Exercise in elite summer athletes: Challenges for diagnosis
Exercise in elite summer athletes: Challenges for diagnosis
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DOI：
10.1067/mai.2002.127784
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发表时间：
2002-09-01
影响因子：
14.2
通讯作者：
Douglass, J
中科院分区：
文献类型：
--
作者：
Holzer, K;Anderson, SD;Douglass, J
背景：当诊断基于症状和药物使用时，优秀运动员中哮喘和运动性支气管收缩（EIB）的患病率很高。一些体育机构现在需要客观的测量来支持哮喘或EIB的诊断，以证明使用-受体激动剂是合理的。这些测量可以包括甲胆碱支气管刺激，干燥空气（替代运动）的呼吸急促（EVH），或两者兼而有之。目的：研究一组未入选的优秀夏季运动运动员哮喘症状、甲胆碱反应和EVH挑战之间的关系。结果将告知从业人员一个合适的客观方法来识别哮喘和EIB患者。方法：从澳大利亚墨尔本的运动队和运动医学中心招募了50名患有或不患有哮喘的优秀夏季运动运动员。所有受试者都完成了一份呼吸问卷，并在不同的日子里用甲胆碱和EVH进行支气管激发激发试验。结果：42例受试者在过去一年中报告了一种或多种呼吸道症状，9例有甲胺胆碱攻击结果阳性（平均PD20为1.69±2.05 μ mol）， 25例有EVH攻击结果阳性（平均FEV1下降25.4%±15%）。虽然所有甲基胆碱刺激结果阳性的受试者EVH刺激结果均为阳性，但甲基胆碱对EVH反应的阴性预测值仅为61%，敏感性为36%。结论：这些发现提示，优秀运动员的EIB发病机制可能与哮喘不同，因此，无论是症状还是甲胆碱激发试验都不应专门用于诊断EIB。
Background: There is a high prevalence of asthma and exercise-induced bronchoconstriction (EIB) in elite athletes when the diagnosis is based on symptoms and medication use. Objective measurements are now required by some sporting bodies to support a diagnosis of asthma or EIB to justify use of beta-agonists. Such measurements could include bronchial provocation with methacholine, with eucapnic voluntary hyperpnea (EVH) of dry air (a surrogate for exercise), or both.Objective: The aim of the study was to investigate the relationship between asthma symptoms and responses to methacholine and the EVH challenge in a group of unselected elite summer-sport athletes. The outcome would be to inform practitioners of a suitable objective approach to identifying those with asthma and EIB.Methods: Fifty elite summer-sport athletes with or without asthma were recruited from sporting teams and sports medicine centers throughout Melbourne, Australia. All subjects completed a respiratory questionnaire and, on separate days, underwent a bronchoprovocation challenge test with methacholine and EVH.Results: Forty-two subjects reported one or more respiratory symptoms in the past year, 9 had positive methacholine challenge results (mean PD20 of 1.69 +/- 2.05 mumol), and 25 had posit e EVH challenge results (mean fall in FEV1 of 25.4% +/- 15%). Although all subjects with positive methacholine challenge results had positive EVH challenge results, methacholine had a negative predictive value of only 61% and a sensitivity of 36% for identifying those responsive to EVH.Conclusion: These findings suggest that the pathogenesis of EIB in elite athletes might be different from that of asthma, and as such, neither symptoms nor the methacholine challenge test should be used exclusively for identifying EIB.