Respiratory symptoms are common in elite level swimmers, as is a diagnosis of asthma. Previous studies have suggested higher levels of eosinophilic disease in swimmers compared to other endurance sports. How the degree of symptoms relates to airways flammation and airways hyperresponsiveness remains unclear, especially whether there is a particular phenotype for `swimmers asthma`. Methods: Athletes were inhaled corticosteroid naïve or stopped steroids for 4 weeks prior to testing. All had symptoms suggestive of exercise asthma. They had baseline exhaled nitric oxide, spirometry, EVH and an induced sputum inflammatory cell percentage carried out using our standard research protocols. Symptoms were scored using the Juniper Asthma Control Questionnaire Results: A total of 60 athletes took part in the study. The complex relationship between symptoms (ACQ score), airways inflammation (log sputum eosinophil %) and airways hyperresponsiveness (>10% fall in FEV1 post EVH) is shown in the graph below. Conclusions: There is marked heterogeneity within the swimming population for athletes with the same or similar levels of symptoms on exertion. This would suggest that the return to clinical diagnosis in this group as suggested by the revised WADA guidelines is unhelpful and detailed objective assessment is needed to appropriately guide treatment and management.
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