Perception of bronchoconstriction following methacholine and eucapnic voluntary hyperpnea challenges in elite athletes.

OBJECTIVE Self-reported respiratory symptoms are poor predictors of exercise-induced bronchoconstriction (EIB) in athletes. The objective of this study was to determine whether athletes have an inadequate perception of bronchoconstriction. METHODS One hundred thirty athletes and 32 nonathletes completed a standardized questionnaire and underwent eucapnic voluntary hyperpnea (EVH) and methacholine inhalation test. Perception scores were quoted on a modified Borg scale before each spirometry measurement for cough, breathlessness, chest tightness, and wheezing. Perception slope values were also obtained by plotting the variation of perception scores before and after the challenges against the fall in FEV1 expressed as a percentage of the initial value [(perception scores after - before)/FEV1]. RESULTS Up to 76% of athletes and 68% of nonathletes had a perception score of ≤0.5 at 20% fall in FEV1 following methacholine. Athletes with EIB/airway hyperresponsiveness (AHR) had lower perception slopes to methacholine than nonathletes with asthma for breathlessness only (P=.02). Among athletes, those with EIB/AHR had a greater perception slope to EVH for breathlessness and wheezing (P=.02). Female athletes had a higher perception slope for breathlessness after EVH and cough after methacholine compared with men (P<.05). The age of athletes correlated significantly with the perception slope to EVH for each symptom (P<.05). CONCLUSIONS Minimal differences in perception of bronchoconstriction-related symptoms between athletes and nonathletes were observed. Among athletes, the presence of EIB/AHR, older age, and female sex were associated with slightly higher perception scores.

[1]  S. Anderson,et al.  Metabolic and ventilatory changes in asthmatic patients during and after exercise , 1972, Thorax.

[2]  A. Rubinfeld,et al.  PERCEPTION OF ASTHMA , 1976, The Lancet.

[3]  E. R. Mcfadden,et al.  Influence of heat and humidity on the airway obstruction induced by exercise in asthma. , 1978, The Journal of clinical investigation.

[4]  G. Borg Psychophysical bases of perceived exertion. , 1982, Medicine and science in sports and exercise.

[5]  E. Juniper,et al.  The perception of breathlessness in asthma. , 2015, The American review of respiratory disease.

[6]  M. Lebowitz,et al.  Changes in the normal maximal expiratory flow-volume curve with growth and aging. , 1983, The American review of respiratory disease.

[7]  J. Stager,et al.  Pulmonary Structure and Function in Swimmers , 1988, Sports medicine.

[8]  D. Postma,et al.  Perception of airway obstruction in a random population sample. Relationship to airway hyperresponsiveness in the absence of respiratory symptoms. , 1992, The American review of respiratory disease.

[9]  C M Higgs,et al.  Accuracy of perception of severity of asthma: patients treated in general practice. , 1993, BMJ.

[10]  L. Boulet,et al.  Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. , 1994, Chest.

[11]  Y Kikuchi,et al.  Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. , 1994, The New England journal of medicine.

[12]  D. Dusser,et al.  Perception of bronchial obstruction in asthmatic patients. Relationship with bronchial eosinophilic inflammation and epithelial damage and effect of corticosteroid treatment. , 1995, The Journal of clinical investigation.

[13]  T Matsuda,et al.  Female gender as a determinant of cough threshold to inhaled capsaicin. , 1996, The European respiratory journal.

[14]  W. Timens,et al.  (A)symptomatic bronchial hyper-responsiveness and asthma. , 1997, Respiratory medicine.

[15]  A. James,et al.  Increased perception of airway narrowing in patients with ild asthma , 1998, Respirology.

[16]  K. Rauf,et al.  The influence of gender on cough reflex sensitivity. , 1998, Chest.

[17]  P. Sterk,et al.  Impaired perception of dyspnea in patients with severe asthma. Relation to sputum eosinophils. , 1998, American journal of respiratory and critical care medicine.

[18]  L. Boulet,et al.  Changes in lung volumes and poor perception of bronchoconstriction-induced respiratory symptoms. , 1998, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[19]  W. Timens,et al.  Chapter 2 ( A ) SYMPTOMATIC BRONCHIAL HYPERRESPONSIVENESS AND ASTHMA , 1999 .

[20]  J. Weiler,et al.  Asthma in United States olympic athletes who participated in the 1998 olympic winter games. , 2000, The Journal of allergy and clinical immunology.

[21]  J. Hankinson,et al.  Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. , 2000, American journal of respiratory and critical care medicine.

[22]  L. Boulet,et al.  Airway hyperresponsiveness in elite athletes. , 2000, American journal of respiratory and critical care medicine.

[23]  J A Dempsey,et al.  Symptom perception and respiratory sensation in asthma. , 2000, American journal of respiratory and critical care medicine.

[24]  L. Mayers,et al.  Self-reported symptoms and exercise-induced asthma in the elite athlete. , 2001, Medicine and science in sports and exercise.

[25]  P. Weiner,et al.  The risk of hospitalization and near-fatal and fatal asthma in relation to the perception of dyspnea. , 2002, Chest.

[26]  L. Boulet,et al.  Prevalence of respiratory symptoms in an athlete population. , 2003, Respiratory medicine.

[27]  Perception of dyspnea during exercise-induced bronchoconstriction. , 2003, Respiratory medicine.

[28]  S. Anderson,et al.  Methods for “Indirect” challenge tests including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols , 2003, Clinical reviews in allergy & immunology.

[29]  O. Bar-or,et al.  Breathing dry or humid air and exercise-induced asthma during swimming , 2004, European Journal of Applied Physiology and Occupational Physiology.

[30]  S. Anderson,et al.  Airway responses to eucapnic hyperpnea, exercise, and methacholine in elite swimmers. , 2008, Medicine and science in sports and exercise.

[31]  P. Brukner,et al.  The role of the bronchial provocation challenge tests in the diagnosis of exercise-induced bronchoconstriction in elite swimmers , 2008, British Journal of Sports Medicine.

[32]  L. Boulet,et al.  Gender differences in the prevalence of airway hyperresponsiveness and asthma in athletes. , 2009, Respiratory medicine.

[33]  L. Boulet,et al.  Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes , 2009, European Respiratory Journal.

[34]  Thomas Janssens,et al.  Inaccurate perception of asthma symptoms: a cognitive-affective framework and implications for asthma treatment. , 2009, Clinical psychology review.

[35]  S. Anderson,et al.  Effect of sodium cromoglycate on mast cell mediators during hyperpnea in athletes. , 2010, Medicine and science in sports and exercise.

[36]  L. Boulet,et al.  Bronchial challenges and respiratory symptoms in elite swimmers and winter sport athletes: Airway hyperresponsiveness in asthma: its measurement and clinical significance. , 2010, Chest.

[37]  C. Bolger,et al.  Hyperpnea-induced bronchoconstriction and urinary CC16 levels in athletes. , 2011, Medicine and science in sports and exercise.

[38]  M. Barbaro,et al.  Dyspnea perception in asthma: role of airways inflammation, age and emotional status. , 2011, Respiratory medicine.

[39]  D. Serebrisky,et al.  Prediction of peak flow values followed by feedback improves perception of lung function and adherence to inhaled corticosteroids in children with asthma , 2012, Thorax.

[40]  L. Boulet,et al.  Seasonal variations of cough reflex sensitivity in elite athletes training in cold air environment , 2012, Cough.