Diagnosis of bronchial hyperresponsiveness in sport by PC20 value

En este trabajo se exponen los criterios de positividad del Comité Olímpico Internacional versus a la Sociedad Española de Neumología y Cirugía Torácica. Participaron en este estudio ochenta deportistas de alto rendimiento, realizando una historia clínica, una espirometría de reposo y un test de metacolina. Se analiza la sensibilidad y especificidad del test de metacolina mediante curvas ROC. El comité Internacional antidopaje (WADA) requiere que la disminución sea con un PC20 < a 4mg/ml, mientras que para la práctica clínica este descenso debe presentar un PC20 < 8mg/ml. Los resultados fueron: 25% tuvieron un PC20 > de 8mg/ml; el 61% obtuvieron un PC20 < 4mg/ml y un 14% presentaron un PC20 entre 4 y 8mg/ml, correspondiendo el mejor punto de corte a PC20 de 7,6mg/ml con especificidad de 98,3 y sensibilidad de 100%. Se tendría que determinar los mismos criterios para el diagnóstico de los deportistas y los que no lo son.In this work criteria of the International Olympic Committee versus the Spanish Society of Pneumology and Thoracic Surgery are exposed. A study was conducted in eighty high performance athletes of several sports . Who underwent a medical history, resting spirometry and a methacholine challenge test. You get the sensitivity and specificity of methacholine challenge test using Receiver Operating Curves (ROC curves). International anti-doping Committee requires that the decline is a PC20 < 4mg/ml, while clinical practice this fall must submit a PC20 < 8mg/ml. Twenty five percent of those studied had a PC20 > of 8mg/ml, 61% had a PC20 < 4mg/ml and 14% had a 4 to 8mg/ml PC20. The best cutoff point was found for a PC20 of 7.6 mg/ml with a specificity of 98.3 and a sensitivity of 100%. It would have to determine the same criteria for positive diagnosis of athletes and those who are not

The Effect of 400 µg Inhaled Salbutamol on 3 km Time Trial Performance in a Low Humidity Environment.

The Objectives of the study were to investigate whether 400 µg inhaled salbutamol influences 3 km running time-trial performance and lung function in eucapnic voluntary hyperpnoea positive (EVH+ve) and negative (EVH-ve) individuals. Fourteen male participants (22.4 ± 1.6yrs; 76.4 ± 8.7kg; 1.80 ± 0.07 m); (7 EVH+ve; 7 EVH-ve) were recruited following written informed consent. All participants undertook an EVH challenge to identify either EVH+ve (↓FEV1>10%) or EVH-ve (↓FEV110% from baseline) in FEV1 following any time-trial. Administration of 400µg inhaled salbutamol does not improve 3 km time-trial performance in either mild EVH+ve or EVH-ve individuals despite significantly increased HR and FEV1

Screening elite winter athletes for exercise induced asthma: A comparison of three challenge methods

The official published version can be obtained from the link below.Background: The reported prevalence of exercise induced asthma (EIA) in elite winter athletes ranges from 9% to 50%. Many elite winter athletes do not report symptoms of EIA. At present there is no gold standard test for EIA. Objective: To establish the efficacy of screening for EIA and examine the role of the eucapnic voluntary hyperventilation (EVH) challenge and laboratory based and sport specific exercise challenges in the evaluation of elite winter athletes. Methods: 14 athletes (mean (SD) age 22.6 (5.7) years, height 177.2 (7.0) cm, body mass 68.9 (16.9) kg) from the Great Britain short-track speed skating (n=10) and biathlon teams (n=4) were studied. Each athlete completed a laboratory based and sport specific exercise challenge as well as an EVH challenge, in randomised order. Results: All 14 athletes completed each challenge. Two had a previous history of asthma. Ten (including the two with a previous history) had a positive test to at least one of the challenges. Ten athletes had a positive response to EVH; of these, only three also had a positive response to the sport specific challenge. No athletes had a positive response to the laboratory based challenge. Conclusions: Elite athletes should be screened for EIA. EVH is a more sensitive challenge in asymptomatic athletes than sport specific and laboratory based challenges. If sporting governing bodies were to implement screening programmes to test athletes for EIA, EVH is the challenge of choice

The Impact of Inhaled Salbutamol on Repeated Sprint Ability in Pre- Fatigued Soccer Players

