Occupational Asthma Reference

Price OJ, Ansley L, Menzies-Gow A, Cullinan P, Hull JH, Airway dysfunction in elite athletes – an occupational lung disease?, Allergy, 2013;68:1343-1352,
(Plain text: Price OJ, Ansley L, Menzies-Gow A, Cullinan P, Hull JH, Airway dysfunction in elite athletes - an occupational lung disease?, Allergy)

Keywords: review, occupational asthma, athlete, exercise, swimmer, skier, review, Bradford Hill

Known Authors

Paul Cullinan, Royal Brompton Hospital, London, UK Paul Cullinan

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Abstract

Airway dysfunction is prevalent in elite endurance athletes and when left
untreated may impact upon both health and performance. There is now concern
that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete’s respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations
to ensure airway health is maintained and optimized in this population. We
conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.

Plain text: Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete's respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.

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Comments

The review uses the Bradford Hill criteria to show that vigorous exercise, particularly in cold air athletes and swimmers, causes asthma. For professional athletes this is occupational asthma. The review convincingly shows that hyperventilation is more important than the environment, with cross-country skiers developing asthma more frequently than ski jumpers, and endurance swimmers more comonly than divers. Intrigingly synchronised swimmers are at increased risk, perhaps because of the long breath-hold time after inhaling chloramines. This is a good and comprehensive review, but shies away from the obvious occupation consequence of removing the athlete from further exposure. One rule for the industrial worker, another for the athlete.
11/20/2013

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