Hallstrand TS, Curtis JR, Koepsell TD, et al. J Pediatr. 2002;141:343–349
Purpose of the Study.
To determine if physician-administered physical examination and screening questionnaire accurately detects exercise-induced bronchoconstriction (EIB) in adolescent athletes.
Two hundred fifty-six adolescents participating in organized sports from 3 suburban high schools.
The number screened positive from the examination and questionnaire was compared with EIB diagnosed by the “gold standard” of a 7-minute exercise challenge followed by serial spirometry.
EIB was diagnosed in 9.4% of the athletes. However, 39.5% of the group had a diagnosis suggestive of EIB by screening tests, verified by challenge in only 12.9%. Among the remainder with a negative screen, 7.8% actually had EIB on challenge. Adolescent athletes who screened negative for a history of asthma, EIB, and allergic rhinitis accounted for 45.8% of the subjects diagnosed with EIB.
EIB occurs frequently in adolescent athletes and screening by physical examination and medical history does not accurately detect it.
The diagnosis of EIB is important because the disorder can be severe and previous studies show that of children who died suddenly during sports participation, 32 of 108 died of severe asthma identified clinically at the time of death or on autopsy. An accompanying editorial by Bokulic points out that it is impractical to perform exercise testing with spirometry in all adolescent athletes. The editorial also emphasizes a number of other controversial aspects of the diagnosis of EIB and variations in testing procedures. The International Olympic Committee has announced that β-agonists will not be permitted without a documented need to treat asthma or EIB and that clinical proof and laboratory evidence is needed to justify the treatment. This approach may someday extend to athletes in other venues. Clearly, more sensitive screening methods are needed.