Respiratory symptoms cannot be relied on to make a diagnosis of asthma and/or airways hyperresponsiveness (AHR) in elite athletes. For this reason, the diagnosis should be confirmed with bronchial provocation tests. Asthma management in elite athletes should follow established treatment guidelines (eg, Global Initiative for Asthma) and should include education, an individually tailored treatment plan, minimization of aggravating environmental factors, and appropriate drug therapy that must meet the requirements of the World Anti-Doping Agency. Asthma control can usually be achieved with inhaled corticosteroids and inhaled Beta2-agonists to minimize exercise-induced bronchoconstriction and to treat intermittent symptoms. The rapid development of tachyphylaxis to Beta2-agonists after regular daily use poses a dilemma for athletes. Long-term intense endurance training, particularly in unfavorable environmental conditions, appears to be associated with an increased risk of developing asthma and AHR in elite athletes. Globally, the prevalence of asthma, exercise-induced bronchoconstriction, and AHR in Olympic athletes reflects the known prevalence of asthma symptoms in each country. The policy of requiring Olympic athletes to demonstrate the presence of asthma, exercise-induced bronchoconstriction, or AHR to be approved to inhale Beta2-agonists will continue. Article Outline: Diagnosis of asthma in elite athletes Does the athlete have asthma? Bronchial provocation tests Management of asthma in elite athletes Optimal management of asthma in athletes Benefits and dangers of Beta2-agonists Experience of athletes having to demonstrate the need to inhale Beta2-agonists Beta2-Agonists experience at Olympic Games IAAF Beta2-agonist experience Environmental aspects of asthma in elite athletes Training as a cause of asthma Why are patients with asthma successful at the Olympic Games? Conclusion Why inhaled Beta2-agonists are prohibited and why the IOC has introduced its policy on inhaled Beta2-agonists The effect of inhaled Beta2-agonists on endurance performance: Olympic medalists inhaling Beta2-agonists Genetic aspects of asthma IOC consensus statement on asthma in elite athletes Diagnosis of asthma in elite athletes Management of asthma in elite athletes Environmental aspects of asthma in elite athletes Training as a cause of asthma in elite athletes Past experience of Beta2-agonist use in elite athletes Future of Beta2-agonists in elite athletes
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