Wheezing after Respiratory Tract Infection in Athletes

Abstract

Wheezing is a commonly encountered complaint by patients seen in sports medicine practice. Wheezes are a continuous musical sound heard best on expiration and can originate from one or more of several defined anatomical locations in the human airway. While common causes of wheezing include exercise-induced bronchoconstriction, postnasal drip, and asthma, wheezing also follows specific respiratory infections and can persist for months after the onset of symptoms. Abnormal lung physiology following pneumonia can persist for decades. These postinfectious pulmonary changes affect the ability of athletes to return to sports. In addition to history and physical examination, diagnosis may require pulmonary function testing and exercise challenge testing. The cornerstone to management is an accurate diagnosis and using lifestyle and pharmacologic intervention. Return to play should be gradual and allowed only after individuals demonstrate adequate pulmonary capacity to meet the demands of their sport. Providers also should be aware of governing body regulations regarding treatments and required therapeutic use exemptions.

Asthma, allergy and the Olympics

“…Although URTIs have been shown to be followed by wheezing in athletes [16], allergy is considered to be the major risk factor for asthma in this population. In fact, the risk of asthma increases 25-fold in atopic speed and power athletes, 42-fold in atopic long-distance runners and 97-fold in atopic swimmers [17].…”

“…However, independently from the above potential confounders, studies performed in Olympic teams before 2000 show that the prevalence of asthma in elite athletes is high and increasing, from 9.7% in 1976 to 21.9% in 1996 in the Australian Olympic delegation [4,5], and from 11.2% in 1984 to 16.7% in 1996 in the US Olympic delegation [6,7]. Asthma in elite athletes appears to be a distinct phenotype [8][9][10][11][12] which needs adequate attention and management considering that 23.1% of the 263 sudden deaths in athletes reported by Becker et al [13] occurred in asthmatic athletes.…”