Reier-Nilsen, TonjeSewry, Nicola AnnChenuel, BrunoBacker, VibekeLarsson, KjellPrice, Oliver J.Pedersen, LarsBougault, ValerieSchwellnus, Martin PeterHull, James H.2023-03-142023-03-142023-04Reier-Nilsen, T., Sewry, N., Chenuel, B. et al. Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’. British Journal of Sports Medicine 2023 Apr;57(8):481-489. doi: 10.1136/bjsports-2022-106059.0306-3674 (print)1473-0480 (online)10.1136/bjsports-2022-106059https://repository.up.ac.za/handle/2263/90103OBJECTIVES : To compare the performance of various diagnostic bronchoprovocation tests (BPT) in the assessment of lower airway dysfunction (LAD) in athletes and inform best clinical practice. DESIGN : Systematic review with sensitivity and specificity meta-analyses. DATA SOURCES : PubMed, EBSCOhost and Web of Science (1 January 1990–31 December 2021). ELIGIBILITY CRITERIA : Original full-text studies, including athletes/physically active individuals (15–65 years) who underwent assessment for LAD by symptom-based questionnaires/history and/or direct and/or indirect BPTs. RESULTS : In 26 studies containing data for quantitative meta-analyses on BPT diagnostic performance (n=2624 participants; 33% female); 22% had physician diagnosed asthma and 51% reported LAD symptoms. In athletes with symptoms of LAD, eucapnic voluntary hyperpnoea (EVH) and exercise challenge tests (ECTs) confirmed the diagnosis with a 46% sensitivity and 74% specificity, and 51% sensitivity and 84% specificity, respectively, while methacholine BPTs were 55% sensitive and 56% specific. If EVH was the reference standard, the presence of LAD symptoms was 78% sensitive and 45% specific for a positive EVH, while ECTs were 42% sensitive and 82% specific. If ECTs were the reference standard, the presence of LAD symptoms was 80% sensitive and 56% specific for a positive ECT, while EVH demonstrated 65% sensitivity and 65% specificity for a positive ECT. CONCLUSION : In the assessment of LAD in athletes, EVH and field-based ECTs offer similar and moderate diagnostic test performance. In contrast, methacholine BPTs have lower overall test performance.en© Author(s) (or their employer(s)) 2023.AsthmaAthletesExercise‐induced bronchoconstrictionDiagnosisRespiratory symptomsBronchoprovocation tests (BPT)Lower airway dysfunction (LAD)Postprint Article