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Prevalence, age at onset, and risk factors of self-reported asthma among Swedish adolescent elite cross-country skiers
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. (Arcum)ORCID-id: 0000-0003-3739-0084
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. (Arcum)
2018 (Engelska)Ingår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 28, nr 1, s. 180-186Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The objective of the study was to compare the prevalence of self-reported physician-diagnosed asthma and age at asthma onset between Swedish adolescent elite skiers and a reference group and to assess risk factors associated with asthma. Postal questionnaires were sent to 253 pupils at the Swedish National Elite Sport Schools for cross-country skiing, biathlon, and ski-orienteering (skiers) and a random sample of 500 adolescents aged 16-20, matched for sport school municipalities (reference). The response rate was 96% among the skiers and 48% in the reference group. The proportion of participants with self-reported physician-diagnosed asthma was higher among skiers than in the reference group (27 vs 19%, P=.046). Female skiers reported a higher prevalence of physician-diagnosed asthma compared to male skiers (34 vs 20%, P=.021). The median age at asthma onset was higher among skiers (12.0 vs 8.0years; P<.001). Female sex, family history of asthma, nasal allergy, and being a skier were risk factors associated with self-reported physician-diagnosed asthma. Swedish adolescent elite cross-country skiers have a higher asthma prevalence and later age at asthma onset compared to a reference population. Being an adolescent, elite skier is an independent risk factor associated with asthma.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2018. Vol. 28, nr 1, s. 180-186
Nyckelord [en]
asthma, epidemiology, athlete, skiing
Nationell ämneskategori
Lungmedicin och allergi
Identifikatorer
URN: urn:nbn:se:umu:diva-144355DOI: 10.1111/sms.12879ISI: 000422630100019PubMedID: 28314090Scopus ID: 2-s2.0-85017530379OAI: oai:DiVA.org:umu-144355DiVA, id: diva2:1180444
Anmärkning

Corrigendum: The first author name has been changed from Linda M. Eriksson to Linda Eklund. (DOI: 10.1111/sms.13401)

Tillgänglig från: 2018-02-05 Skapad: 2018-02-05 Senast uppdaterad: 2023-05-08Bibliografiskt granskad
Ingår i avhandling
1. Prevalence and incidence of and risk factors for asthma and exercise-induced laryngeal obstruction in elite endurance athletes
Öppna denna publikation i ny flik eller fönster >>Prevalence and incidence of and risk factors for asthma and exercise-induced laryngeal obstruction in elite endurance athletes
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Asthma is highly prevalent in endurance athletes, but we lack up-to-date information on the prevalence and incidence of asthma in cross-country skiers. Exercise-induced laryngeal obstruction (EILO) is an important differential diagnosis to exercise-induced asthma, and its symptoms can mimic asthma. The two conditions may co-exist, and misdiagnosis of EILO may result in unnecessary asthma treatment. The gold standard diagnostic test for EILO is continuous laryngoscopy during exercise (CLE). 

Aims: The aim of this thesis was to study the prevalence and incidence of asthma in endurance athletes, with a special focus on cross-country skiers. In addition, the thesis aimed to assess the prevalence of EILO in cross-country skiers and to study the intra-individual variability of laryngeal obstruction scores using the CLE test. 

Methods: Study 1 (papers I & II) comprised a cohort of elite endurance athletes who participated in an annual postal survey including questions regarding asthma, allergy, and exercise between 2011 and 2015. The invited athletes were Swedish elite skiers and orienteers, belonging to national teams, universities with elite sport contracts, Swedish National Elite Sport Schools, or national top ranking. The study population in paper I comprised adolescent skiers at Swedish National Elite Sport Schools (n=253) between 2011 and 2013, together with a reference population aged 16–20 years that was matched for school municipality (n=500) and invited in 2013. Paper II included all skiers and orienteers (n=666) participating in the prospective survey in 2011–2015. The incidence of physician- diagnosed asthma was defined as the number of incident cases of physician- diagnosed asthma divided by the summarized time at risk in person-years in the population without physician-diagnosed asthma at baseline. 

In study 2 (papers III & IV), elite skiers and competitive athletes (n=109) were screened for allergy, exercise-induced bronchoconstriction, and EILO at Östersund Hospital between 2015 and 2017. The participants answered a questionnaire regarding asthma, allergy, and exercise and underwent a CLE test, eucapnic voluntary hyperventilation (EVH) test, and skin prick test. Laryngeal obstruction was assessed at the glottic and supraglottic levels using a visual grade iv score (0–3 points). EILO was defined as ≥ 2 points at maximal effort exercise. Current asthma was defined as self-reported physician-diagnosed asthma and use of asthma medication in the last 12 months. All participants were invited to a follow-up examination off-season if the first examination was performed during the competitive season, or on-season if the first visit occurred during off-season. Paper III included 89 elite skiers that completed the first baseline visit. Paper IV included all 29 athletes that completed the baseline and follow-up testing regardless of diagnosis, treatment, and respiratory symptoms. 

