Prevalence of asthma and atopy in Italian Olympic athletes

This study aimed to assess the prevalence of asthma and atopy in the Italian athletes who were trying for a position on the Italian Olympic team for the 2000 Sydney Olympic Games. Overall, 1060 athletes (mean age 24 years, range 15 - 69 years, 729 males) were recruited and divided into three groups of sport activities: 1) anaerobic, 2) aerobic-anaerobic, 3) aerobic. Asthmatic and atopic athletes were identified by a self-administered, standardized questionnaire modified from the ISAAC questionnaire. Spirometry was performed in the athletes who reported wheezing or asthma and in an equal number of randomly selected controls. Athletes reporting wheezing or asthma were 15 %. However, only a minority of asthmatics had moderate or severe disease: indeed, 2.5 % reported more than 4 attacks in the last year. The prevalence of atopy was 18 %. Asthma was more common in athletes engaged in aerobic sport activities than in the other groups. Asthmatic athletes had a significantly lower value of some spirometric parameters in comparison with the control group. In conclusion, the prevalence of wheezing or asthma in a large sample of Italian competitive athletes was found higher than in general population; respiratory symptoms were more prevalent in athletes engaged in aerobic sport activities; a significant impairment of lung function was found in athletes suffering from mild and rarely symptomatic asthma.     

An overview of asthma and airway hyper-responsiveness in Olympic athletes

Data from the past five Olympic Games obtained from athletes seeking to inhale β2 adrenoceptor agonists (IBA) have identified those athletes with documented asthma and airway hyper-responsiveness (AHR). With a prevalence of about 8%, asthma/AHR is the commonest chronic medical condition experienced by Olympic athletes. In Summer and Winter athletes, there is a marked preponderance of asthma/AHR in endurance-trained athletes. The relatively late onset of asthma/AHR in many older athletes is suggestive that years of endurance training may be a contributory cause. Inspiring polluted or cold air is considered a significant aetiological factor in some but not all sports. During the last five Olympic Games, there has been improved management of athletes with asthma/AHR with a much higher proportion of athletes combining inhaled corticosteroids (ICS) with IBA and few using long-acting IBA as monotherapy. Athletes with asthma/AHR have consistently outperformed their peers, which research suggests is not due to their treatment enhancing sports performance. Research is necessary to determine how many athletes will continue to experience asthma/AHR in the years after they cease intensive endurance training.     

Prevalence of asthma-like symptoms, asthma and its treatment in elite athletes

The objective was to determine the prevalence of asthma-like symptoms and asthma and the use of asthma medication in Danish elite athletes. A cross-sectional questionnaire survey of Danish elite athletes was conducted in 2006. All elite athletes ( N =418) financially supported by the national organization of elite athletes comprised the study group; 329 (79%) completed the questionnaire concerning their sport, asthma-like symptoms, asthma and use of asthma medication. Asthma-like symptoms at rest were reported by 41% of respondents; 55% reported asthma-like symptoms at rest or at exercise. Physician-diagnosed asthma was present in 16% and 14% had current asthma. Asthma medication was taken by 7% of the athletes, of whom 79% used inhaled corticosteroids and 21% used inhaled β₂-agonists only. Athletes participating in endurance sports had higher prevalences of current asthma (24%) and use of asthma medication (15%) than all other athletes ( P <0.01). Athletes participating in endurance sports have a higher prevalence of asthma and use of asthma medication. The frequency of asthma medication is lower than the prevalence of current asthma indicating that there is no overuse of asthma medication among Danish elite athletes.     

Bronchial asthma in high-performance athletes

Bronchial asthma is as frequent among high performance athletes as in the general population. We requested information from 2961 athletes of national or international level about these matters and received 2060 answers. From these, we identified 146 athletes (7.1%) with exercise-related deep respiratory airways symptoms. Athletes subject to hay fever (42%) suffer significantly more often (p less than 0.001) from such symptoms during exercise. 80% of these 146 cases had an insufficient diagnostic investigation and/or were treated with medicines unsuited to their needs or even not treated at all. Of particular interest, athletes who additionally had hay fever also received inadequate treatment, even though it is well known that they are subject to enhanced bronchial irritability during the pollen season. As a rule, athletes with exercise-related respiratory problems should be advised to abstain from smoking, especially if they suffer from an atopy-like illness, such as hay fever.     

Asthma, airway inflammation and treatment in elite athletes

Highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many inhalant irritants and allergens all year round. Asthma occurs most commonly in athletes engaging in endurance events such as cross-country skiing, swimming, or long-distance running. As well as the type of training, a major risk factor is atopic disposition. A mixed type of eosinophilic and neutrophilic airway inflammation has been shown to affect elite swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a form of repeated thermal, mechanical, or osmotic airway trauma resulting in a healing or remodelling process. Elite athletes commonly use antiasthma drugs to treat exercise-induced bronchial symptoms. Only a few controlled studies have been conducted on the effects of antiasthma drugs on asthma symptoms, bronchial hyperresponsiveness and airway inflammation in elite athletes. Inhaled beta(2)-adrenoceptor agonists are effective against exercise-induced bronchospasm. In contrast, airway inflammation, bronchial hyperresponsiveness and symptoms have responded poorly to inhaled corticosteroids and leukotriene antagonists. As discontinuing high-level exercise has proved effective in reducing eosinophilic airway inflammation, exercise or training should be restricted in athletes having troublesome symptoms and sputum eosinophilia. Switching training to less irritating environments should be considered whenever possible. It appears to be difficult to change the 'natural course' of asthma in athletes by anti-inflammatory treatment.     

