Fitch Kenneth D, Sue-Chu Malcolm, Anderson Sandra D, Boulet Louis-Philippe, Hancox Robert J, McKenzie Donald C, Backer Vibeke, Rundell Kenneth W, Alonso Juan M, Kippelen Pascale, Cummiskey Joseph M, Garnier Alain, Ljungqvist Arne
School of Sports Science, Exercise and Health, Faculty of Life Sciences, University of Western Australia, Crawley, Australia.
J Allergy Clin Immunol. 2008 Aug;122(2):254-60, 260.e1-7. doi: 10.1016/j.jaci.2008.07.003.
Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled beta(2)-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to beta(2)-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale beta(2)-agonists will continue.
在精英运动员中，不能仅依靠呼吸道症状来诊断哮喘和/或气道高反应性（AHR）。因此，诊断应通过支气管激发试验来确认。精英运动员的哮喘管理应遵循既定的治疗指南（如全球哮喘防治创议），应包括教育、个性化的治疗方案、尽量减少加重病情的环境因素，以及必须符合世界反兴奋剂机构要求的适当药物治疗。通常使用吸入性糖皮质激素和吸入性β2受体激动剂来控制哮喘，以尽量减少运动诱发的支气管收缩并治疗间歇性症状。运动员在每日规律使用β2受体激动剂后会迅速产生快速耐受性，这给他们带来了两难境地。长期高强度耐力训练，尤其是在不利的环境条件下，似乎会增加精英运动员患哮喘和AHR的风险。在全球范围内，奥运会运动员中哮喘、运动诱发的支气管收缩和AHR的患病率反映了每个国家已知的哮喘症状患病率。要求奥运会运动员证明存在哮喘、运动诱发的支气管收缩或AHR才能被批准吸入β2受体激动剂的政策将继续执行。
