Self-reported symptoms and exercise-induced asthma in the elite athlete

Purpose: The purpose of this study was to compare self-reported symptoms fo r exercise-induced asthma (EIA) to postexercise challenge pulmonary functio n test results in elite athletes. Methods: Elite athletes (N = 158; 83 men and 75 women; age: 22 +/- 4.4 yr) performed pre- and post-exercise spiromet ry and were grouped according to postexercise pulmonary function decrements (PFT-positive, PFT-borderline. and PFT-normal for EIA). Before the sport/e nvironment specific exercise challenge, subjects completed an EIA symptoms- specific questionnaire. Results: Resting FEV1 values were above predicted v alues (114-121%) and not different between groups. Twenty-six percent of th e study population demonstrated >10% postexercise drop in FEV1 and 29% repo rted two or more symptoms. However, the proportion of PFT-positive and PFT- normal athletes reporting two or more symptoms was nor different (39% vs. 4 1%). Postrace cough was the most reported symptom, reported significantly m ore frequently for PFT-positive athletes (P < 0.05). Sensitivity/specificit y analysis demonstrated a lack of effectiveness of self-reported symptoms t o identify PFT-positive or exclude PFT-normal athletes. Postexercise lower limit reference ranges (MN-2SDs) were determined from normal athletes for F EV1, FEF25-75% and PEF to be -7%, -12.5%, and -18%, respectively. Conclusio n: Although questionnaires provide reasonable estimates of ELA prevalence a mong elite cold-weather athletes, the use of self-reported symptoms for EIA diagnosis in this population will likely yield high frequencies Of both fa lse positive and false negative results. Diagnosis should include spirometr y using an exercise/environment specific challenge in combination with the athlete's history of asthma symptoms.