Bronchial hyperresponsiveness testing in athletes of the Swiss Paralympic team

Mirjam Osthoff,Matthias Strupler,Claudio Perret,Franz Michel,Jörg D Leuppi,Anne B Taegtmeyer,David Miedinger

doi:10.1186/2052-1847-5-7

Abstract

BackgroundThe aim of this study was to assess airway hyperresponsiveness to eucapnic voluntary hyperventilation and dry powder mannitol challenge in athletes aiming to participate at the Paralympic Games 2008 in Beijing, especially in athletes with spinal cord injury.MethodsForty-four athletes with a disability (27 with paraplegia (group 1), 3 with tetraplegia (group 2) and 14 with other disabilities such as blindness or single limb amputations (group 3) performed spirometry, skin prick testing, measurement of exhaled nitric oxide, eucapnic voluntary hyperventilation challenge test (EVH) and mannitol challenge test (MCT). A fall in FEV1 of ≥10% in either challenge test was deemed positive for exercise-induced bronchoconstriction.ResultsFourteen (32%) athletes were atopic and 7 (16%) had a history of physician-diagnosed asthma. Absolute lung function values were significantly lower in patients of group 1 and 2 compared to group 3. Nine (20%) athletes were positive to EVH (8 paraplegics, 1 tetraplegic), and 8 (18%) athletes were positive to MCT (7 paraplegics, 1 tetraplegic). Fourteen (22.7%) subjects were positive to at least one challenge; only three athletes were positive to both tests. None of the athletes in group 3 had a positive test. Both challenge tests showed a significant association with physician-diagnosed asthma status (p = 0.0001). The positive and negative predictive value to diagnose physician-diagnosed asthma was 89% and 91% for EHV, and 75% and 86% for MCT, respectively.ConclusionEVH and MCT can be used to identify, but especially exclude asthma in Paralympic athletes.

Highlights

The aim of this study was to assess airway hyperresponsiveness to eucapnic voluntary hyperventilation and dry powder mannitol challenge in athletes aiming to participate at the Paralympic Games 2008 in Beijing, especially in athletes with spinal cord injury
The diagnosis of asthma was based on previous physician-diagnosed asthma [12]
(31.8%) athletes were found to be atopic and seven (15.9%) subjects had a history of physician diagnosed asthma; eleven athletes (25%) were diagnosed with asthma after assessment

Summary

Introduction

The aim of this study was to assess airway hyperresponsiveness to eucapnic voluntary hyperventilation and dry powder mannitol challenge in athletes aiming to participate at the Paralympic Games 2008 in Beijing, especially in athletes with spinal cord injury. Athletes participating at the Paralympic Games 2008 in Beijing had to apply for a therapeutic use exemption if they wished to use inhaled beta agonists as these were prohibited substances according to the World AntiDoping Code Prohibited List [1] They had to provide objective criteria for the existence of exercise-induced bronchoconstriction or exercise induced asthma according to the World Antidoping Agency’s Therapeutic Use Exemption Guidelines [2]. As exercise challenge tests are quite insensitive to identify exercise induced bronchoconstriction in elite bronchoconstriction and asthma [7,8,9] and correlated well with EVH in able-bodied athletes [10]. Whether these tests can be used to assess athletes with a disability, is unknown. We set out to test and compare EVH and MCT and their utility to diagnose exercise-induced asthma in elite athletes with a disability, in particular in athletes with spinal cord injury

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