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Self-reported symptoms after induced and inhibited bronchoconstriction in athletes

Simpson, Andrew J.; Romer, Lee M.; Kippelen, Pascale


Lee M. Romer

Pascale Kippelen


Purpose: A change in the perception of respiratory symptoms
after treatment with inhaled beta2 agonists is often used to aid diagnosis of exercise-induced bronchoconstriction (EIB). Our aim was to test the association between subjective ratings of respiratory symptoms and changes in airway caliber after induced and inhibited bronchoconstriction in athletes with EIB.
Methods: Eighty-five athletes with diagnosed or suspected EIB performed a eucapnic voluntary hyperpnea (EVH) challenge with dry air. Of the 45 athletes with hyperpnea-induced bronchoconstriction [i.e., post-EVH fall in forced expiratory volume in 1 s (FEV1) Q10%, EVHj], 36 were randomized in a double-blind, placebo-controlled, crossover study. Terbutaline (0.5 mg) or placebo was administered by inhalation 15 min before EVH. Spirometry (for FEV1) was performed before and after EVH, and respiratory symptoms were recorded 15 min after EVH on visual analog scales.
Results: Terbutaline inhibited bronchoconstriction (i.e., maximal fall in FEV1 G10% after EVH) in 83% of the EVH-positive athletes, with an average degree of bronchoprotection of 53% (95% confidence interval [CI], 45% to 62%). Terbutaline reduced group mean symptom scores (P G 0.01), but the degree of bronchoprotection did not correlate with individual differences in symptom scores between terbutaline and placebo. Of the 29 athletes who had less than 10% FEV1 fall after EVH in the terbutaline condition, almost half (48%) rated at least one respiratory symptom higher under terbutaline, and more than one quarter (28%) had a higher total symptom score under terbutaline. Conclusion: Self-reports of respiratory symptoms in conditions of induced and inhibited bronchoconstriction do not correlate with changes in airway caliber in athletes with EIB. Therefore, subjective ratings of respiratory symptoms after treatment with inhaled beta2 agonists should not be used as the sole diagnostic tool for EIB in athletes.


Simpson, A. J., Romer, L. M., & Kippelen, P. (2015). Self-reported symptoms after induced and inhibited bronchoconstriction in athletes. Medicine and Science in Sports and Exercise, 47(10), 2005-2013.

Journal Article Type Article
Acceptance Date Feb 1, 2015
Publication Date 2015-10
Deposit Date Nov 23, 2017
Publicly Available Date Dec 8, 2017
Journal Medicine & Science in Sports & Exercise
Print ISSN 0195-9131
Electronic ISSN 1530-0315
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 47
Issue 10
Pages 2005-2013
Keywords Exercise-induced bronchoconstriction; Asthma; Inhaled Beta2 agonist; Terbutaline; Sport
Public URL
Publisher URL
Copyright Statement © 2015 by the American College of Sports Medicine


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