Boulet Louis-Philippe, Turmel Julie, Irwin Richard S
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada.
Chest. 2017 Feb;151(2):441-454. doi: 10.1016/j.chest.2016.10.054. Epub 2016 Nov 16.
Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed.
This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process.
Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes.
The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations.
咳嗽是运动员常见的症状，尤其是在运动后。我们进行了一项系统评价，以评估该人群中的以下方面：（1）急性和复发性咳嗽的主要原因，无论是否由运动诱发；（2）咳嗽的评估方法；（3）该人群中咳嗽的治疗方法。通过系统评价，制定了管理建议。
本评价根据CHEST方法学指南以及推荐分级评估、制定与评价框架进行，截至2015年4月。纳入的研究必须符合以下标准：参与者必须是运动员以及年龄≥12岁的成人和青少年，且必须主诉咳嗽，无论咳嗽持续时间或与运动的关系如何。专家咳嗽小组根据从评价中提取的数据以及通过德尔菲法达成共识的最终分级提出建议。
只有60篇报告符合纳入标准，我们的分析结果显示，关于运动员咳嗽原因以及如何具体评估和治疗咳嗽的证据质量很低。虽然没有对运动员人群咳嗽原因进行正式评估，但报告的最常见原因是哮喘、运动诱发的支气管收缩、呼吸道感染（RTI）、上气道咳嗽综合征（UACS）（主要源于鼻炎）以及环境暴露。在各种不太常见的原因中，咳嗽也被报告与运动诱发的声带功能障碍有关。虽然胃食管反流病（GERD）在运动员中很常见，但我们未发现关于该人群中咳嗽与GERD的相关出版物。咳嗽原因的评估主要通过支气管激发试验和疑似疾病特异性检查进行。指导运动员咳嗽治疗的证据薄弱或不存在，具体取决于病因。由于运动员咳嗽的数据隐藏在一组其他数据（呼吸道症状）中，难以制作证据表，仅针对运动员咳嗽治疗进行了相关工作。
运动员咳嗽的原因似乎与普通人群略有不同。它通常与运动训练环境相关的环境暴露有关，主要发生在剧烈运动之后。临床病史和特异性检查应有助于确定咳嗽原因并针对性治疗。在对运动员进行管理研究之前，应应用普通人群现有的指南对运动员咳嗽进行评估和治疗，同时考虑到特定的训练背景和反兴奋剂规定。
