New guidance to improve diagnosis of respiratory problems in athletes

A new clinical statement on exercise-associated respiratory problems, the first of its kind in the UK, is set to improve diagnosis, according to a consultant respiratory physician at Royal Brompton Hospital.

Dr James Hull, also a member of the Institute of Sport, Exercise and Health, UCL, chaired the group behind the British Thoracic Society (BTS) Clinical Statement for the Assessment and Management of Respiratory Problems in Athletic Individuals, which was published today. 

The group brought together experts in respiratory medicine, sports medicine, primary care, physiotherapy, speech and language therapy, physiology, and patient input.

Dr Hull said it was "an honour to chair the development of the clinical Statement, which aims to ensure that any athletic individual struggling with breathing-related problems gets the best advice on the cause of their issues and treatment. 

The Statement looks at the diagnosis, evaluation, and management of respiratory problems, with an estimated one in four athletic individuals reporting troublesome exercise-related respiratory issues, such as breathlessness, cough, and wheeze,

"This guidance is the first to cover the whole comprehensive gamut, covering all clinical issues, with relevance nationally and globally," Dr Hull said.

The guidance emphasises the need to use high-quality investigations to ensure a secure diagnosis and characterise breathing issues in athletes, as there is a significant risk of misdiagnosis if an assessment is based solely on clinician-based evaluation. 

While people present to primary care with exercise-associated respiratory problems approximately once per month, this is the first focused guidance on this issue to aid clinicians in diagnosis and management. Previously many athletic individuals have been advised that the simplest way to improve their symptoms is to avoid or reduce sporting activity.

The authors provide guidance and a pragmatic approach to assessing the most frequently encountered sports-related respiratory issues and highlight essential considerations in helping manage athletic individuals with general respiratory disorders, such as an athlete with pneumonia or a collapsed lung.

Asthma is the most prevalent medical condition among competitive athletes, impacting one of four who partakes in endurance sports. The Statement highlights clinical presentations unique to sport, such as swimming-induced pulmonary oedema.

"Therefore, whilst the broad principles of clinical assessment of the respiratory system apply, there are several caveats and considerations when assessing the athletic population.

"This Statement should support clinicians faced with tackling respiratory issues in athletic individuals and ensure people can continue to partake in and enjoy sporting activity successfully," Dr Hull added. 

Dr Richard Grocott-Mason, CEO of Royal Brompton and Harefield Hospitals, said: “The new Clinical Statement will have a huge impact on how athletes with respiratory problems are diagnosed and treated. I’m very proud of Dr Hull’s contribution as Chair of this significant work.”