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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, T (author)
- Sewry, N (author)
- Chenuel, B (author)
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- Backer, V (author)
- Larsson, K (author)
- Price, OJ (author)
- Pedersen, L (author)
- Bougault, V (author)
- Schwellnus, M (author)
- Hull, JH (author)
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- 2023-01-30
- 2023
- English.
- In: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 57:8, s. 481-
- Journal article (peer-reviewed)
Abstract
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- 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.DesignSystematic review with sensitivity and specificity meta-analyses.Data sourcesPubMed, EBSCOhost and Web of Science (1 January 1990–31 December 2021).Eligibility criteriaOriginal 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.ResultsIn 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.ConclusionIn 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 numberCRD42020170915.
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- Reier-Nilsen, T
- Sewry, N
- Chenuel, B
- Backer, V
- Larsson, K
- Price, OJ
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- Pedersen, L
- Bougault, V
- Schwellnus, M
- Hull, JH
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- Karolinska Institutet
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