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E!114053 Evaluation of exercise induced bronchoconstriction by field test using lung function and a novel automated digital clinical dec sys

Alternative title: Kan anstrengelsesutløst bronkokonstriksjon påvises med et bærbart og trådløst spirometer?

Awarded: NOK 0.80 mill.

Exercise-induced asthma is common in endurance sports and negatively affects both the health and performance of athletes. Many athletes experience breathing difficulties in training or in competition, but these difficulties may not necessarilybe present when they seek help from a phycisian, often several weeks after the occasion. Asthma can be regarded as a strain injury, where the lower airways becomes inflamed as a result of an overload of for example exercise (a lot of breathing/endurance training), allergenic air or respiratory infections.The inflamed lower airways results in airway narrowing and causes reduced airflow. The diagnosis of asthma is made by the presence of typical symptoms (cough, wheezing, mucus, shortness of breath) and detection of reduced airflow. Athletes with exertional dyspnoea were tested in the lab using the two most often used methods to provoke exercise-induced asthma: 1) a hyperventilation test, where you breathe as much as you can for eight minutes while sitting on a chair. This is known as the best lab test to provoke exercise-induced airway inflammation and narrowing (exercise-induced bronchoconstriction), and 2) methacholine provocation test (methacholine is a respiratory irritant). In addition, the athletes were tested with 2 different field tests, i.e. tests in the athlete's current training environment: 1) a standardized field test, where the athlete conducted an eight-minute running test outside, and 2) unstandardized sport-specific field test, which is a real training session or competition. In field tests, athletes measured airflow with an app-based spirometer before and after the training session/exertion. We found that 59 per cent of the athletes who were diagnosed with exercise-induced asthma did not have a positive laboratory test (methacholine or hyperventilation test), but only a positive field test. That means there's almost a 50-50 chance that someone with exercise-induced asthma will get a positive lab test. This finding may be explained by field tests being able to include the real impact on the airways from the actual training load, including length and intensity, as well as weather and other environmental factors.

Unsupervised field-based sport specific exercise challenge tests were proven to have the best test performance as compared with other bronchial provocation tests performed in the laboratory. This is now taken into account in the new national consensus of Diagnosing EIB in athletes, where field-tests are regarded as gold standard for EIB, published on internet in August 2023 (https://olympiatoppen.no/fagomrader/helse/fagstoff/luftveissymptomer/). Field-tests are also proven valuable in individulazing eventual asthma treatment. By using field-tests, there is for the first time, a proven significant association between respiratory symptoms and documentation of EIB. AsthmaTuner was by the athletes to perform the field-tests, and is a feasible, time and cost-efficient diagnosis and self-monitoring of EIB and asthma.

Asthma is the most common chronic condition in Olympic athletes. While exercise-induced “sports” asthma (EIA) describes symptoms and signs of asthma provoked by exercise, exercise-induced bronchoconstriction (EIB) is defined as the transient narrowing of the lower airway after exercise. Asthma and EIB represent an important challenge for the athlete, and correct diagnosis is important as it affects health as well as performance with strict regulations concerning asthma medication. Presence of BHR is demonstrated by direct bronchial provocation testing commoncly by inhalation of methcacholine, or indirectly by eucapnic voluntary hyperventilation. However, indirect exercise field test (FT) has been suggested to as the true “gold standard” for a sports-specific EIA, as it includes the right intensity, load and ambient conditions. Nevertheless, previous papers have reported low sensitivity for FTs. A narrow time-interval between symptoms and challenge testing is suggested to increase sensitivity og FT. This may require repeated FTs, which may be difficult to implement. The advantages of monitoring with peak expiratory flow (PEF) or forced expiratory volume in 1 s (FEV1) outside a laboratory with a portable PEF meter or spirometer, respectively, are that the device is simple and cheap. It enables bronchial challenge testing in close relationship to symptoms, with the possibility of repeated challenges. The AsthmaTuner (Medituner AB) is such a device, consisting of a patient smartphone application, a portable wireless spirometer for measuring lung function (PEF/FEV1), and a healthcare interface including treatment plan. Such electronically clinical decision support systems (CDSS) has gained acceptance for the diagnosis of asthma. Questionnaires for baseline characteristics and feasibility of use will be given the participants before and after the challenges in the study protocol.

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