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’

• Published in: British journal of sports medicine 2022-02, Vol.56 (4), p.213-222
• Main Authors: Price, Oliver J, Sewry, Nicola, Schwellnus, Martin, Backer, Vibeke, Reier-Nilsen, Tonje, Bougault, Valerie, Pedersen, Lars, Chenuel, Bruno, Larsson, Kjell, Hull, James H
• Format: Article
• Language: English
• Subjects: Asthma; athlete; Athletes; Bias; Bronchial Provocation Tests; Consensus; Digital Object Identifier; Ecology, environment; epidemiology; Female; Health; Histamine; Human health and pathology; Humans; Illnesses; Life Sciences; Male; Males; Medicin och hälsovetenskap; Meta-analysis; Prevalence; Respiratory diseases; Review; risk factor; Sports; Systematic review; Tissues and Organs
• ISSN: 0306-3674; 1473-0480; 1473-0480
• DOI: 10.1136/bjsports-2021-104601

ObjectiveTo report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups.DesignSystematic review and meta-analysis.Data sourcesPubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020).Eligibility criteriaOriginal 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).ResultsIn 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%).ConclusionLower 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.