The prevalence of reversible airway obstruction in professional football players

General Medical Emergencies in Athletes

This article focuses on the management of the most common on-field medical emergencies. As with any discipline in medicine, a well-defined plan and systematic approach is the cornerstone of quality health care delivery. In addition, the team-based collaboration is necessary for the safety of the athlete and the success of the treatment plan.

Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on 'acute respiratory illness in the athlete'

OBJECTIVE

To report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020).

ELIGIBILITY CRITERIA

Original full-text studies, including male or female athletes/physically active individuals/military personnel (aged 15-65 years) who had a prior asthma diagnosis and/or underwent screening for lower airway dysfunction via self-report (ie, patient recall or questionnaires) or objective testing (ie, direct or indirect bronchial provocation challenge).

RESULTS

In total, 1284 studies were identified. Of these, 64 studies (n=37 643 athletes) from over 21 countries (81.3% European and North America) were included. The prevalence of lower airway dysfunction was 21.8% (95% CI 18.8% to 25.0%) and has remained stable over the past 30 years. The highest prevalence was observed in elite endurance athletes at 25.1% (95% CI 20.0% to 30.5%) (Q=293, I²=91%), those participating in aquatic (39.9%) (95% CI 23.4% to 57.1%) and winter-based sports (29.5%) (95% CI 22.5% to 36.8%). In studies that employed objective testing, the highest prevalence was observed in studies using direct bronchial provocation (32.8%) (95% CI 19.3% to 47.2%). A high degree of heterogeneity was observed between studies (I²=98%).

CONCLUSION

Lower airway dysfunction affects approximately one in five athletes, with the highest prevalence observed in those participating in elite endurance, aquatic and winter-based sporting disciplines. Further longitudinal, multicentre studies addressing causality (ie, training status/dose-response relationship) and evaluating preventative strategies to mitigate against the development of lower airway dysfunction remain an important priority for future research.

Allergies and Exercise-Induced Bronchoconstriction in a Youth Academy and Reserve Professional Soccer Team

OBJECTIVES

A high prevalence of respiratory allergies and exercise-induced bronchoconstriction (EIB) has been reported among endurance athletes. This study was designed to analyze the frequency of sensitization to respiratory allergens and EIB in young soccer players.

DESIGN

Prospective cohort design.

SETTING

Youth academy and reserve professional soccer team during the seasons 2012 to 2013 and 2013 to 2014.

PARTICIPANTS

Eighty-five soccer players (mean age: 20 ± 4 years) participated.

INTERVENTION

Players underwent skin prick tests (SPTs) during the seasons 2012 to 2013 and 2013 to 2014. Spirometry and a eucapnic voluntary hyperpnea test were performed on soccer players during the first season 2012 to 2013 (n = 51) to detect EIB. Two self-administered questionnaires on respiratory history and allergic symptoms (European Community Respiratory Health Survey and Allergy Questionnaire for Athletes) were also distributed during both seasons (n = 59).

MAIN OUTCOME MEASURES

The number of positive SPTs, exercise-induced respiratory symptoms, presence of asthma, airway obstruction, and EIB.

RESULTS

Forty-nine percent of players were sensitized to at least one respiratory allergen, 33% reported an allergic disease, 1 player presented airway obstruction at rest, and 16% presented EIB. Factors predictive of EIB were self-reported exercise-induced symptoms and sensitization to at least 5 allergens.

CONCLUSIONS

Questioning players about exercise-induced respiratory symptoms and allergies as well as spirometry at the time of the inclusion medical checkup would improve management of respiratory health of soccer players and would constitute inexpensive preliminary screening to select players requiring indirect bronchial provocation test or SPTs.

CLINICAL RELEVANCE

This study showed that despite low frequencies, EIB and allergies are underdiagnosed and undertreated in young soccer players.

Comparative Study of Bronchial Hyperresponsiveness Between Football and Judo Groups in Prepubertal Boys

BACKGROUND

Exercise induced bronchospasm (EIB) commonly occurs during exercise. The comparative effects of different sports on airway responsiveness among prepubertal boys remain to be determined.

OBJECTIVES

To assess differences in post exercise spirometry between footballers, judokas and a control group in prepubertal boys.

