The Director of UP SEMLI, Prof Martin Schwellnus, lead a team of international collaborators in formulating an International Olympic Committee (IOC) Consensus Statement on acute respiratory illness in athletes. This Consensus aimed to provide the Sport and Exercise Medicine (SEM) clinician with an overview and practical clinical approach to acute respiratory infections (ARinf) (Part 1) and non-infective acute respiratory illness (ARill) (Part 2) in athletes. Acute illnesses affecting the respiratory tract are common and form a significant component of the work of SEM clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf).

Part 1 of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines. The key points highlighted in the paper include:

• Acute illnesses account for up to ~50% of all medical consultations at major sporting events, with ~50% of all acute illnesses involving the respiratory system.
• Acute respiratory infections (ARinf) account for most of the acute respiratory illnesses in athletes and are caused primarily by viruses.
• ARinf involve predominantly the upper airways and two clinical syndromes (ie, acute viral rhinitis/rhinosinusitis with or without systemic symptoms) are responsible for most ARinf in athletes.
• Sport and Exercise Medicine clinicians can implement a practical clinical approach to the diagnosis, management, return-to-sport decision making and prevention of ARinf in athletes.

Part 2 of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/ pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines. The authors highlight the following key points in the second part on this Consensus:

• Acute illness accounts for up to ~50% of all medical consultations at major sporting events with ~50% of cases involving the respiratory system.
• Acute respiratory illness (ARill) includes acute respiratory infections and non-infective ARill.
• Causes of non-infective ARill in athletes can involve predominantly the upper (eg, structural nasal obstruction, acute allergic and nonallergic rhinitis/rhinosinusitis and exerciseinduced laryngeal obstruction) or the lower airways (lower airway dysfunction and rarer conditions such as excessive dynamic airway collapse) and tracheobronchomalacia).
• In this consensus, we provide the Sport and Exercise Medicine clinician with an overview and practical clinical approach to the diagnosis, management, return-to-sport decision-making and prevention of these non-infective causes of ARill in athletes.

Excerpts from and summary of the following references:

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections. Martin Schwellnus, Paolo Emilio Adami, Valerie Bougault, Richard Budgett, Hege Havstad Clemm, Wayne Derman, Uğur Erdener, Ken Fitch, James H Hull, Cameron McIntosh, Tim Meyer, Lars Pedersen, David B Pyne, Tonje Reier-Nilsen, Wolfgang Schobersberger, Yorck Olaf Schumacher, Nicola Sewry, Torbjørn Soligard, Maarit Valtonen, Nick Webborn, Lars Engebretsen.  Br J Sports Med Epub ahead of print doi:10.1136/ bjsports-2022-105759

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness.  Martin Schwellnus, Paolo Emilio Adami, Valerie Bougault, Richard Budgett, Hege Havstad Clemm, Wayne Derman, Uğur Erdener, Ken Fitch, James H Hull, Cameron McIntosh, Tim Meyer, Lars Pedersen, David B Pyne, Tonje Reier-Nilsen, Wolfgang Schobersberger, Yorck Olaf Schumacher, Nicola Sewry, Torbjørn Soligard, Maarit Valtonen, Nick Webborn, Lars Engebretsen.  Br J Sports Med Epub ahead of print. doi:10.1136/ bjsports-2022-105567