Sex Differences in Exercise Induced Bronchoconstriction in Athletes: A Systematic Review and Meta-Analysis

Abstract

Exercise induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. It is estimated that about 90% of patients with underlying asthma experience EIB. Sex differences in the prevalence of asthma have been widely reported, with higher rates in boys vs. girls before puberty, and higher rates in women than men after puberty. Because atopy has been reported to occur at higher rates in athletes than in non-athletes, in this study we investigated sex differences in EIB and atopy in athletes. A systematic literature review identified 60 studies evaluating EIB and/or atopy in post-pubertal adult athletes (n=7501). Collectively, these studies reported: 1) a 23% prevalence of EIB in athletes; 2) a higher prevalence of atopy in male athletes vs. females; 3) a higher prevalence of atopy in athletes with EIB; and 4) a significantly higher rate of atopic EIB in male vs. female athletes. Our analysis indicates that the physiological changes that occur during exercise may differentially affect male and female athletes, and suggest an interaction between male sex, exercise, and atopic status in the course of EIB. Understanding these sex differences is important to provide personalized management plans to athletes with underlying asthma and/or atopy.

Asthma, atopy, and exercise: Sex differences in exercise-induced bronchoconstriction

“…We have recently systematically reviewed these studies and found that the average prevalence of EIB in athletes is around 23% (Figure 1). 15 We also found that the prevalence of atopy was reportedly higher in male vs. female athletes, and in athletes with EIB vs. those without EIB. Collectively, the reviewed studies indicate that the prevalence of atopic EIB is higher in male athletes and regular exercisers than in females on these groups.…”

“…Collectively, the reviewed studies indicate that the prevalence of atopic EIB is higher in male athletes and regular exercisers than in females on these groups. 15 Identifying such differences has clear implications for understanding sex and gender specific adaptations to exercise for athletic performance and overall health. 29 Figure 1.…”

“…In general, it is recommended that the diagnosis of EIB is confirmed by demonstration of airways reversibility or challenge in association with a history consistent with EIB, because the use of self-reported measures or symptoms to diagnose EIB is not predictive of whether athletes have objectively documented EIB. 27,35 In our prior review of the literature, 15 we found that in studies including both males and females, 43% used exercise challenge alone as a diagnostic measure, whereas 14.2% used it in combination with a bronchial provocation test such as mannitol or methacholine, and 9% used self-reporting data via questionnaires. While we do not know whether a sex bias exists in the ability of these tests to accurately diagnose EIB, sex differences in selfreported measures of airway hyperresponsiveness and other symptoms during exercise have been documented.…”

“…12 Interestingly, this percentage that is greater among male than female patients with asthma and athletes, and is also higher in athletes and individuals who exercise regularly than in sedentary people. [13][14][15] In addition, athletes with atopy often experience exercise-induced bronchoconstriction (EIB). EIB, also known as exercise-induced bronchospasm, is defined as the transient narrowing of the lower airways that occurs during or after exercise in the presence…”

Validity and repeatability of the Pediatric Allergy Questionnaire for Athletes (AQUAped) for the screening of atopy

“…Notably, sensitization to inhalant allergens can be detected even in subjects without symptoms 4 . Moreover, atopy has been significantly associated with bronchial hyper‐reactivity and asthma in elite athletes, with increasing effect sizes associated with an increasing number of positive skin test reactions to inhalant allergens 5,6 . Since allergic diseases can have serious consequences on health, a screening tool for athletes may help with the early identification of atopy, which may burden the physical performances 7 .…”