Maximizing Respiratory Health In Elite Swimmers - A Systematic Approach To Optimize Total Airway Health

Abstract

Elite Swimmers are known to have high prevalence of exercise induced bronchoconstriction (EIB), nasal and sinus disorders. There is however limited data available regarding the impact of a systematic assessment, addressing all aspects of airway health in this cohort. PURPOSE: To report the findings of a systematic approach to evaluating total airway health in elite swimmers with EIB, prior to the 2016 Olympics. METHODS: 15 elite swimmers (9 males, 6 females), age 22.2 ± 2.9 yrs underwent a systematic assessment of total airway health three months prior to the Olympics. All swimmers had a prior diagnosis of EIB, confirmed by indirect bronchoprovocation challenge and measurement of exhaled nitric oxide (FeNO). All were prescribed appropriate inhaler therapy and educated on inhaler technique. At the systematic assessment spirometry, FeNO, inhaler flow-rate, nasal flow was measured and they also underwent an assessment with a pulmonologist. Results were analysed using paired t-tests and are presented as mean ± SD. RESULTS: All swimmers had at least one co-existing condition in addition to EIB including nasal disease, reflux, sensations of laryngeal closure, recurrent respiratory tract infection and abnormal breathing sensations. One-third reported side effects from inhaler use. All swimmers demonstrated sub-optimal inhaler technique based on an inhalation rate of 348 ± 49.4 L.min-1. Despite being prescribed treatment for EIB, three swimmers had on-going airflow obstruction with bronchodilator reversibility of FEV1 by 12.9 ± 7.7 % above baseline. At the review FeNO was reduced (pre: 27.7 ± 15.1, post: 16.3 ± 6.5 ppb (p = 0.006) from first consult. CONCLUSION: Despite being prescribed EIB treatment over half of an elite cohort of swimmers reported troublesome respiratory and allied symptoms. Moreover, inhaler technique was sub-optimal with frequent report of side-effects. Respiratory health in elite swimmers can be optimized through systematic assessment of airway health.