International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Abstract

Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to ‘core’ members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.

The COVID-19 in athletes (COVA) study: a national study on cardio-pulmonary involvement of SARS-CoV-2 infection among elite athletes

“…However, only one had obstructive lung function at the time of examination, and the remaining 10 athletes with obstructive lung function after COVID-19 were not known to have asthma. The diagnosis of asthma can be difficult to establish, and studies have shown a higher prevalence of airway hyperresponsiveness and asthma (‘lower airway dysfunction’) when using objective testing methodology [ 40 , 41 ]. We have no information on how the diagnosis of asthma had been determined before entering our study, but one possible explanation for the high number of athletes with obstructive lung function could be that they had undiagnosed asthma before the COVID infection.…”

COVID-19 and elite sport: Cardiovascular implications and return-to-play

“…The International Olympic Committee (IOC) recently published a two-part consensus statement that covers acute respiratory infections 55 and non-infective acute respiratory illness. 56 The drive behind these statements is to provide guidance to sport and exercise science/medicine practitioners working with athletes and to uphold the Medical and Scientific Commission's value of protecting athletes, whilst focusing on prevention and management and enabling the development of effective return to sport protocols following acute illness. Data from the report highlights that almost half of all athlete's medical consultations at international events such as the Olympics and Para Olympics relate to acute respiratory illness (4.2 per 1000 athlete days).…”

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections

“…Non-infective ARill was defined as an illness not caused by infection from a specific pathogen, by clinical diagnosis or laboratory investigation(s). There are several conditions that cause non-infective ARill and these are comprehensively reviewed in part 2 of the IOC Consensus statement on ARill in athletes 23…”

“…(4,7,8,10,12) The aim of this consensus statement is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. This document forms Part 1 of a three-part series, with Part 2 focusing on non-infective acute respiratory illness in athletes (23) and Part 3 on SARS-CoV-2 infection in athletes. (24) The specific focus of Part 1 is to review clinically relevant aspects of ARinf in athletes.…”

“…This document forms Part 1 of a three-part series, with Part 2 focusing on non-infective acute respiratory illness in athletes (23) and Part 3 on SARS-CoV-2 infection in athletes. (24) The specific focus of Part 1 is to review clinically relevant aspects of ARinf in athletes. The first section of this manuscript proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting.…”