PATIENTS AND METHODS

A total of ninety six prepubertal boys were studied. Bronchial hyper responsiveness (BHR) to exercise challenge test was defined by a diagnosis of baseline spirometry, followed by an incremental exercise test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity exercise. A 10% or greater post-challenge fall in forced expiratory volume in FEV1 is used as a diagnostic criterion.

RESULTS

There was no significant difference in baseline spirometry between all groups (P > 0.05). The post exercise spirometry test revealed the presence of EIB in 16 of 32 (50%) footballers against 9 out of 32 (28.12%) in both judokas and control subjects at 5 min after the exercise. Also, there was a significantly higher decrease (P < 0.05) in mean FEV1 at 5 minuts in footballers (-9.60 ± 6.18) compared to judokas (-5.41 ± 5.85).

CONCLUSIONS

The footballers have more BHR than judokas, especially at 5min after the exercise. This may be due to prolonged hyperventilation, atopy and increased exposure to inhaled allergens and pollutants during training and competition.

The health profile of football/soccer players in Northern Ireland - a review of the uefa pre-participation medical screening procedure

Background

It is compulsory that domestic football/soccer teams in UEFA competitions organise players’ pre-participation medicals. Although screening guidelines have been established, these remain controversial. The findings of medical examinations can have lasting consequences for athletes and doctors. No previous studies have reported UEFA pre-participation screening results in semi-professional footballers. This study aims to further knowledge regarding ‘normal’ data in this population.

Method

Retrospective audit and analysis of records of pre-season medicals for all male first-team players at one semi-professional Northern Ireland Premiership team between 2009-2012. Medicals were conducted by the club doctor following the UEFA proforma. Height, weight, blood pressure (BP), full blood count (FBC), dipstick urinalysis and resting electrocardiogram (ECG) were conducted by an independent nurse. Only one ECG must be documented during a player’s career; other tests are repeated yearly.

Results

89 medicals from 47 players (6 goalkeepers, 11 defenders, 22 midfielders and 8 attackers; mean age 25.0 years (SD 4.86)) were reviewed. Mean height of the players was 179.3 cm (SD 5.90) with a mean weight of 77.6 kg (SD 10.5). Of 89 urine dipsticks, 7 were positive for protein; all 7 were normal on repeat testing following 48 hours of rest. Of 40 ECGs (mean ventricular rate 61.2 bpm (SD 11.6)), one was referred to cardiology (right bundle branch block; prolonged Q-T interval). No players were excluded from participation.

Conclusions

This study provides important information about ‘normal’ values in a population of semi-professional footballers. Urinalysis showing protein is not uncommon but is likely to be normal on repeat testing.

Prevalence of exercise-induced bronchoconstriction in teenage football players in Tunisia

BACKGROUND AND OBJECTIVES

Studies on exercise-induced bronchoconstriction (EIB) in team sports are lacking. The aim of this study was to screen for EIB among amateur teenage football players in Tunisia and to compare EIB prevalence between regions.

METHODS

One hundred ninety-six male football players (mean age [SD], 13.5 [0.5] yrs), practicing in three different cities of Tunisia (Tunis, Sousse and Sfax), underwent an outdoor free run of 7 minutes. Forced expiratory volume in one second (FEV subset1) was recorded prior to and at 0, 3, 5, 10, 15, 20 and 30 minutes after the run. Players were screened for EIB positivity defined as a greater than 10% decline in FEV subset1 from the resting value at any timepoint.

RESULTS

FEV1 decreased more than 10% in 30% of the players. EIB positivity was more common in Sfax (15.8%) than in Tunis (7.7%) (P=.03). Air humidity during the study was higher in Tunis.

CONCLUSION

EIB is prevalent among amateur teenage football players in Tunisia. The prevalence differs between regions and seems to be dependent on air humidity levels.

Sensitization, asthma and allergic disease in young soccer players

BACKGROUND

The aim of this study was to identify the prevalence of allergic disease in young soccer players compared to age-matched students and to evaluate if this prevalence changes as the intensity of training increases.