Results: In paper I, the response rate was 96% in the skier population and 48% in the reference population. Skiers at Swedish National Elite Sport Schools had a higher prevalence of physician-diagnosed asthma than the reference population (27% vs. 19%, p=0.046). Median age at asthma onset was higher in skiers compared to in the reference population (12.0vs 8.0 years, p<0.001). Female sex, family history of asthma, nasal allergies, and being a skier were independent risk factors associated with physician-diagnosed asthma. 

In paper II, the response rate was 88.7% at baseline and decreased by year of follow-up. The population at risk at baseline consisted of 290 skiers and 159 orienteers, and the incidence rate (95% confidence interval [CI]) of physician- diagnosed asthma was 61.2 (45.7–80.3) per 1000 person-years. Risk factors for incident physician-diagnosed asthma were family history of asthma, being a skier, and wheezing without having a cold. 

In paper III, 24 (27%) of the 89 elite cross-country skiers fulfilled the study criterion for EILO. Current asthma was present in 34 (38%) skiers, whereof 10 (29%) of whom had concomitant EILO. A higher proportion of skiers with EILO and current asthma reported wheezing or shortness of breath following exercise compared to skiers with asthma only. 

In paper IV, the CLE score was mainly unchanged at follow-up after 3–23 months. In the 11 athletes with moderate supraglottic obstruction at first visit and receiving advice for breathing exercises, 3 (27%) had mild obstruction at follow- up. Among athletes without no or mild supraglottic obstruction at first visit, 3 (17%) had moderate laryngeal supraglottic obstruction at follow-up. 

Conclusions: Adolescent skiers have a high prevalence of self-reported physician-diagnosed asthma. The onset of asthma commonly occurs during early adolescence. Endurance athletes also have a high incidence of physician-diagnosed asthma v during their career, especially among skiers. Furthermore, skiers have a high prevalence of EILO, including nearly 30% of skiers with current asthma. In endurance athletes, the grade of laryngeal obstruction according to CLE was fairly stable when reassessed after 3–23 months, regardless of the grade of laryngeal obstruction, respiratory symptoms at baseline, and advice on breathing exercises after the first visit. Therefore, when assessing skiers with exercise-related respiratory symptoms, both EILO and asthma should be considered. 

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet, 2021. s. 77
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2138
Nyckelord
asthma, exercise-induced laryngeal obstruction, EILO, continuous laryngoscopy during exercise test, CLE, prevalence, risk factors, incidence, athletes, skiers, endurance athletes
Nationell ämneskategori
Lungmedicin och allergi Oto-rino-laryngologi
Forskningsämne
idrottsmedicin; lungmedicin; oto-rhino-laryngologi
Identifikatorer
urn:nbn:se:umu:diva-182734 (URN)978-91-7855-516-1 (ISBN)978-91-7855-515-4 (ISBN)
Disputation
2021-05-28, Hörsalen, Östersund, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2021-05-07 Skapad: 2021-05-04 Senast uppdaterad: 2021-05-04Bibliografiskt granskad
2. Cold air, physical activity, and the airways: epidemiological and experimental studies
Öppna denna publikation i ny flik eller fönster >>Cold air, physical activity, and the airways: epidemiological and experimental studies
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Kall luft, fysisk aktivitet och luftvägarna : epidemiologiska och experimentella studier
Abstract [en]

Background: Cold exposure is associated with increased morbidity and mortality. Elite cross-country skiers are regularly exposed to cold, dry air and have a high prevalence of asthma compared to the Swedish population. However, evidence is limited regarding how a combination of sub-zero temperatures and physical activity affects the airways of healthy individuals.

Aims: The aims of this thesis were to study the prevalence of self-reported asthma, age at asthma onset, and predictors of asthma in Swedish endurance athletes, with a focus on cross-country skiers. This thesis also aimed to assess the effects of subzero temperature and physical activity on healthy human airways.

