Reier-Nilsen T, Stang JS, Flatsetøy H, et al. Unsupervised field-based exercise challenge tests to support the detection of exercise-induced lower airway dysfunction in athletes.


The full article can be found here


Tell us more about yourself and the author team

I, Tonje Reier-Nilsen, corresponding author and PI for the present study, hold a speciality in paediatrics (2011), allergology (2016 + PhD 2019) and sports and exercise medicine (2020), and am an active scientist in ORAACLE and Oslo Sports Trauma Research Centre (OSTRC). I was previously responsible for asthma at the Pediatric Department for Allergology and Lung Diseases at Oslo University Hospital. I am responsible for breathing issues in athletes at the National Olympic Training Centre in Oslo, Norway. Björn Nordlund is a registered nurse, associate professor in pediatric allergology, research group leader at Karolinska Institutet, and the director for research and development at Astrid Lindgren Children’s Hospital in Stockholm. Julie Stang holds a PhD in exercise lung physiology and is an active scientist at the Norwegian School of Sport Sciences. Hanne Flatsetøy is a physiologist and was assisting in conducting the bronco provocation tests in the lab. Roald Bahr is a professor in sports medicine at the Norwegian School of Sport Sciences, Chief Medical Officer of OSTRC, and medical chief at the Norwegian Olympic Sports Centre. Martine Isachsen M.Sc is a registered nurse in the B. Nordlund research group at Karolinska Institutet and also the implementation leader of AsthmaTuner at MediTuner AB in Stockholm, and Henrik Ljungberg PhD is a pediatric pulmonologist at Astrid Lindgren Children’s Hospital, affiliated to Karolinska Institutet, and medical chief of MediTuner AB in Stockholm.


What is the story behind your study?

This story is about what may happen when good friends meet during a congress, perhaps while having a beer in the bar. My friend, Björn Nordlund, told me during the EAACI congress in pre-pandemic 2019 that he just had published a paper on how an app-based spirometer may improve asthma control. That made sense since asthma is a fluctuating condition, and seeing patients in the clinic on a day with no exposure in a clean and warm room is logically not bringing the worst asthma reactions to the patient. We agreed that this could be transferred to athletes, who often experience symptoms during their training and competition, which is not reproduced in the lab. Hence, physicians in sports and exercise medicine often struggle with documentation of exercise-induced asthma and evaluation of proper treatment. In well-resourced countries, this is dealt with by bringing equipment and personnel to the athletes’ training area, including actual environment, workload, and intensity, i.e. field-based exercise challenge tests (ECTs). However, this is resource-demanding and unfair to lower-resource countries and sports. An idea was born.

In the Systematic Review and Meta-analysis on diagnostic approaches to lower airway dysfunction (LAD) in athletes, published in BJSM in January 2023, the conclusion was that eucapnic voluntary hyperpnoea test and field-based ECTs offered similar diagnostic test performance, but field-based ECTs seemed to be better.


In your own words, what did you find?

The findings in this study support that the actual environment, workload and intensity in the athletes sport specific training and competition are not possible to reproduce in standardised bronchial provocation tests performed in the lab. Hence, an app-based spirometer used in field-based ECTs may support the diagnostic process of the fluctual condition LAD.


What is the main challenge you faced in your study?

The main challenge is to demonstrate the reliability of this innovative method. However, the paper thoroughly discusses this, including the built-in ATS/ERS guidelines in the software and the normalisation of findings after asthma treatment. We can also inform you that we are about to complete a feasibility study from the users’ perspective, demonstrating that almost all participants found the app-based spirometer easy to use and almost without technical problems.


If there is one take-home message from your study, what would it be?

Using an app-based spirometer, we can now detect, document and treat LAD in athletes who otherwise would not have any diagnosis explaining their symptoms. This new method may also reduce the worldwide gap in access to appropriate assessment for LAD-symptomatic athletes.  

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