METHODS

A modified ECRHS questionnaire was administered to 194 soccer players divided by age as Beginners (8-11 years), Juniors (12-16 years) and Under 21 (17-20 years) to evaluate the prevalence of allergic diseases and symptoms as well as drug consumption. Subjects with a positive personal history of allergic diseases underwent skin prick and/or patch tests. Age-matched students (n = 136) were used as a control group.

RESULTS

The prevalence of allergic diseases was 34.5% in soccer players and 31.6% in control subjects (n.s.). Skin sensitization to inhalant allergens was detected in 14.4% of symptomatic soccer players and in 19.2% of control students (n.s.). Patch tests were positive in 35.7% of soccer players and 23.0% of controls with allergic dermatitis (n.s.). The prevalence of allergic diseases did not significantly change in relation to the intensity of training. Although the relative prevalence of sensitization to perennial allergens and asthma was less frequent in soccer players than in controls, and the occurrence of exercise-induced bronchoconstriction was similar in the two groups, soccer players used twice as many anti-allergic and anti-asthmatic drugs as control students.

CONCLUSIONS

An increasingly intensive training programme is not associated with greater risk of allergic disease in soccer players. Therapy regimens of allergic athletes and exercisers should be monitored more closely to guarantee adequate treatment yet avoid inappropriate drug use and doping practices.

Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN

AIMS

To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features of these conditions and to make recommendations for their diagnosis.

METHODS

The Task Force reviewed present literature by searching Medline up to November 2006 for relevant papers by the search words: asthma, bronchial responsiveness, EIB, athletes and sports. Sign criteria were used to assess level of evidence and grades of recommendation.

RESULTS

The problems of sports-related asthma and allergy are outlined. Epidemiological evidence for an increased prevalence of asthma and BHR among competitive athletes, especially in endurance sports, is provided. The mechanisms for development of asthma and bronchial hyperresponsiveness in athletes are outlined. Criteria are given for the diagnosis of asthma and exercise induced asthma in the athlete.

CONCLUSIONS

The prevalence of asthma and bronchial hyperresponsiveness is markedly increased in athletes, especially within endurance sports. Environmental factors often contribute. Recommendations for the diagnosis of asthma in athletes are outlined.

Sideline management of asthma

The timely, efficient, and effective sideline management of asthma must be grounded on an understanding of the disease processes, awareness of evidence-based therapeutic intervention, and thorough knowledge of the individual athlete's medical history and current physical condition. There is accumulating evidence that exercise-induced airway narrowing, if unrecognized or inadequately treated, can progress to a severe life-threatening status and should always be viewed as a potential medical emergency. A widening range of therapeutic measures is currently available to prevent and to treat exercise asthma, and treatment must be tailored to the individual circumstances to optimize response.

Sideline management of asthma

The timely, efficient, and effective sideline management of asthma must be based on an understanding of the disease processes, awareness of evidence-based therapeutic intervention, and thorough knowledge of the individual athlete's past and present medical history. There is accumulating evidence that exercise-induced airway narrowing, if unrecognized or inadequately treated, can progress to a severe life-threatening status and should always be viewed as a potential medical emergency. A widening range of therapeutic measures is currently available to prevent and treat exercise asthma, and treatment must be tailored to the individual circumstances in order to optimize response.

Return to play following exercise-induced bronchoconstriction

OBJECTIVE

To review evidence-based support for return to play criteria following acute exercise-induced bronchoconstriction.

DATA SOURCES

Electronic databases Ovid Medline and PubMed were searched for papers relating to exercise related asthma and bronchoconstriction and return to play criteria. Additional references from the bibliographies of retrieved articles were also reviewed.

DATA SYNTHESIS

There is clear evidence that exercise-induced airways narrowing is increasing in prevalence among athletes from school children to Olympians to professionals, yet there have been no studies specifically addressing return to play criteria. Although deaths from exercise associated bronchoconstriction were previously thought to be rare, recent reports of such deaths call for increased awareness by physicians, athletic trainers, and coaches of the potential fatal consequences of unrecognized episodes or of inadequate treatment.

CONCLUSIONS

No agreed-upon protocol for safe return to play following an acute episode of exercise induced bronchoconstriction has been published. A specific detailed protocol for return to play would assist physicians and other heath professionals to determine with greater confidence that an athlete is fully recovered and can safely return to play.