Common causes of dyspnoea in athletes: a practical approach for diagnosis and management

Abstract

Key points“Dyspnoea” during exercise is a common complaint in seemingly otherwise healthy athletes, which may be associated with fatigue and underperformance.Because dyspnoea is an general term and may be caused by numerous factors, ranging from poor aerobic fitness to serious, potentially fatal respiratory and nonrespiratory pathologies, it is important for clinicians to obtain an appropriate case history and ask relevant exercise-specific questions to fully characterise the nature of the complaint so that a targeted diagnostic plan can be developed.Exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction are two common causes of dyspnoea in athletes, and both are regularly misdiagnosed and mismanaged due to poor adherence to available practice parameters.Aside from airway dysfunction, iron deficiency and anaemia, infectious disease, and musculoskeletal conditions are common problems in athletes which ultimately may lead to complaints of dyspnoea.Educational aimsTo inform readers of the common causes of dyspnoea encountered in athletes.To highlight that airway diseases, such as asthma and exercise-induced bronchoconstriction, are commonly misdiagnosed and mismanaged.To introduce readers to common nonairway causes of dyspnoea in athletes, including clinical features and general principles of diagnosis, and management.To emphasise the importance of a detailed case history and proper adherence to established protocols in evaluating and managing the dyspnoeic athlete.To provide readers with a general framework of appropriate questions that are useful for developing a targeted diagnostic plan for evaluating dyspnoeic athletes.Dyspnoea during exercise is a common chief complaint in athletes and active individuals. It is not uncommon for dyspnoeic athletes to be diagnosed with asthma, “exercise-induced asthma” or exercise-induced bronchoconstriction based on their symptoms, but this strategy regularly leads to misdiagnosis and improper patient management. Dyspnoea during exercise can ultimately be caused by numerous respiratory and nonrespiratory conditions, ranging from nonpathological to potentially fatal in severity. As, such it is important for healthcare providers to be familiar with the many factors that can cause dyspnoea during exercise in seemingly otherwise-healthy individuals and have a general understanding of the clinical approach to this patient population. This article reviews common conditions that ultimately cause athletes to report dyspnoea and associated symptoms, and provides insight for developing an efficient diagnostic plan.

Exercise-induced bronchoconstriction, temperature regulation and the role of heat shock proteins in non-asthmatic recreational marathon and half-marathon runners

“…The observation of falls in FVC directs the attention to phenomena other than EIB that cause exercise-induced dyspnoea. The possibilities range from athletes reaching their physiological limits (deconditioned or unfit athletes), organic pathologies other than EIB, functional or structural forms of dysfunctional breathing and other pulmonary and non-pulmonary pathologies (arrhythmia, intracardiac shunts) 34 , 35 . The field test may be particularly prone to blur the picture of EIB in athletes who may have even sprinted to the finish line and also present with fatigue.…”

Breath Tools: A Synthesis of Evidence-Based Breathing Strategies to Enhance Human Running

“…An estimated 20%–40% of otherwise healthy runners experience EID even at low absolute exercise intensities ( Johansson et al, 2015 ; Smoliga et al, 2016 ; Ersson et al, 2020 ). This could be because unfit or deconditioned individuals may approach high levels of exertion and experience limb fatigue at low absolute workloads ( Abu-Hasan et al, 2005 ).…”

“…During high intensity exercise, large increases in ventilatory flow may cause narrowing of the airway related to the Venturi effect and Bernoulli principle, among other constraints. This is termed “exercise-induced largyngeal obstruction,” and it is particularly common in elite athletes who generate large V E at high intensities ( Smoliga et al, 2016 ). Up to 20% of elite athletes, females, adolescents, and overweight individuals may experience this during low-intensity activity ( Smith et al, 2017 ; Dempsey et al, 2020 ; Ersson et al, 2020 ).…”

Regulated Monosyllabic Talk Test vs. Counting Talk Test During Incremental Cardiorespiratory Exercise: Determining the Implications of the Utterance Rate on Exercise Intensity Estimation

“…The higher cardiorespiratory fitness seen in the previous study’s participants may not justify the lower range of %CTT values when compared to the present study because individuals with excellent aerobic fitness do not usually show dyspnea during exercise without any evidence of pathology. Instead, they are usually well accustomed to the ventilatory demands of exercise Smoliga et al (2016) , and thus may show greater utterance output with a higher %CTT than individuals with poor fitness. However, the cardiorespiratory fitness in the participants of the present study was limited due to estimation from a non-exercise test model with cross validity between 0.72 and 0.8 ( Jurca et al, 2005 ).…”