Differences in lung function, bronchial hyperresponsiveness and respiratory health between elite athletes competing in different sports

Figures & data

Table 1. Descriptive statistics of study participants across the different sports. Results are provided as mean with standard deviation (SD) or numbers (n) with percent of total in parentheses.

	Swimming n = 30	Cross Country Skiing n = 32	Speed skating n = 16	Rowing/paddling n = 11	Ball game n = 40	p-value*
Age (years)	19.5 (3.2)	26.2 (4.7)	23.0 (5.2)	27.0 (4.1)	25.2 (3.8)	<0.001
Height (cm)	179.7 (8.8)	176.8 (8.4)	182.8 (6.7)	182.6 (11.4)	173.0 (6.7)	<0.001
Weight (kg)	72.7 (10.4)	71.9 (10.5)	78.7 (8.9)	78.8(14.0)	67.9 (6.8)	<0.001
BMI (kg/m^2)	20.1 (2.1)	20.2 (2.1)	21.5 (1.8)	21.4 (2.6)	20.2 (1.7)	<0.001
Medication
ICS, n(%)	5 (16.7%)	23 (71.9%)	5 (31.3%)	4 (36.4%)	3 (7.5%)	<0.001
IB, n(%)	2 (6.7%)	20 (62.5%)	0 (0%)	2 (18.2%)	0 (0%)	<0.001
SABA, n(%)	5 (16.7%)	14 (43.8%)	3 (18.8%)	4 (36.4%)	3 (7.5%)	0.003
LABA, n(%)	4 (13.3%)	13 (40.6%)	3 (18.8%)	4 (36.4%)	3 (7.5%)	0.005
Leukotrienantagonists, n(%)	2 (6.7%)	2 (6.3%)	3 (18.8%)	0 (0%)	2 (5%)	0.425
Antihistamines, n(%)	9 (30.0%)	8 (25.0%)	6 (37.5%)	3 (27.3%)	4 (10.0%)	0.113

Note: BMI: Body mass index; IB: Ipratropium bromide; ICS: inhaled corticosteroids; LABA: long acting beta2 agonist; SABA: Short acting beta2 agonist.

*differences across sports, using ANOVA, Welch’s ANOVA (in the weight variable due to unequal variance) or Fisher's Exact test, as appropriate.

Table 2. Lung function of elite athletes participating in different sports. Values are presented in z-scores and Lower Limit of Normal (LLN) according to Quanjer et al. (2012) (Lazovic-Popovic et al., 2016).

	Swimming n = 30	Cross Country S n = 32	Speed skating n = 16	Rowing/paddling n = 11	Ball game n = 40
z-FVC
mean (95%CI)	1.16 (0.80, 1.51)	0.44 (0.14, 0.73)	0.17 (−0.14, 0.48)	0.57 (0.02, 1.13)	0.62 (0.35, 0.90)
B (95%CI)	0.53 (0.13, 0.93)	−0.18 (−0.58, 0.21)	−0.45 (−0.94, 0.04)	−0.05 (−0.61, 0.51)	Ref
LLN (n, %)	0 (0%)	0 (0%)	0 (0%)	0 (0%)	0 (0%)
z-FEV1
mean (95%CI)	0.48 (0.13, 0.84)	−0.16 (−0.51, 0.19)	−0.21 (−0.64, 0.22)	−0.01 (−0.62, 0.59)	0.69 (0.41, 0.97)
B (95%CI)	−0.20 (−0.64, 0.23)	−0.85 (−1.28, −0.42)	−0.89 (−1.43, −0.36)	−0.70 (−1.31, −0.09)	Ref
LLN (n, %)	0 (0%)	2 (6.2%)	0 (0%)	0 (0%)	0 (0%)
z-FEF25-75
Mean (95%CI)	−0.48 (−0.85, −0.11)	−0.86 (−1.22, −0.51)	−0.50 (−1.02, 0.02)	−0.86 (−1.47, −0.26)	0.18 (−0.12, 0.48)
B (95%CI)	−0.65 (−1.11, −0.19)	−1.04 (−1.49, −0.59)	−0.68 (−1.24, −0.11)	−1.04 (−1.69, −0.39)	Ref
LLN (n, %)	4 (13.3%)	8 (25.0%)	1 (6.2%)	2 (18.2%)	1 (2.5%)
z-FEV1/FVC
Mean (95%CI)	−0.93 (−1.34, −0.53)	−0.89 (−1.24, −0.54)	−0.64 (−1.07, −0.21)	−0.87 (−1.44, −0.29)	0.00 (−0.31, 0.31)
B (95%CI)	−0.94 (−1.41, −0.48)	−0.89 (−1.35, −0.44)	−0.64 (−1.21, −0.07)	−0.87 (−1.52, −0.21)	Ref
LLN (n, %)	8 (26.7%)	9 (28.1%)	1 (6.2%)	2 (18.2%)	2 (5.0%)

