Detection Of Respiratory Illness In Athletes Of The University Of The Free State Through A Periodic Health Evaluation With And Without Spirometry
Background - Exercise-induced bronchospasm (EIB) is a common medical condition which can have devastating complications, particularly in otherwise healthy active athletes. Since EIB is unpredictable but preventable, medical personnel and coaches are often the primary support givers in such events and need not be informed about the risk factors and proper management of the athlete with this, sometimes undiagnosed, respiratory problem. The periodic health evaluation (PHE) is mandatory in some, but not all, sports and covers a few basic questions regarding the athlete’s respiratory health.
Objectives - To determine the prevalence of underlying respiratory disease in a population of varsity level athletes. In addition, the study aimed to test whether the addition of a specific tool would increase the sensitivity of the PHE as it is implemented by the International Olympic Committee (IOC), therefore investigating if spirometry before and after an exercise challenge would diagnose any new athletes with exercise-induced bronchospasm (EIB).
Methods - Thirty-two participants met the inclusion criteria. Periodic health evaluations were done to enquire about a detailed history from the athletes and physical examination with special attention to the respiratory system. Baseline spirometry followed by an exercise challenge test and serial post-exercise spirometries were done on all the participants according to the guidelines provided by the American Thoracic Society.
Results - The results of this study confirmed that a thorough history and clinical examination alone do not lead to the diagnosis of EIB. Furthermore, we conclude that a resting baseline spirometry does not indicate that an athlete is at risk for, or, has EIB. In the absence of eucapnic voluntary hyperpnea (EVH) as the preferred challenge test according to the International Olympic Committee-Medical Commission (IOC-MC), an exercise challenge test will be as valuable. Almost 10% of the athletes in our study, which were healthy according to the PHE and baseline spirometry, had a positive spirometry for EIB after an exercise challenge test as indicated by a fall of ≥ 10% from the baseline forced expiratory volume in one second (FEV1).
Conclusion - As the aim of a PHE is to assure safe sports participation, proper identification and treatment of athletes with EIB should be implemented. Our study confirms that clinical assessment alone is not of significant predictive value and another tool such as serial post-exercise spirometry is necessary to identify the athletes with unrecognized EIB. The addition of a standardized exercise challenge followed by serial spirometries to all participants will in fact have a very positive impact on the current medical care of the athletes.
Keywords - Exercise-induced bronchospasm (EIB); Spirometry; Exercise challenge test; Periodic Health Evaluation (PHE); International Olympic Committee-Medical Commission (IOC-MC)