Creatine activates airway epithelium in asthma

Airway epithelium plays important roles in the pathophysiology of asthma. Creatine supplementation (Cr) was shown to increase asthma features in a murine model of allergic asthma; however, the role of the airway epithelium in this inflammatory response is not known. BALB/c mice were divided into control, creatine supplementation, ovalbumin-sensitized (OVA) and OVA plus creatine supplementation groups. OVA sensitization occurred on days 0, 14, 28 and 42, and ovalbumin challenge from days 21-53. Cr was also given on days 21-53. Total and differential cells counts in BALF were evaluated. Quantitative epithelial expression of interleukin (IL)-4, IL-5, IL-13, CCL11, CCL5, CCL2, iNOS, VCAM-1, ICAM-1, NF-κB, VEGF, TGF-β, IGF-1, EGFR, TIMP-1, TIMP-2, MMP-9, MMP-12 and arginase II were performed. Cr increased the number of total cells and eosinophils in BALF, the epithelial content of goblet cells and the epithelial expression of IL-5, CCL2, iNOS, ICAM-1, NF-κB, TGF-β, TIMP-1 and MMP-9 when compared to the control group (p<0.05). Creatine supplementation also exacerbated goblet cell proliferation, and IL-5 and iNOS expression by epithelial cells compared to the OVA group (p<0.01). Creatine up-regulates the pro-inflammatory cascade and remodelling process in this asthma model by modulating the expression of inflammatory mediators by epithelial cells.     

Prevalence of stress and urge urinary incontinence in elite athletes and controls

PURPOSE: The purposes of the present study were to examine the prevalence of stress and urge incontinence in female elite athletes and controls, assess a possible association between urge and stress incontinence and eating disorders, and assess a possible association between stress and urge incontinence and menstrual irregularity. METHODS: This was a two-stage study including a screening part by questionnaire and a clinical interview. Questions included in the questionnaire were related to training history, menstrual history, eating behavior, and stress and urge incontinence. DSM-IV criteria were used in the clinical part of the study to diagnose eating disorders in those classified as being at risk. The total population of female elite athletes, defined as one representing the national team for junior or senior (N = 660), and age-matched nonathlete controls (N = 765) aged 15-39 were asked to answer the questionnaire. The response rate was 87% and 75% for athletes and controls, respectively. RESULTS: Four percent of the athletes and 33% of the controls had delivered (P < 0.05). There was no significant difference in prevalence of stress urinary incontinence (SUI) in the athletes and controls, 41% and 39%, respectively. No significant difference was observed between sport groups. No difference in the frequency of urge incontinence was found when athletes (16%) and controls (19%) were compared. Twenty percent of the elite athletes and 9% of the controls met the DSM-IV criteria for eating disorder. The prevalence of SUI (49.5%) and urge incontinence (20%) in eating disordered athletes was significantly higher than in healthy athletes, 38.8% (P = 0.003) and 15% (P = 0.048). No difference in prevalence was observed when eating disordered nonathletes (39%) and healthy nonathletes (39%) were compared (P = 0.426). CONCLUSION: There is a high prevalence of stress and urge incontinence in female elite athletes. The frequency of SUI and urge incontinence was significantly higher in eating disordered athletes compared with healthy athletes.     

Prevalence of smoking among Israeli male athletes.

A survey of smoking habits was carried out on 2447 males age 14-40 years. The subjects were athletes trained in a wide variety of sports. Overall 15.5% of the athlete population were smokers. When broken down into training groups, the highest smoking prevalence was reported by subjects not engaged in specific training, while the lowest prevalence was reported by endurance trained athletes. When divided into specific sports, the highest percent of group smoking was found in soccer players. Smoking prevalence increased with increasing age. No significant differences in smoking prevalence existed between groups of varying ethnic origin. This study provides data on groups of athletes to target in smoking intervention programs.     

Cough and upper airway disorders in elite athletes: a critical review

Respiratory diseases such as asthma, chronic cough, recurrent respiratory infections and various upper airways conditions are common in elite athletes, but these conditions are often underdiagnosed and undertreated. Recurrent cough, often observed after exercise, is the most commonly reported symptom in athletes, particularly winter athletes, but it does not predict airway function; its intensity correlates with the dryness of inspired air but may not be associated with airway hyper-responsiveness. Rhinitis, either allergic or not, is highly prevalent in athletes, particularly non-allergic rhinitis in swimmers. Finally, dysfunctional breathing, including vocal cord dysfunction, may mimic or accompany asthma in a significant number of athletes. These conditions should be recognised and treated properly according to current guidelines, although how these last apply in the athlete is uncertain. Furthermore, regulatory agencies' restrictions on the type of drugs allowed for therapeutic use of these conditions in competitive athletes should be checked.     

