Elite swimmers can be considered a different population to recreational swimmers, as a result of their differing exposure patterns. It may be that the increased exposure to chlorine leads to an airway remodelling and inflammatory process, giving a positive EVH test. One potential problem is the dry air used for EVH tests at only 2% humidity, versus the 60% humidity seen in a typical swimming pool, which may affect airway responsiveness during the testing process. As yet this has not been accounted for in the research. Further work needs to be performed to look at the difference in individual swimmers when they change training environments, to see if this alters the EVH response and possibly ENO levels. This may give further clues as to whether the environment is the cause of the higher EVH-positive rates. It is currently not established whether treating athletes with previously undiagnosed EIB leads to an increase in performance. Treatment of nasal symptoms probably decreases the rates of unpleasant symptoms and increases the quality of life for swimmers. It may also decrease the incidence of upper respiratory tract infection, but this has not been confirmed. In those swimmers with respiratory symptoms, but a negative EVH test, breathing re-training exercises may be beneficial. To help guide treatment options in swimmers presenting with breathing dysfunction, an EVH test is invaluable to determine the presence of EIB and should be considered by sports and primary care physicians. The increased rate of positive EIB tests in elite athletes should not be used as evidence that swimming causes asthma in children or recreational swimmers, due to the different exposure patterns between these groups.
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