Unsupervised field-based exercise challenge tests to support the detection of exercise-induced lower airway dysfunction in athletes

Tonje Reier-Nilsen; Julie Sørbø Stang; Hanne Flatsetøy; Martine Isachsen; Henrik Ljungberg; Roald Bahr; Björn Nordlund

doi:10.1136/bmjsem-2023-001680

Unsupervised field-based exercise challenge tests to support the detection of exercise-induced lower airway dysfunction in athletes

BMJ Open Sport Exerc Med. 2023 Jul 24;9(3):e001680. doi: 10.1136/bmjsem-2023-001680. eCollection 2023.

Authors

Tonje Reier-Nilsen^{1

2}, Julie Sørbø Stang³, Hanne Flatsetøy⁴, Martine Isachsen⁵, Henrik Ljungberg^{5

6}, Roald Bahr^{1

2}, Björn Nordlund^{5

6}

Affiliations

¹ The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway.
² Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
³ Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.
⁴ Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
⁵ Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
⁶ Astrid Lindgren Children's Hospital, Stockholm, Sweden.

Abstract

Background: Athletes are at risk for developing exercise-induced lower airway narrowing. The diagnostic assessment of such lower airway dysfunction (LAD) requires an objective bronchial provocation test (BPT).

Objectives: Our primary aim was to assess if unsupervised field-based exercise challenge tests (ECTs) could confirm LAD by using app-based spirometry. We also aimed to evaluate the diagnostic test performance of field-based and sport-specific ECTs, compared with established eucapnic voluntary hyperpnoea (EVH) and methacholine BPT.

Methods: In athletes with LAD symptoms, sensitivity and specificity analyses were performed to compare outcomes of (1) standardised field-based 8 min ECT at 85% maximal heart rate with forced expiratory volume in 1 s (FEV₁) measured prechallenge and 1 min, 3 min, 5 min, 10 min, 15 min and 30 min postchallenge, (2) unstandardised field-based sport-specific ECT with FEV₁ measured prechallenge and within 10 min postchallenge, (3) EVH and (4) methacholine BPT.

Results: Of 60 athletes (median age 17.5; range 16-28 years.; 40% females), 67% performed winter-sports, 43% reported asthma diagnosis. At least one positive BPT was observed in 68% (n=41/60), with rates of 51% (n=21/41) for standardised ECT, 49% (n=20/41) for unstandardised ECT, 32% (n=13/41) for EVH and methacholine BPT, while both standardised and unstandardised ECTs were simultaneously positive in only 20% (n=7/35). Standardised and unstandardised ECTs confirmed LAD with 54% sensitivity and 70% specificity, and 46% sensitivity and 68% specificity, respectively, using EVH as a reference, while EVH and methacholine BPT were both 33% sensitive and 85% specific, using standardised ECTs as reference.

Conclusion: App-based spirometry for unsupervised field-based ECTs may support the diagnostic process in athletes with LAD symptoms.

Trial registration number: NCT04275648.

Keywords: app-based spirometer; asthma; athlete; bronchoprovocation tests; diagnosis; exercise testing; exercise-induced bronchoconstriction; field-based exercise challenge test; lower airway dysfunction.

Associated data

ClinicalTrials.gov/NCT04275648