Relationship between the airway wall area and asthma control score in moderate persistent asthma

Objectives

To assess the association between airway wall area and clinical asthma control, assessed by the Asthma Control Test (ACT).

Methods

This cross-sectional study evaluated 96 adults for asthma control [“at least well controlled” (ACT ≥ 20; n = 52) or “not well controlled” (ACT < 20; n = 44) and airway dimensions: luminal area (LA), wall area (WA) and WA%], obtained using automated dedicated software measurements from volumetric CT images. Results were analysed for segmental bronchi, subsegmental bronchi in the right upper lobe and basilar segments, both uncorrected and corrected for body surface area (BSA).

Results

For all bronchi corrected for BSA, there was no correlation between airway wall area and ACT score. There was a weak but statistically significant correlation between uncorrected WA and ACT score (r = -0.203; P = 0.047); WA values were numerically higher in the “not well-controlled” versus the “at least well-controlled asthma” subgroups. For sub-segmental bronchi, there was a correlation between the ACT score and both WA/BSA (r = -0.204; P = 0.047) and WA (r = -0.249; P = 0.014), and for upper lobe bronchi, between the ACT score and WA (r = -0.207; P = 0.044).

Conclusion

We demonstrated a correlation between subsegmental bronchial airway measurements and clinical control of asthma; this is probably a reflection of airway remodelling and structural changes in chronic poorly controlled asthma.

Key Points

? Volumetric computed tomography offers new insights into bronchial morphology. ? The relationship between current asthma control and airway wall abnormalities is assessed. ? Some relationships between airway wall area and clinical control were demonstrated. ? We observed less shape variation of bronchi in “not well-controlled” asthma patients.     

Prevalence of exercise-induced bronchospasm in a cohort of varsity college athletes

INTRODUCTION: Exercise-induced bronchospasm (EIB) occurs more commonly in elite athletes than in the general population. There have been relatively few prevalence studies examining EIB in college athletes despite studies which have shown significant morbidity from asthma attacks related to exercise occurring in athletes in this age group. None of the previous studies utilized eucapnic voluntary hyperpnea (EVH) testing, which is the currently recommended test to document EIB in Olympians. METHODS: Varsity athletes at The Ohio State University underwent EVH testing to assess for EIB. RESULTS: One hundred seven athletes from 22 sports participated. Forty-two of 107 athletes (39%) were EIB positive according to EVH results. Thirty-six of 42 EIB-positive athletes (86%) had no prior history of EIB or asthma. There were no significant differences in the prevalence of EIB according to sex of the athlete (P=0.65) or ventilation demands of the sport (P=0.64). Symptoms were not predictive of EIB (P=0.44). The prevalence of EIB was 36% in athletes with negative symptoms and 35% for those with positive symptoms. Athletes in high-ventilation sports were significantly more symptomatic (48%) than athletes in low-ventilation sports (25%) (P=0.02); however, there was no difference in the prevalence of EIB between the two groups (P=0.64). CONCLUSIONS: Varsity athletes show a high incidence of EIB when objectively diagnosed by a variety of pulmonary function criteria. Sex of the athlete or ventilation demands of the sport does not affect the prevalence of EIB. The use of symptoms to diagnose EIB is not predictive of whether athletes have objectively documented EIB. Empiric diagnosis and treatment of EIB on the basis of subjective symptoms alone may lead to an increased number of inaccurate diagnoses and increased morbidity.     

Prevalence of urinary incontinence among elite athletes of both sexes

ObjectivesTo determine the prevalence of urinary incontinence (UI) among elite athletes and to compare prevalences between sexes and across different sports modalities.MethodsThis was a cross-sectional, observational study conducted in 754 elite athletes (455 women or girls and 299 men or boys). Participants completed a questionnaire to collect self-reported anthropometric measures, medical history and sport-related data, and the questionnaires International Consultation on Incontinence Questionnaire-UI Short-Form (ICQ-UI SF), Three Incontinence Questions (3IQ) and Incontinence Severity Index (ISI).ResultsAccording to replies to the ICQ-UI SF questionnaire, 33% of the athletes had UI at a mean age of 23.75 ± 7.74 years. Prevalences were 45.1% in female compared to 14.7% male athletes (p < 0.001) such that females were 5.45 times more likely to suffer this condition. In 59.9%, incontinence was stress UI. In 30.9%, UI was described as moderate to severe (according to ISI), and quality of life related to UI was scored 4.35 ± 2.98 out of 10 (ICQ-UI SF). 22.7% reported they had experienced urine leakage while training; in 40.5% this occurred when jumping, in 19.6% while running and in 20.2% in different situations.ConclusionsThe prevalence of UI observed in elite athletes was 33%. This prevalence was greater in females and also varied according to the sport practised.