Asthma and lower airway disease
Prevalence and characteristics of asthma in the aquatic disciplines

https://doi.org/10.1016/j.jaci.2015.01.041Get rights and content

Background

Despite the health benefits of swimming as a form of exercise, evidence exists that both the swimming pool environment and endurance exercise are etiologic factors in the development of asthma. The prevalence of asthma in swimmers is high compared with that in participants in other Olympic sport disciplines. There are no publications comparing the prevalence of asthma in the 5 aquatic disciplines.

Objective

The purpose of this study is to examine and compare the prevalence of asthma in the aquatic disciplines and in contrast with other Olympic sports.

Methods

Therapeutic Use Exemptions containing objective evidence of athlete asthma/airway hyperresponsiveness (AHR) were collected for all aquatic athletes participating in swimming, diving, synchronized swimming, water polo, and open water swimming for major events during the time period from 2004-2009. The prevalence of asthma/AHR in the aquatic disciplines was analyzed for statistical significance (with 95% CIs) and also compared with that in other Olympic sports.

Results

Swimming had the highest prevalence of asthma/AHR in comparison with the other aquatic disciplines. The endurance aquatic disciplines have a higher prevalence of asthma/AHR than the aquatic nonendurance disciplines. Asthma/AHR is more common in Oceania, Europe, and North America than in Asia, Africa, and South America. In comparison with other Olympic sports, swimming, synchronized swimming, and open water swimming were among the top 5 sports for asthma/AHR prevalence.

Conclusion

Asthma/AHR in the endurance aquatic disciplines is common at the elite level and has a varied geographic distribution. Findings from this study demonstrate the need for development of aquatic discipline–specific prevention, screening, and treatment regimens.

Section snippets

Determination of the study period

We studied historical data derived from Therapeutic Use Exemptions (TUEs) containing the objective diagnoses of AHR of all competing aquatic athletes at the 2005, 2007, and 2009 FINA World Championships and the 2004 and 2008 Olympic Games. Commencing in 2002, the International Olympic Committee (IOC) instituted legislation requiring all athletes competing at the Olympic Games and using inhaled β2-agonists to provide objective proof of AHR.28, 29 In 2004, all inhaled β2-agonists, including

Results

A total of 1,811 (1,441 from FINA and 370 from the IOC) TUEs from the aquatic disciplines for the study period were processed. After removal of TUEs for athletes who did not compete at the target events in the study period, a total of 1,468 aquatic TUEs comprised the study sample. For the nonaquatic Olympic sports, 920 TUEs were included in the study. The source population of aquatic athletes participating in the major events between 2004 and 2009 totaled 9,343. The total number of athletes

Discussion

This study is the first to report the comparison of asthma/AHR prevalence between the aquatic disciplines in the elite athlete population and in contrast with other Olympic sports. The predominant finding of a high prevalence of TUEs for inhaled β2-agonists (IBAs) in swimming compared with the other aquatic disciplines is consistent with published data demonstrating a higher prevalence of asthma in swimmers than in the general population.18, 20, 34 There is only one published study27 on asthma

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    Disclosure of potential conflict of interest: M. Mountjoy is employed by the McMaster Medical School and the University of Guelph, has received payment for delivering lectures from Serie Cientifica Latinoamerican, and has received compensation for travel and other meeting-related expenses from the International Olympic Committee, FINA, and the World Anti-Doping Agency. K. Fitch has received payment for the development of educational presentations from the Australasian College of Sports Physicians. L.-P. Boulet has received compensation for board membership from GlaxoSmithKline, Novartis, AstraZeneca, Merck, and Schering; has received or has grants pending from AstraZeneca, GlaxoSmithKline, Merck, Schering, AllerGen, Altair, Amgen, Asmacure, Boehringer Ingelheim, Genentech, Novartis, Ono Pharma, Pharmaxis, and Wyeth; has received payment for delivering lectures from AstraZeneca, GlaxoSmithKline, Merck, and Novartis; has received payment for the development of educational presentations from AstraZeneca, GlaxoSmithKline, Merck, Boehringer Ingelheim, Novartis; and has received payment as a governmental advisor for INNESS, the Quebec National Health Institute, and as a member of the Quebec Workmen Compensation Board Respiratory Committee. The rest of the authors declare that they have no relevant conflicts of interest.

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