By Marina Green

One in five elite endurance athletes has asthma — a troubling statistic that has held constant for four decades in what some experts term “an occupational lung disease.”

For those top athletes who make it to the very pinnacle of performance, respiratory health is a priority.

Now, the International Olympic Committee Medical and Scientific Commission (IOC-MSC) has identified respiratory health as a critical issue for athletes and designated a special group to provide guidance on the topic.

“Respiratory issues represent a major burden in the context of competitive sport and significantly affect athlete health, wellbeing, and performance,” according to a recent article published in The Lancet. “Lessons learned from evaluating this population could benefit the care of all active individuals and those participating in vigorous exercise.”

Exactly why competitive athletes so frequently wheeze, cough and experience breathlessness is unclear, but symptoms are exacerbated when exercise occurs in places with poor air quality. That isn’t limited to traditional forms of air pollution, but can extend to highly chlorinated swimming pools where elite swimmers work out.

“If you’re an elite athlete, you’re twice as likely to experience an asthma-related condition than you are if you were just a member of the general population,” John Dickinson, a Professor in Sport and Exercise Sciences at the University of Kent, told Euro News.

Airway hyper-responsiveness, an asthma symptom in which bronchospasms are easily triggered, can develop over an elite athlete’s career and can regress once exercise is halted, research has found.

“Indeed, the repeated episodes of hyperpnoea, necessitated by vigorous exercise, could lead to the development of distinct airway pathobiology, with studies revealing airway cellular changes akin to a form of airway injury,” according to The Lancet authors. “As such, it has been argued that asthma in athletes could be viewed as an occupational lung disease.”

Clearly, some top athletes, plagued by asthma all their lives, have overcome its challenges and attained Olympic gold. Swimmer Amy Van Dyken, Sprinter Noah Lyles and figure skater Kristi Yamaguchi are just a few.

Still, even as understanding of respiratory issues in athletes grows, little is known about the lung health of Olympians from less developed countries where training facilities can be located near industrial areas, with few adjustments made for training or competing during times of peak pollution levels.

The Lancet authors call on respiratory and sports physicians to step in to protect the lung health of elite athletes through:

• Better disease understanding before respiratory issues occur
• Improved detection and diagnosis of respiratory disorders during exercise
• Restricting poor air quality exposure by establishing cancellation or postponement guidelines for training and competitions
• Sharing knowledge with countries with fewer resources, to promote health equity

The increased study comes none-too-soon as locations from Canada to Greece and beyond experience threats to air quality from raging wildfires and seasonal haze — problems only expected to grow with global warming.

Surfers & Chess Players is encouraged by the IOC’s new focus on lung health in Olympic athletes. We believe it’s every bit as important as their attention to mental health, harassment and abuse. Better understanding of respiratory diseases among athletes can help society overall, especially given an aging population with rising cases of airway ailments, including chronic obstructive pulmonary disease (COPD).

As research on respiratory challenges in athletes grows more sophisticated, physicians can better distinguish symptoms that mimic asthma and avoid unnecessary treatment. One example is Exercise Induced Laryngeal Obstruction (EILO) which afflicts top athletes, including a large contingent of elite cross-country skiers, especially women. It is characterized by transient partial closure of the laryngeal inlet during vigorous exercise.