Sports Physician, Olympic Park Sports Medicine Centre, Olympic Boulevarde, Melbourne, Victoria 3004, Australia.
Br J Sports Med. 2010 Aug;44(10):736-40. doi: 10.1136/bjsm.2008.051169. Epub 2008 Oct 23.
The International Olympic Committee-Medical Commission (IOC-MC) accepts a number of bronchial provocation tests for the diagnosis of exercise-induced bronchoconstriction (EIB) in elite athletes, none of which have been studied in elite swimmers. With the suggestion of a different pathogenesis involved in the development of EIB in swimmers, there is a possibility that the recommended test for EIB in elite athletes, the eucapnic voluntary hyperpnoea (EVH) challenge, may be missing the diagnosis in elite swimmers.
The aim of this study was to assess the effectiveness of the EVH challenge, the field swim challenge and the laboratory cycle challenge in the diagnosis of EIB in elite swimmers.
33 elite swimmers were evaluated on separate days for the presence of EIB using 3 different bronchial provocation challenge tests: an 8 minute field swim challenge, a 6 minute laboratory EVH challenge, and an 8 minute laboratory cycle challenge.
Change in forced expiratory volume in 1 second (FEV(1)) pre and post test protocol. A fall in FEV(1) from baseline of > or =10% post challenge was diagnostic of EIB.
Only 1 of the 33 subjects (3%) had a positive field swim challenge with a fall in FEV(1) of 16% from baseline. 18 of the 33 subjects (55%) had a positive EVH challenge, with a mean fall in FEV(1) of 20.4 (SD 11.7)% from baseline. 4 of the subjects (12%) had a positive laboratory cycle challenge, with a mean fall in FEV(1) of 14.8 (4.7)% from baseline. Only 1 of the 33 subjects was positive to all 3 challenges.
These results suggest that the EVH challenge is a highly sensitive challenge for identifying EIB in elite swimmers, in contrast to the laboratory and field-based exercise challenge tests, which significantly underdiagnose the condition. The EVH challenge, a well-established and standardised test for EIB in elite winter and summer land-based athletes, should thus be used for the diagnosis of EIB in elite swimmers, as recommended by the IOC-MC.
国际奥林匹克委员会医学委员会（IOC-MC）接受了许多支气管激发试验来诊断精英运动员的运动诱发性支气管收缩（EIB），但这些试验都没有在精英游泳运动员中进行过研究。由于游泳运动员中 EIB 的发病机制可能不同，因此建议用于精英运动员 EIB 诊断的推荐试验——呼碱性自主过度通气（EVH）挑战，可能会漏诊精英游泳运动员的 EIB。
本研究旨在评估 EVH 挑战、现场游泳挑战和实验室循环挑战在诊断精英游泳运动员 EIB 中的有效性。
33 名精英游泳运动员在不同的日子里使用 3 种不同的支气管激发挑战试验来评估 EIB 的存在情况：8 分钟现场游泳挑战、6 分钟实验室 EVH 挑战和 8 分钟实验室循环挑战。
试验前后用力呼气量（FEV1）的变化。试验后 FEV1 较基线下降≥10%为 EIB 阳性。
只有 1 名（3%）受试者的现场游泳挑战阳性，FEV1 较基线下降 16%。33 名受试者中有 18 名（55%）EVH 挑战阳性，FEV1 较基线平均下降 20.4%（标准差 11.7%）。4 名受试者（12%）的实验室循环挑战阳性，FEV1 较基线平均下降 14.8%（4.7%）。只有 1 名受试者对 3 种挑战均为阳性。
这些结果表明，EVH 挑战是一种高度敏感的挑战，可以识别精英游泳运动员中的 EIB，而实验室和现场运动挑战测试则显著低估了该疾病的发生率。因此，正如 IOC-MC 所建议的，EVH 挑战作为一种用于诊断精英游泳运动员 EIB 的已确立且标准化的测试，应该用于精英游泳运动员的 EIB 诊断。
