The prevalence of lower airway dysfunction in athletes

Posted on November 01, 2021

Lower airway dysfunction, which includes asthma and/or exercise-induced bronchoconstriction [EIB] and/or airway hyper-responsiveness [AHR], is often cited as the most common chronic medical condition in athletes.  It is now recognised that high-intensity exercise leads to a shift from nasal to predominantly oral breathing; thus ‘bypassing’ the upper airway (nasal and nasopharyngeal) protective structures and exposing the lower airways to significant physical, thermal and/or chemical stress. This can precipitate acute lower airway narrowing in susceptible individuals, leading to respiratory symptoms, such as cough, wheeze and dyspnea.

The IOC (International Olympic Committee) Consensus Group on “acute respiratory illness in the athlete”, which included representatives from SEMLI, published a systematic review and meta-analysis in which they reported that lower airway dysfunction affects approximately one in five endurance athletes across a broad range of sporting disciplines and abilities.  The highest prevalence was observed in elite endurance athletes at 25.1%, those participating in aquatic sports (39.9%) and winter-based sporting disciplines (29.5%). The review included 64 studies (37 643 athletes) from over 21 countries (81.3% European and North America) and the Group concluded that further longitudinal, multicentre studies remain an important priority for future research. These should address causality (i.e. training status/dose-response relationship) and evaluate preventative strategies to mitigate against the development of lower airway dysfunction.


Reference for this article:

Oliver J Price, Nicola Sewry, Martin Schwellnus, Vibeke Backer, Tonje Reier-Nilsen, Valerie Bougault, Lars Pedersen, Bruno Chenuel, Kjell Larsson, James H Hull. Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on 'acute respiratory illness in the athlete'. Br J Sports Med 2021 Dec 6; bjsports-2021-104601.


Published by Jill Borresen

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