Methods: Study 1 (papers I-II) consisted of an annual postal questionnaire investigating asthma prevalence and predictors of asthma that was sent to invited athletes in 2011–2015. Invited athletes were Swedish elite cross-country skiers, biathletes, ski orienteers, and orienteers from Swedish National Elite Sport Schools, national teams, and Swedish Ski Universities, or top orienteers according to national ranking. Former Swedish Olympic skiers and an adolescent reference group were invited in 2013. Paper I included cross-sectional data from 2011 for adolescents/adults and from 2013 for former skiers (n=491). Paper II included adolescent elite skiers (n=253) from the Swedish National Elite Sport Schools invited during 2011-2013, as well as a reference group (n=500) aged 16-20 years that was matched for school municipalities and invited in 2013. Study 2 (papers III-IV) comprised whole-body experimental exposure of healthy adults to sub-zero temperatures and exercise in an environmental chamber. Lung function and biochemical markers in plasma and urine were measured before and after exposure. Symptoms were investigated before, during, and after exposure. In both trials, study subjects were exposed for 50 min on two separate occasions in randomized order. Paper III comprised 31 subjects and moderate-intensity exercise (30 min running at 62-78% of VO2max), at 10°C vs. -10°C. Paper IV included 29 subjects and hard-intensity exercise (30 min of running at 85% of VO2max) vs. rest, both at a temperature of -15°C.

Results: In paper I, the overall response rate was 82%. Athletes reporting asthma in the different age categories were: 29% of skiers (38% of the female skiers) and 17% of orienteers (p=0.071) among 15 to 19-year-olds; 35% of skiers and 16% of orienteers (p=0.029) among 20 to 34-year-olds; and 22% of the skiers aged 40–94 years. Asthma onset occurred in adolescence among the active athletes. Increasing age, female sex, allergy, family history of allergy/asthma, and being a skier were predictors of self-reported physician-diagnosed asthma. In paper II, the response rate was 96% for skiers and 48% for the reference group. Skiers reported a higher prevalence of self-reported physician-diagnosed asthma than the reference population (27% vs. 19%, p=0.046). Physician-diagnosed asthma was more frequently reported by female skiers than male skiers (34% vs. 20%, p=0.021). Median age at asthma onset was higher among skiers than in the reference population (12.0 vs. 8.0 years; p<0.001). Female sex, family history of asthma, nasal allergy, and being a skier were risk factors associated with self-reported physician-diagnosed asthma. In paper III, exercise at -10°C decreased FEV1 (p=0.002) and FEV1/FVC (p<0.001) and increased resistance at 20 Hz (p=0.016) to similar magnitudes as exercise at 10°C. Exercise at 10°C increased reactance (p=0.005), which differed (p=0.042) from a less pronounced response after exercise at -10°C. Plasma CC16 increased similarly after both exposures, without significant differences. More intense symptoms from the upper airways were reported after exercise at -10°C than at 10°C. Symptoms from the lower airways were few and mild. In paper IV, FEV1 decreased from baseline after both rest (p<0.001) and exercise (p=0.012) at -15°C, with no differences between exposures. Compared to rest, exercise at -15°C induced greater increases in reactance (p=0.023), plasma CC16 (p<0.001), and plasma IL-8 (p<0.001). Exercise gave rise to more intense symptoms from the lower airways, whereas rest induced more general symptoms.

Conclusions: In the 1990s, a high prevalence of physician-diagnosed asthma was reported among Swedish elite cross-country skiers, and our studies show that this has not changed. Asthma onset commonly occurs in early adolescence among skiers, in the beginning of their career. Being an elite skier is an independent risk factor associated with asthma. Targeted preventive measures should be introduced at an early age to avoid the development of asthma in endurance athletes. Healthy individuals performing short-duration moderate- and hard-intensity exercise in sub-zero temperatures responded with lung function changes and an increased airway permeability. These findings warrant further research on airway responses to sub-zero temperatures in vulnerable individuals such as elite endurance athletes.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2023. s. 67
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2238
Nyckelord
asthma, asthma medication, athletes, cold temperature, environmental chamber, epidemiology, healthy, orienteers, physical activity, respiratory symptoms, risk factors, skiers
Nationell ämneskategori
Lungmedicin och allergi
Forskningsämne
lungmedicin
Identifikatorer
urn:nbn:se:umu:diva-208096 (URN)978-91-8070-047-4 (ISBN)978-91-8070-048-1 (ISBN)
Disputation
2023-06-02, Hörsalen, Östersunds sjukhus, 09:00 (Svenska)
Opponent
Handledare
Forskningsfinansiär
Region Jämtland Härjedalen, 8291Region Jämtland Härjedalen, 8260Visare Norr, 2751
Tillgänglig från: 2023-05-12 Skapad: 2023-05-08 Senast uppdaterad: 2023-08-25Bibliografiskt granskad

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