Asthma in runners

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6961.1087 (Published 22 October 1994) Cite this as: BMJ 1994;309:1087
  1. H O Tikkanen,
  2. I Helenius
  1. Research Institute for Olympic Sports, Rautpohjankatu 6, 40 700 Jyvaskyla, Finland
  2. Department of Allergic Diseases, Helsinki University Central Hospital, Helsinki, Finland.

    EDITOR, - Larrson et al reported that out of 42 Swedish elite cross country skiers, 23 had asthma and 31 asthma-like symptoms.1 In 1984, 11.2% of the athletes in the United States' Olympic team had asthma induced by exercise.2 Thus, in elite athletes and espically in skiers symptoms of exercise induced asthma are common.1 Running is the most effective way to provoke such asthma,3 and bronchoconstriction in connection with exercise is exacerbated by inhalation of cold dry air or allergens.4,5 However, exercise induced asthma has not yet been thoroughly studied in runners. During winter in countries with four distinct seasons runners train outdoors in cold temperatures or indoors, where air quality may be poor. During spring and summer they are exposed to many pollen allergens.

    We studied the occurrence of asthma, asthma like symptoms, and allergy in elite athletes. Volunteer subjects were 103 runners from the Finnish adult and junior national teaning. Their main event ranged from the 400 m to the marathon, and they had run a mean distance in training in the previous year of 4140 km (range 1500-8500 km). Their mean age was 22.9 (SD5.5) years, and they had been active competitors for a mean of 9.3 (4.5) years. They completed questionnaires about allergies, asthma, and asthma-like symptoms connected with exercise (cough, breathlessness, or wheeze) and their relation to training and environmental conditions.

    Sixteen of the runners had asthma documented by a physician. Twenty four of the 87 remaining runners (28%) had allergies. All 16 runners with asthma and 14 of the 24 runners with allergies (58%) reported having symptoms like exercise induced asthma. However, 23 of the 63 runners without asthma or allergies (37%) reported having such symptoms occasionally. Thus asthma-like symptoms were strongly associated with allergies as 75% (30/40) of the runners with allergies had symptoms compared with 37% (23/63) of the runners without allergies (X2 test, P<0.01). Indoor training caused symptoms like exercise induced asthma in 41 of the 103 runners (40%), and outdoor training in cold air caused such symptoms in 31 (30%).

    Asthma and symptoms like exercise induced asthma adversely affect not only cross country skiers1 but also middle and long distance runners, with over half of the runners in our study (52% (53/103)) being affected. In countries with four distinct seasons the circumstances of training may stress the airway mucous membranes to induce exercise induced asthma and symptoms like it in elite athletes, who use large ventilation volumes and train intensively all year round. In runners cold weather may be a minor problem, but allergy and exposure to aeroallergens during the pollen season in spring and indoor training in winter may be important factors in provoking asthma-like symptoms.


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