Cross-country skiers’ suffer non-allergic asthma

Competitive cross-country skiers who undertake an intensive training schedule have an increased risk of non-allergic asthma, researchers report today.

Cross-country skiers are twice as likely to develop asthma as the general population, with symptoms usually starting in the early teens.

While the risk factors for allergic asthma are well known, those for different types of non-allergic asthma aren’t as clearly defined.

Researchers, led by a team at Tampere University, Finland, invited all Finnish cross-country skiers who had enrolled in either national championships from the age of 17 onwards or the largest national junior skiing Hopeasompa competition, which is open to 13–16 year olds, to complete a questionnaire on asthma development.

Out of 1282 competitive skiers, 351 responded and they were matched for age, gender, and geographical region with 338 people who weren’t cross-country skiers.

The findings from this observational study are published in *BMJ Open Sports & Exercise Medicine*.

For the study, current asthma was defined as experiencing one or more of: three asthma-related symptoms; active use of any asthma medication; or an Asthma Control Test (ACT) score of fewer than 25 points to indicate good asthma control.

Out of the 351 respondents, 189 had been diagnosed, or tested, for asthma, and 91 had current symptoms. This compared to 69 of the non-skiers, 31 of whom had current symptoms. More skiers used medication to control their asthma than those in the control group at 123 compared to 39.

The researchers also found that 36 of the 91 skiers with current asthma symptoms had allergic asthma, compared with 19 of the 31 non-skiers, but 55 of the skiers with current symptoms had non-allergic asthma compared with 12 of the non-skiers.

While there was no difference in the prevalence of allergic asthma between the two groups, there were significant differences in the prevalence of non-allergic asthma between the two groups at 60% compared to 39%.

Cross-country skiers were nearly 3.5 times as likely to have asthma, nearly twice as likely to have allergic asthma, but more than five times as likely to have non-allergic asthma as non-skiers.

Asthma in parents or siblings and allergic rhinitis were strongly associated with current asthma in both groups, but the team found sporting success and training hours were also influential.

Looking at the skiers, 163 (46%+) had participated in International Ski Federation (FIS) competitions. Those with asthma had fewer FIS points – and so were more highly ranked – than those without asthma, at 173.22 compared to 213.65.

And in the most successful skiers, the prevalence of asthma was the highest at 56%, with 65% of this non-allergic. This group was also the oldest and trained the most.

The researchers acknowledge this is an observational study and say the response rates were relatively low, with much of the information provided relying on recall and subjective assessment of symptoms.

But, they write: “Before starting their skiing career, there was no difference in asthma prevalence between cross-country skiers and the [comparison group], and the [comparison group] mainly had allergic asthma.

“We conclude that the excess prevalence of asthma among competitive cross-country skiers compared with that in the general population is mainly because of non-allergic asthma emerging a couple of years after the onset of an active skiing career.”

Mäki-Heikkilä R, Karjalainen J, Parkkari J et al. High training volume is associated with increased prevalence of non-allergic asthma in competitive cross country skiers. * BMJ Open Sport & Exercise Medicine* 14 June 2022; doi 10.1136/bmjsem-2022-001315


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