Note: Results are provided as mean with 95%CI, unstandardised regression coefficients (B) with 95%CI, and count (percent). FEF_25-75: forced expiratory flow between 25 and 75% of FVC; FEV₁: forced expiratory volume in the first second; FVC: Forced vital capacity; LLN – Lower limit of normal.

Figure 1. The distribution of the elite athletes’ responses to increasing cumulative doses of methacholine across the different sports, with a reduction in FEV₁ ≥20% as the event of interest. The vertical line shows the diagnostic criteria for severe BHR (PD_20met ≤2 µmol), moderate BHR (PD_20met ≤4 µmol) and mild BHR (PD_20met ≤8 µmol). The Kaplan-Meier curves differ depending on sport (p < 0.001), with the highest proportion of responding athletes in the swimmers.

Table 3. Allergy, bronchial hyperresponsiveness (BHR), fractional exhaled nitric oxide (FE_NO), self-reported exercise-induced respiratory symptoms and doctor diagnosed asthma in elite athletes participating in different sports

	Swimming n = 30	Cross country skiing n = 32	Speed skating n = 16	Rowing/paddling n = 11	Ball game n = 40
Allergy, skin prick test
One or more pos. test, n (%)	8 (26.0%)	12 (37.5%)	8 (50%)	6 (54.5%)	13 (33.3)
BHR
PD20met≤2 µmol, n (%)	15 (50.0%)	8 (25.0%)	3 (20.0%)	2(18.2%)	0(0%)
PD20met≤4 µmol, n (%)	22(73.3%)	12(37.5%)	4(26.7%)	4(36.4%)	0(0%)
PD20met≤8 µmol, n (%)	26 (86.7%)	15 (46.9%)	8 (53.3%)	4 (36.4%)	7 (17.5%)
FENO (ppb), mean (95%CI)	14.4 (12.2, 16.7)	22.6 (14.6, 30.6)	20.2 (11.9, 28.5)	21.5 (7.1, 35.8)	15.8 (13.5, 18.2)
Resp. symptoms	25 (83.3%)	28 (87.5%)	13 (81.3%)	7 (63.6%)	21 (52.5%)
Cough, n (%)	16 (53.3%)	24 (75.0%)	11 (68.8%)	5 (45.5%)	18 (45%)
Phlegm, n (%)	3 (10%)	17 (53.1%)	3 (18.8%)	2 (18.2%)	5 (12.5%)
Wheeze, n (%)	8 (26.7%)	13 (40.6%)	5(31.3%)	6 (54.5%)	6 (15.0%)
Chest tightness, n (%)	16 (53.3%)	12 (37.5%)	4 (25.0%)	5 (45.5%)	8 (20.0%)
Doctor’s diagnosed asthma, n (%)	9 (30.0%)	22 (68.7%)	3 (18.7%)	4 (36.4%)	4 (10.0%)

Note: Results are provided as counts (percent) or mean and 95% CI. CI: Confidence intervals; BHR: Bronchial hyperresponsiveness, defined as the methacholine dose causing 20% reduction in FEV₁; ppb: parts per billion.

Quanjer, P. H., Stanojevic, S., Cole, T. J., Baur, X., Hall, G. L., Culver, B. H., Enright, P. L., Hankinson, J. L., Ip, M. S. M., Zheng, J., & Stocks, J. (2012). Multi-ethnic reference values for spirometry for the 3-95-yr age range: The global lung function 2012 equations. European Respiratory Journal, 40(6), 1324–1343. https://doi.org/10.1183/09031936.00080312

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Lazovic-Popovic, B., Zlatkovic-Svenda, M., Durmic, T., Djelic, M., Djordjevic Saranovic, S., & Zugic, V. (2016). Superior lung capacity in swimmers: Some questions, more answers! Revista Portuguesa de Pneumologia (English Edition), 22(3), 151–156. https://doi.org/10.1016/j.rppnen.2015.11.003

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