Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’ - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue British Journal of Sports Medicine Année : 2023

Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’

Tonje Reier-Nilsen
Nicola Sewry
  • Fonction : Auteur
Bruno Chenuel
Vibeke Backer
  • Fonction : Auteur
Kjell Larsson
  • Fonction : Auteur
Oliver Price
Lars Pedersen
Martin Schwellnus
James Hull

Résumé

Objectives To compare the performance of various diagnostic bronchoprovocation tests (BPT) in the assessment of lower airway dysfunction (LAD) in athletes and inform best clinical practice. Design Systematic review with sensitivity and specificity meta-analyses. Data sources PubMed, EBSCOhost and Web of Science (1 January 1990–31 December 2021). Eligibility criteria Original full-text studies, including athletes/physically active individuals (15–65 years) who underwent assessment for LAD by symptom-based questionnaires/history and/or direct and/or indirect BPTs. Results In 26 studies containing data for quantitative meta-analyses on BPT diagnostic performance (n=2624 participants; 33% female); 22% had physician diagnosed asthma and 51% reported LAD symptoms. In athletes with symptoms of LAD, eucapnic voluntary hyperpnoea (EVH) and exercise challenge tests (ECTs) confirmed the diagnosis with a 46% sensitivity and 74% specificity, and 51% sensitivity and 84% specificity, respectively, while methacholine BPTs were 55% sensitive and 56% specific. If EVH was the reference standard, the presence of LAD symptoms was 78% sensitive and 45% specific for a positive EVH, while ECTs were 42% sensitive and 82% specific. If ECTs were the reference standard, the presence of LAD symptoms was 80% sensitive and 56% specific for a positive ECT, while EVH demonstrated 65% sensitivity and 65% specificity for a positive ECT. Conclusion In the assessment of LAD in athletes, EVH and field-based ECTs offer similar and moderate diagnostic test performance. In contrast, methacholine BPTs have lower overall test performance. PROSPERO registration number CRD42020170915.

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Dates et versions

hal-04206137 , version 1 (13-09-2023)

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Citer

Tonje Reier-Nilsen, Nicola Sewry, Bruno Chenuel, Vibeke Backer, Kjell Larsson, et al.. Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’. British Journal of Sports Medicine, 2023, 57 (8), pp.481-489. ⟨10.1136/bjsports-2022-106059⟩. ⟨hal-04206137⟩
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