« Previous Next »The Journal of Allergy and Clinical Immunology
Volume 122, Issue 2 , Pages 254-260.e7, August 2008

Asthma and the elite athlete: Summary of the International Olympic Committee's Consensus Conference, Lausanne, Switzerland, January 22-24, 2008

Kenneth D. Fitch, MBBS, MD
- School of Sports Science, Exercise and Health, Faculty of Life Sciences, University of Western Australia, Crawley, Australia
- Reprint requests: Kenneth D. Fitch, MBBS, MD, School of Sports Science, Exercise and Health, Faculty of Life Sciences, University of Western Australia, M408 Crawley, Western Australia.
Malcolm Sue-Chu, MBChB, PhD
- Department of Lung Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
- Department of Circulation and Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Sandra D. Anderson, PhD, DSc
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
Louis-Philippe Boulet, MD, FCCP, FRCPC
- Institut de Cardiologie et de Pneumologie de l'Université Laval, Hôpital Laval, Laval, Québec, Canada
Robert J. Hancox, MBChB, MD
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
Donald C. McKenzie, MD, PhD
- Division of Sports Medicine and the School of Human Kinetics, University of British Columbia, Vancouver, British Columbia, Canada
Vibeke Backer, MD, DMSci
- Department of Respiratory Medicine L, Bispebjerg University Hospital, Copenhagen, Denmark
Kenneth W. Rundell, PhD
- Human Physiology Laboratory, Marywood University, Scranton, Pa
Juan M. Alonso, MD
- Medical Department, Royal Spanish Athletics Federation, Madrid, Spain
- Medical and Anti-Doping Commission, International Association of Athletics Federations, Monaco
Pascale Kippelen, PhD
- School of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom
Joseph M. Cummiskey, MD
- Respiratory Medicine, Blackrock Clinic, Dublin, Ireland
Alain Garnier, MD
- World Anti-Doping Agency, Lausanne, Switzerland
Arne Ljungqvist, MD, PhD
- Medical Commission, International Olympic Committee, Lausanne, Switzerland

Received 7 March 2008; received in revised form 3 July 2008; accepted 3 July 2008.

Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled β2-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to β2-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale β2-agonists will continue.

Key words: Respiratory symptoms, exercise-induced bronchoconstriction, asthma, β2-agonists, airway hyperresponsiveness, bronchial provocation, Olympic Games, endurance training, environment

Abbreviations used: AHR, Airway hyperresponsiveness, ASM, Airway smooth muscle, ATUE, Abbreviated Therapeutic Use Exemption, BPT, Bronchial provocation test, EIB, Exercise-induced bronchoconstriction, EVH, Eucapnic voluntary hyperpnea, IAAF, International Association of Athletics Federations, ICS, Inhaled corticosteroid, IOC, International Olympic Committee, ISAAC, International Study on Asthma and Allergies in Childhood, PM, Particulate matter, WADA, World Anti-Doping Agency

Consensus Conference supported by the International Olympic Committee.

Disclosure of potential conflict of interest: K. D. Fitch is a member of the International Olympic Committee (IOC) Medical Commission and chair of the IOC Independent Asthma Panel. M. Sue-Chu is on the Advisory Board of Novartis and GlaxoSmithKline, has delivered lectures funded by AstraZeneca, has participated in a clinical trial funded by Novartis, and is a member of the IOC Independent Asthma Panel. S. D. Anderson invented the mannitol test for Pharmaxis Ltd and is a member of the IOC Independent Asthma Panel. L.-P. Boulet has received sponsorship or funding from AstraZeneca, GlaxoSmithKline, Merck Frosst, Schering-Plough, Novartis, Alexion, AsthmaTx, Boehringer-Ingelheim, Ception, Genentech, IVAX, MedImmune, Topigen, and Wyeth. D. C. McKenzie has received research funding from the World Anti-Doping Agency and is a member of the IOC Independent Asthma Panel. V. Backer has received research funding from Pharmaxis Ltd and the Danish Lung Association and is a member of the Advisory Board of MSD, Novartis, ALK-Abelló, AstraZeneca, and GlaxoSmithKline. K. W. Rundell has delivered lectures sponsored by Merck and has received research funding from the World Anti-Doping Agency, Pharmaxis, SkyPharma, and Forest Research. P. Kippelen has received research funding from the British Olympic Association and is a member of the IOC Independent Asthma Panel. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(08)01305-5

doi:10.1016/j.jaci.2008.07.003

« Previous Next »The Journal of Allergy and Clinical Immunology
Volume 122, Issue 2 , Pages 254-260.e7, August 2008