% specific for a positive EVH, while ECTs were 42% sensitive and 82% specific. If ECTs were the reference standard, the presence of LAD symptoms was 80% sensitive and 56% specific for a positive ECT, while EVH demonstrated 65% sensitivity and 65% specificity for a positive ECT.

Conclusion In the assessment of LAD in athletes, EVH and field-based ECTs offer similar and moderate diagnostic test performance. In contrast, methacholine BPTs have lower overall test performance.

PROSPERO registration number CRD42020170915.

  • Asthma
  • Diagnosis
  • Athletes
  • Exercise Test
  • Respiratory System

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bjsports-2022-106059

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @ReierTonje, @oliverjprice, @VBougault

    • Contributors Conception and design: TR-N, NS, BC, VB, KL, OJP, LP, VB, MS and JHH. Analysis and interpretation: TR-N and NS. Drafting the manuscript for important intellectual content: TR-N, NS, BC, VB, KL, OJP, LP, VB, MS and JHH. TR-N confirms full responsibility for the content of the manuscript.

    • 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.

    • Competing interests None declared.

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

    • © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

    • 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.