Asthma in elite athletes

There is a high prevalence of asthma among elite performance athletes, particularly those who train and compete with high ventilation rates in austere environments, such as cross country skiers and swimmers. How best to assess, diagnose, and treat asthma or exercise-induced bronchoconstriction (EIB) in athletes remains controversial. The underlying high cardiorespiratory fitness levels of athletes make the diagnostic process more complex as do a variety of both common and rare alternative diagnoses that must be considered. To add to this, the pathophysiology of EIB in athletes is believed to differ significantly from the exercise-induced asthma seen in clinical patients, with less allergic inflammation and less steroid responsive airways pathology. This review aims to examine the underlying differences in EIB and exercise-induced asthma, to discuss diagnostic testing, and to look at the evidence that suggests how we should direct management and therapy. This discussion raises a number of questions about the diagnosis and treatment of airways symptoms in athletes, and it also suggests how future research should be targeted to answer these questions. Copyright © 2010 by Lippincott Williams & Wilkins.