Impact of changes in the International Olympic Committee Medical

1
Impact of changes in the International Olympic
Committee Medical

• Commission (IOCMC) Criteria for Astma

• Prevalence of astma in Olympic atletes - between
  9 and 55
• High in winter sport athletes and swimmers
• IOCMC criteria for diagnosis of asthma
• positive bronchodilator response to inhaled B-2
  agonists
• fall of FEV 1 more than 1O after exercise or
  eucapnic voluntary hyperpnea

2
False negative results

• Cough equivalent of asthma without airway
  obstruction (underlying upper or lower airway
  inflammation, increased respiratory heat
  exchange)
• Intense hyperventilation-increased stimulation of
  sensory nerve endings (cold air,enviromental
  pollutants, chlorine in
  swimmers)
• Variability over time - intercurrent allergen
  exposure-timing of the test crucial

3
False positive results

• Asymptomatic airway hyperresponsiveness (Rundel,
  2001 - 26 positive results, only 39 of them
  symptoms of asthma)
• Overuse of bronchodilators in Olympic athletes
• Progressive increase of B-2 agonists use since
  1980
• Alaranta, 2004 - Finnish olympic athletes - 7,4
  using B-2 agonists, nonasthmatics - 3,0
• Shaaban, 2007 - protective effect of physical
  activity against bronchial hyperreactivity
• Bonsignore, 2008 - casual relationship between
  endurance exercise and low BHR - probably
  mediated by ventilation
  at increased lung volumes
• increased number of neutrophils in induced
  sputum in runners (no
  activation observed)
• marathon runners- response to methacholine
  inhalation blunted shortly after the race

4
Conclusion

• Objective measurement of variable airflow
  obstruction in athletes
  (bronchodilatation tests) needed to prevent
  non-indicated use of asthma drugs
• Exploration of relationships between high level
  exercise and asthma and
  various consequences of intensive training in
  athletes (noninvasive measures of airway
  inflammation)
• Reconsider beneficial effects of regular exercise
  as a strategy to
  preserve respiratory health