Immunology

Summary
As physicians, we suspect exercise-induced asthma when a patient presents with shortness of breath induced by aerobic activity. To assess the validity of such a history in professional athletes, the authors of this investigation studied English professional soccer players. They evaluated 65 players who had a physician diagnosis of exercise-induced asthma. Their evaluation consisted of pulmonary function testing, recording of medication use and symptoms, bronchial provocation testing with dry air (42 players) and with mannitol (18 players), and in players with abnormal resting spirometry, a bronchodilator test.  
 
Of the 65 players evaluated, 57 (88%) used regular asthma medication. Only 33 players had a positive bronchodilator or bronchial provocation test. Neither symptoms nor the use of inhaled corticosteroids were predictive of pulmonary function test results.  
 
The authors concluded that a high proportion of English professional soccer players medicated for exercise-induced asthma showed no evidence of this condition when tested for reversible airway obstruction or airway hyperresponsiveness.
 
Comment: We are all presented with patients who show no evidence of asthma per se, but who present with shortness of breath only on exertion. It is important to note that in a significant number of instances, the dyspnea, although diagnosed as exercise asthma, is not due to this condition.  
 
Reference
Ansley L, et al. Misdiagnosis of exercise-induced bronchoconstriction in professional soccer players. Allergy 2012; 67(3):390-395.