Chest
Volume 123, Issue 2, February 2003, Pages 468-474
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Clinical Investigations
AIRWAYS
Inspiratory Stridor in Elite Athletes*

https://doi.org/10.1378/chest.123.2.468Get rights and content

Study objectives:

Diagnosis and medical intervention for exercise-induced bronchospasm (EIB) are often based on self-reported symptoms, without spirometric confirmation. Inspiratory stridor (IS), a symptom of vocal cord dysfunction (VCD), is frequently mistaken for EIB wheeze. Athletes with exercise IS that spontaneously resolves on activity cessation are suspect for VCD and may not have EIB. This study estimated IS prevalence in elite athletes and determined its relationship to EIB.

Subjects/methods:

Three hundred seventy athletes (174 female and 196 male subjects) provided a medical history, and underwent spirometry before and after exercise challenge. Exercise challenges were conducted in cold, dry ambient conditions. EIB positive (EIB +) was defined as a ≥ 10% postexercise fall in FEV1. Athletes were monitored for IS during exercise; 78.4% of the athletes in this study (n = 290) were tested on multiple occasions.

Results:

EIB was identified in 30% of 370 athletes tested (58 female and 53 male subjects). IS was observed in 5.1% (18 female and 1 male subjects) during exercise and spontaneously resolved in these subjects within 5 min after exercise cessation. Ten IS-positive (IS +) athletes (52.6%) were EIB +, and 8 of these athletes had a previous EIB diagnosis; however, β2-agonist treatment resolved IS in only 2 subjects. Eight of nine IS +/EIB-negative (EIB −) athletes had a previous EIB diagnosis; seven subjects received β2-agonist treatment with no IS resolution. Resting spirometric measurements did not distinguish IS, but postexercise mid-flow (FEF50/FIF50) ratio > 1.5 was more frequent (33%, p < 0.05) among IS + athletes. The FEF50/FIF50 ratio was higher for IS +/EIB + athletes than for IS −/EIB + athletes (1.97 ± 1.69 vs 0.81 ± 0.39, p < 0.05). The postexercise fall in FVC was greater (p < 0.05) for IS +/EIB − athletes (9.2 ± 5.0%) than for IS-negative (IS −) /EIB − athletes (5.3 ± 4.3%). No difference in postexercise FEV1 was identified between IS + and IS − athletes (within EIB + or EIB − groups).

Conclusions:

Five percent of athletes were IS +, with EIB comorbidity observed in 53% of these subjects. Misdiagnosis of IS as EIB is common. The lack of a β2-agonist response in combination with postexercise serial spirometry can be useful in excluding solitary IS and confirming EIB diagnosis.

Section snippets

Subjects

All subjects (n = 370) were developmental or elite athletes between the ages of 16 years and 37 years who volunteered to undergo routine evaluation for asthma and/or EIB at the US Olympic Training Center in Lake Placid, NY. No significant difference in study group gender proportion existed (174 female and 196 male subjects). Of the 370 athletes, 169 trained and competed outdoors and 201 trained and competed indoors. The vast majority of the subjects (n = 318) competed in winter sports, 49

Results

Thirty percent (n = 111; 58 female and 53 male subjects) of the 370 athletes were identified as EIB + by a ≥ 10% postexercise fall in FEV1 (Table 1). The 111 EIB + athletes demonstrated postexercise falls in FEV1 of 18.6 ± 10.0% (mean ± SD), compared to 3.1 ± 4.6% for the 259 EIB − athletes.

Approximately 5% of the 370 athletes (n = 19; 18 female and 1 male subjects) demonstrated IS during and/or immediately after exercise; 53% of the 19 IS + athletes (n = 10) presented comorbid EIB. The 19.4 ±

Discussion

The purpose of this study was to report the prevalence of IS in elite athletes. To our knowledge, this report is the first to provide a comprehensive estimate of IS for an athlete population. Overall prevalence of IS in our cohort of developmental and elite athletes was 5.1%; the 8.3% prevalence in the outdoor athlete group was significantly higher than the 2.5% observed in the indoor athlete group (p < 0.05). The prevalence of IS in the athlete population and within the outdoor subpopulation

ACKNOWLEDGMENT

The authors thank Lester B. Mayers, MD, and Dan A. Judelson and Meredith H. Wilson for technical assistance. We also acknowledge the athletes and coaching staff for their support and assistance.

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    This study was supported by the United States Olympic Committee.

    The views, opinions, and findings contained in this report are those of the authors and should not be construed as an official United States Olympic Committee position.

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