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Bronchial hyperresponsiveness testing in athletes of the Swiss Paralympic team

Mirjam Osthoff1, Franz Michel2, Matthias Strupler2, David Miedinger1, Anne B Taegtmeyer3, Jörg D Leuppi4* and Claudio Perret2

Author affiliations

1 Clinic of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel, CH- 4031, Switzerland

2 Institute of Sports Medicine, Swiss Paraplegic Center, Nottwil, Switzerland

3 Clinic of Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland

4 Faculty of Medicine, University of Basel and University Clinic of Internal Medicine, Kantonsspital Baselland, Liestal, CH4410, Switzerland

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Citation and License

BMC Sports Science, Medicine and Rehabilitation 2013, 5:7  doi:10.1186/2052-1847-5-7

Published: 15 April 2013



The aim of this study was to assess airway hyperresponsiveness to eucapnic voluntary hyperventilation and dry powder mannitol challenge in athletes aiming to participate at the Paralympic Games 2008 in Beijing, especially in athletes with spinal cord injury.


Forty-four athletes with a disability (27 with paraplegia (group 1), 3 with tetraplegia (group 2) and 14 with other disabilities such as blindness or single limb amputations (group 3) performed spirometry, skin prick testing, measurement of exhaled nitric oxide, eucapnic voluntary hyperventilation challenge test (EVH) and mannitol challenge test (MCT). A fall in FEV1 of ≥10% in either challenge test was deemed positive for exercise-induced bronchoconstriction.


Fourteen (32%) athletes were atopic and 7 (16%) had a history of physician-diagnosed asthma. Absolute lung function values were significantly lower in patients of group 1 and 2 compared to group 3. Nine (20%) athletes were positive to EVH (8 paraplegics, 1 tetraplegic), and 8 (18%) athletes were positive to MCT (7 paraplegics, 1 tetraplegic). Fourteen (22.7%) subjects were positive to at least one challenge; only three athletes were positive to both tests. None of the athletes in group 3 had a positive test. Both challenge tests showed a significant association with physician-diagnosed asthma status (p = 0.0001). The positive and negative predictive value to diagnose physician-diagnosed asthma was 89% and 91% for EHV, and 75% and 86% for MCT, respectively.


EVH and MCT can be used to identify, but especially exclude asthma in Paralympic athletes.

Disability; Eucapnic voluntary hyperventilation; Exercise-induced bronchoconstriction; Spinal cord injury; Mannitol challenge; Paraplegia