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'
Reier-Nilsen, Tonje; Sewry, Nicola; Chenuel, Bruno; Backer, Vibeke; Larsson, Kjell; Price, Oliver J.; Pedersen, Lars; Bougault, Valerie; Schwellnus, Martin; Hull, James H.
Peer reviewed, Journal article
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Date
2023Metadata
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Original version
British Journal of Sports Medicine. 2023, 57(8), 481-489. 10.1136/bjsports-2022-106059Abstract
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.
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