Objectives: Investigate the ergogenic effect of inhaling up to 1600 μg of salbutamol on intermittent running performance in pre-fatigued soccer players. Methods: In a single blind randomised repeated measures design seven male and six female soccer players volunteered to participant. All participants were regularly playing competitive soccer and had no history of asthma. Following familiarisation sessions participants visited the exercise physiology laboratory on three occasions to complete an intermittent running protocol followed by twelve 17.5 m sprints. Prior to each trial participants inhaled either: placebo, 800 μg inhaled salbutamol (SAL800) or 1600 μg inhaled salbutamol (SAL1600). Following completion of the sprints a sample from the first urine passed was analysed for salbutamol concentration. A repeated measures ANOVA was used to compare the mean sprint time, maximal sprint power, peak blood lactate post sprints and post sprint salbutamol urine concentration between conditions. Results: Mean sprint time, maximum power, maximum velocity, peak HR and peak blood lactate during the 17.5 m sprints were not significantly different between treatments in soccer players. There was no significant difference between male and female players in urine drug concentration following SAL800 (mean + SD; 201.47 + 294.47 ng.ml-1 vs. 180.2 + 102.15 ng.ml-1) or SAL1600 (739.24 + 549.21 ng.ml-1 vs. 879.58 + 633.14 ng.ml-1). Three players urine drug concentrations were above the WADA decision limit set at 1200 ng.ml-1. Conclusions: Inhaling up to 1600 μg inhaled salbutamol did not significantly improve repeated sprint performance. However, inhalation of 1600 μg may result in a urine concentration above the current WADA upper limit and decision limit leading to a positive test. Athletes should ensure they use inhaled salbutamol at therapeutic doses to avoid the risk of breaching the WADA decision limit

Impact of exercise-induced bronchoconstriction on athletic performance and airway health in rugby union players

Background: There is emerging evidence that the prevalence of exercise-induced bronchospasm (EIB) is significantly under-reported in many sports. There is little known about the potential performance improvement that may exist when sports players are detected and treated for EIB. Methods: Professional rugby union players with no previous history of asthma volunteered to participate in the study. Each player performed the rugby football union (RFU) fitness test and completed a eucapnic voluntary hyperpnoea (EVH) challenge at baseline and 12 weeks later. A player with a positive EVH result was prescribed beclomethasone inhaler (200 µg; two puffs per day) for 12 weeks. Players with a negative EVH test were randomly allocated to either a placebo inhaler group or acted as controls. Results: Twenty-nine rugby union players (mean ± SD; age 22.1 ± 4.2 years; body mass 100.1 ± 6.9 kg; height 1.84 ± 0.07 m) were recruited. Seven players (24% of total) had a positive EVH challenge with a mean decrease in FEV1 of -13.6 ±3.5 % from baseline. There was no significant group difference (P=0.359)in performance improvement of the RFU fitness test between the EVH positive group (mean ?: -22.3 seconds; 8.0 ± 2.8% improvement), placebo group (mean ?: -16.5 seconds; 6.7 ± 1.6% improvement), and controls (mean ?: -12.2 seconds; 5.7 ± 3.5% improvement). Conclusion: Prevalence of EIB in professional rugby union players was 24%. A 12-week prescription of beclomethasone (200 µg) showed similar improvements in RFU fitness test performance in players diagnosed with EIB compared to players with healthy airway responsiveness

Asthma in elite athletes: Who cares?

Asthma or exercise-induced bronchoconstriction (EIB) is highly prevalent in athletes and if untreated has the potential to impact on their health and performance. The condition can be diagnosed and managed effectively yet there is concern that the care afforded to elite athletes with this condition is often sub-optimal. In this respect, it is apparent that more could be done to protect athletes from developing airway dysfunction (e.g. by reducing exposure to irritant environments); that the diagnosis of asthma in athletes is often made without secure objective evidence and that athletes may be advised to reduce activity levels in order to improve symptoms. Moreover there appears to be poor surveillance of airway health in athletes when a diagnosis of asthma has been made. Overall this raises the question of who cares about athletes with asthma? The article that follows presents the case of why this is an important clinical area for physicians. The review provides an overview of asthma in athletes with the overall aim of ensuring that respiratory health in this unique population is optimised

Salbutamol effects on systemic potassium dynamics during and following intense continuous and intermittent exercise

Purpose: Salbutamol inhalation is permissible by WADA in athletic competition for asthma management and affects potassium regulation, which is vital for muscle function. Salbutamol effects on arterial potassium concentration ([K+]a) during and after high-intensity continuous exercise (HIcont) and intermittent exercise comprising repeated, brief sprints (HIint), and on performance during HIint are unknown and were investigated. Methods: Seven recreationally active men participated in a double-blind, randomised, cross-over design, inhaling 1000 µg salbutamol or placebo. Participants cycled continuously for 5 min at 40 % V ˙ O2peak and 60 % V ˙ O2peak, then HIcont (90 s at 130 % V ˙ O2peak), 20 min recovery, and then HIint (3 sets, 5 × 4 s sprints), with 30 min recovery. Results: Plasma [K+]a increased throughout exercise and subsequently declined below baseline (P < 0.001). Plasma [K+]a was greater during HIcont than HIint (P < 0.001, HIcont 5.94 ± 0.65 vs HIint set 1, 4.71 ± 0.40 mM); the change in [K+]a from baseline (Δ[K+]a) was 2.6-fold greater during HIcont than HIint (P < 0.001). The Δ[K+] throughout the trial was less with salbutamol than placebo (P < 0.001, treatment main effect, 0.03 ± 0.67 vs 0.22 ± 0.69 mM, respectively); and remained less after correction for fluid shifts (P < 0.001). The Δ[K+] during HIcont was less after salbutamol (P < 0.05), but not during HIint. Blood lactate, plasma pH, and the work output during HIint did not differ between trials. Conclusions: Inhaled salbutamol modulated the [K+]a rise across the trial, comprising intense continuous and intermittent exercise and recovery, lowering Δ[K+] during HIcont. The limited [K+]a changes during HIint suggest that salbutamol is unlikely to influence systemic [K+] during periods of intense effort in intermittent sports

Eucapnic Voluntary Hyperpnea: Gold Standard for Diagnosing Exercise-Induced Bronchoconstriction in Athletes?

In athletes, a secure diagnos is of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Evaluating spirometric indices of airflow before and following an exercise bout is intuitively the optimal means for the diagnosis; however, this approach is recognized as having several key limitations. Accordingly, alternative indirect bronchoprovocation tests have been recommended as surrogate means for obtaining a diagnosis of EIB. Of these tests, it is often argued that the eucapnic voluntary hyperpnea (EVH) challenge represents the ‘gold standard’. This article provides a state-of-the-art review of EVH, including an overview of the test methodology and its interpretation. We also address the performance of EVH against the other functional and clinical approaches commonly adopted for the diagnosis of EIB. The published evidence supports a key role for EVH in the diagnostic algorithm for EIB testing in athletes. However, its wide sensitivity and specificity and poor repeatability preclude EVH from being termed a ‘gold standard’ test for EIB

Aerobic performance among healthy (non-asthmatic) adults using beta2-agonists: a systematic review and meta-analysis of randomised controlled trials

I Brage finner du siste tekst-versjon av artikkelen, og den kan inneholde ubetydelige forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på bjsm.bmj.com / In Brage you'll find the final text version of the article, and it may contain insignificant differences from the journal's pdf version. The definitive version is available at bjsm.bmj.comObjective: To examine the effect of beta2-agonists on aerobic performance in healthy, non-asthmatic study participants. Design: Systematic review and meta-analysis. Eligibility criteria: We searched four databases (PubMed, Embase, SPORTDiscus and Web of Science) for randomised controlled trials published until December 2019. Studies examining the effect of beta2-agonists on maximal physical performance lasting longer than 1 min were included in the meta-analysis. Data are presented as standardised difference in mean (SDM) with 95% CI. Results: The present meta-analysis includes 47 studies. The studies comprise 607 participants in cross-over trials, including 99 participants in three-way cross-over trials and 27 participants in a four-way cross-over trial. Seventy-three participants were included in parallel trials. Beta2-agonists did not affect aerobic performance compared with placebo (SDM 0.051, 95% CI −0.020 to 0.122). The SDM for the included studies was not heterogeneous (I2=0%, p=0.893), and the effect was not related to type of beta2-agonist, dose, administration route, duration of treatment or performance level of participants. Beta2-agonists had no effect on time trial performance, time to exhaustion or maximal oxygen consumption (p<0.218). Conclusion/implication: The present study shows that beta2-agonists do not affect aerobic performance in non-asthmatic subjects regardless of type, dose, administration route, duration of treatment or performance level of participants. The results of the present study should be of interest to WADA and to anyone who is interested in equal opportunities in competitive sports.acceptedVersionInstitutt for idrettsmedisinske fag / Department of Sports Medicin

Can β2-agonists have an ergogenic effect on strength, sprint or power performance? Systematic review and meta-analysis of RCTs

Author's accepted manuscript version. This article has been accepted for publication in British Journal of Sports Medicine 2020 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/bjsports-2019-100708Objectives: We aimed to examine the effect of β2-agonists on anaerobic performance in healthy non-asthmatic subjects. Design: Systematic review and meta-analysis. Eligibility criteria: We searched four databases (PubMed, Embase, SPORTDiscus and Web of Science) for randomised controlled trials, published until December 2019, examining the effect of β2-agonists on maximal physical performance lasting 1 min or shorter. Data are presented as standardised difference in mean (SDM) with 95% confidence intervals (95% CI). Results: 34 studies were included in the present meta-analysis. The studies include 44 different randomised and placebo-controlled comparisons with β2-agonists comprising 323 participants in crossover trials, and 149 participants in parallel trials. In the overall analyses, β2-agonists improved anaerobic performance by 5% (SDM 0.29, 95% CI 0.16 to 0.42), but the effect was related to dose and administration route. In a stratified analysis, the SDM was 0.14 (95% CI 0.00 to 0.28) for approved β2-agonists and 0.46 (95% CI 0.24 to 0.68) for prohibited β2-agonists, respectively. Furthermore, SDM was 0.16 (95% CI 0.02 to 0.30) for inhaled administration and 0.51 (95% CI 0.25 to 0.77) for oral administration, respectively, and 0.20 (95% CI 0.07 to 0.33) for acute treatment and 0.50 (95% CI 0.20 to 0.80) for treatment for multiple weeks. Analyses stratified for the type of performance showed that strength (0.35, 95% CI 0.15 to 0.55) and sprint (0.17, 95% CI 0.06 to 0.29) performance were improved by β2-agonists. Conclusion/implication: Our study shows that non-asthmatic subjects can improve sprint and strength performance by using β2-agonists. It is uncertain, however, whether World Anti-Doping Agency (WADA)-approved doses of β2-agonists improve performance. Our results support that the use of β2-agonists should be controlled and restricted to athletes with documented asthma.acceptedVersio