Undiagnosed exercise-induced bronchoconstriction in ski-mountaineers

Unsupervised field-based exercise challenge tests to support the detection of exercise-induced lower airway dysfunction in athletes

Background

Athletes are at risk for developing exercise-induced lower airway narrowing. The diagnostic assessment of such lower airway dysfunction (LAD) requires an objective bronchial provocation test (BPT).

Objectives

Our primary aim was to assess if unsupervised field-based exercise challenge tests (ECTs) could confirm LAD by using app-based spirometry. We also aimed to evaluate the diagnostic test performance of field-based and sport-specific ECTs, compared with established eucapnic voluntary hyperpnoea (EVH) and methacholine BPT.

Methods

In athletes with LAD symptoms, sensitivity and specificity analyses were performed to compare outcomes of (1) standardised field-based 8 min ECT at 85% maximal heart rate with forced expiratory volume in 1 s (FEV₁) measured prechallenge and 1 min, 3 min, 5 min, 10 min, 15 min and 30 min postchallenge, (2) unstandardised field-based sport-specific ECT with FEV₁ measured prechallenge and within 10 min postchallenge, (3) EVH and (4) methacholine BPT.

Results

Of 60 athletes (median age 17.5; range 16-28 years.; 40% females), 67% performed winter-sports, 43% reported asthma diagnosis. At least one positive BPT was observed in 68% (n=41/60), with rates of 51% (n=21/41) for standardised ECT, 49% (n=20/41) for unstandardised ECT, 32% (n=13/41) for EVH and methacholine BPT, while both standardised and unstandardised ECTs were simultaneously positive in only 20% (n=7/35). Standardised and unstandardised ECTs confirmed LAD with 54% sensitivity and 70% specificity, and 46% sensitivity and 68% specificity, respectively, using EVH as a reference, while EVH and methacholine BPT were both 33% sensitive and 85% specific, using standardised ECTs as reference.

Conclusion

App-based spirometry for unsupervised field-based ECTs may support the diagnostic process in athletes with LAD symptoms.

Trial registration number

NCT04275648.

Ski Mountaineering-Scientific Knowledge of This New Olympic Sport: A Narrative Review

ABSTRACT

Ski mountaineering (skimo) has been accepted as a new sport for the 2026 Milan-Cortina Olympics. The equipment used in this competitive ski mountaineering varies from leisure ski mountaineering equipment mainly in one point: the minimal weight. At the elite athlete level, skimo demands both maximal endurance performance and a high-intensity anaerobic capacity for the sprint and vertical races. Race time significantly correlates to V˙O2max, body mass index and racing gear mass. Available literature only rarely comments on competitive skimo injuries. Injuries are not only due to falls in downhill skiing but also can result from external hazards, such as avalanches and cold. The high training load of athletes in combination with a low body weight, low body fat, and exposure to cold cause high rates of respiratory infections in athletes. The inclusion of skimo into the Olympic program is expected to result in certain changes, such as higher training loads for the athletes and increased scientific interest into training methods.

Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'

OBJECTIVES

To compare the performance of various diagnostic bronchoprovocation tests (BPT) in the assessment of lower airway dysfunction (LAD) in athletes and inform best clinical practice.

DESIGN

Systematic review with sensitivity and specificity meta-analyses.

DATA SOURCES

PubMed, EBSCOhost and Web of Science (1 January 1990-31 December 2021).

ELIGIBILITY CRITERIA

Original full-text studies, including athletes/physically active individuals (15-65 years) who underwent assessment for LAD by symptom-based questionnaires/history and/or direct and/or indirect BPTs.

RESULTS

In 26 studies containing data for quantitative meta-analyses on BPT diagnostic performance (n=2624 participants; 33% female); 22% had physician diagnosed asthma and 51% reported LAD symptoms. In athletes with symptoms of LAD, eucapnic voluntary hyperpnoea (EVH) and exercise challenge tests (ECTs) confirmed the diagnosis with a 46% sensitivity and 74% specificity, and 51% sensitivity and 84% specificity, respectively, while methacholine BPTs were 55% sensitive and 56% specific. If EVH was the reference standard, the presence of LAD symptoms was 78% sensitive and 45% specific for a positive EVH, while ECTs were 42% sensitive and 82% specific. If ECTs were the reference standard, the presence of LAD symptoms was 80% sensitive and 56% specific for a positive ECT, while EVH demonstrated 65% sensitivity and 65% specificity for a positive ECT.

CONCLUSION

In the assessment of LAD in athletes, EVH and field-based ECTs offer similar and moderate diagnostic test performance. In contrast, methacholine BPTs have lower overall test performance.

PROSPERO REGISTRATION NUMBER

CRD42020170915.

Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease

Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO2, of VO2max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO2 and VO2max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO2 and V̇O2max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed.

Prevalence of lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus group on 'acute respiratory illness in the athlete'

OBJECTIVE

To report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020).

ELIGIBILITY CRITERIA

Original full-text studies, including male or female athletes/physically active individuals/military personnel (aged 15-65 years) who had a prior asthma diagnosis and/or underwent screening for lower airway dysfunction via self-report (ie, patient recall or questionnaires) or objective testing (ie, direct or indirect bronchial provocation challenge).

RESULTS

In total, 1284 studies were identified. Of these, 64 studies (n=37 643 athletes) from over 21 countries (81.3% European and North America) were included. The prevalence of lower airway dysfunction was 21.8% (95% CI 18.8% to 25.0%) and has remained stable over the past 30 years. The highest prevalence was observed in elite endurance athletes at 25.1% (95% CI 20.0% to 30.5%) (Q=293, I²=91%), those participating in aquatic (39.9%) (95% CI 23.4% to 57.1%) and winter-based sports (29.5%) (95% CI 22.5% to 36.8%). In studies that employed objective testing, the highest prevalence was observed in studies using direct bronchial provocation (32.8%) (95% CI 19.3% to 47.2%). A high degree of heterogeneity was observed between studies (I²=98%).

CONCLUSION

Lower airway dysfunction affects approximately one in five athletes, with the highest prevalence observed in those participating in elite endurance, aquatic and winter-based sporting disciplines. Further longitudinal, multicentre studies addressing causality (ie, training status/dose-response relationship) and evaluating preventative strategies to mitigate against the development of lower airway dysfunction remain an important priority for future research.

Ski Mountaineering: Perspectives on a Novel Sport to Be Introduced at the 2026 Winter Olympic Games

Ski mountaineering is a rapidly growing winter sport that involves alternately climbing and descending slopes and various racing formats that differ in length and total vertical gain, as well as their distribution of downhill and uphill sections. In recent years, both participation in and media coverage of this sport have increased dramatically, contributing, at least in part, to its inclusion in the 2026 Winter Olympics in Milano-Cortina. Here, our aim has been to briefly describe the major characteristics of ski mountaineering, its physiological and biomechanical demands, equipment, and training/testing, as well as to provide some future perspectives. Despite its popularity, research on this discipline is scarce, but some general characteristics are already emerging. Pronounced aerobic capacity is an important requirement for success, as demonstrated by positive correlations between racing time and maximal oxygen uptake and oxygen uptake at the second ventilatory threshold. Moreover, due to the considerable mechanical work against gravity on demanding uphill terrain, the combined weight of the athlete and equipment is inversely correlated with performance, prompting the development of both lighter and better equipment in recent decades. In ski mountaineering, velocity uphill is achieved primarily by more frequent (rather than longer) strides due primarily to high resistive forces. The use of wearable technologies, designed specifically for analysis in the field (including at elevated altitudes and cold temperatures) and more extensive collaboration between researchers, industrial actors, and coaches/athletes, could further improve the development of this sport.

Asthma, atopy, and exercise: Sex differences in exercise-induced bronchoconstriction

Asthma is a chronic inflammatory lung disease affecting approximately 7.7% of the US population. Sex differences in the prevalence, incidence, and severity of asthma have been widely described throughout the lifespan, showing higher rates in boys than girls before puberty, but a reversed pattern in adults. Asthma is often associated with atopy, i.e. the tendency to develop allergic diseases, and can be worsened by environmental stimuli and/or exercise. While not exclusive to patients with asthma, exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. Currently, there is limited research on sex differences in EIB and its relationship with atopy and asthma in men and women. In this minireview, we summarize the available literature on this topic. Overall, the collective knowledge supports the notion that physiological changes triggered during exercise affect males and females differently, suggesting an interaction among sex, exercise, sex hormones, and atopic status in the course of EIB pathophysiology. Understanding these differences is important to provide personalized management plans to men and women who exercise regularly and suffer from underlying asthma and/or atopy.

Sex Differences in Exercise-Induced Bronchoconstriction in Athletes: A Systematic Review and Meta-Analysis

Exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. It is estimated that about 90% of patients with underlying asthma (a sexually dimorphic disease) experience EIB; however, sex differences in EIB have not been studied extensively. With the goal of better understanding the prevalence of EIB in males and females, and because atopy has been reported to occur at higher rates in athletes, in this study, we investigated sex differences in EIB and atopy in athletes. A systematic literature review identified 60 studies evaluating EIB and/or atopy in post-pubertal adult athletes (n = 7501). Collectively, these studies reported: (1) a 23% prevalence of EIB in athletes; (2) a higher prevalence of atopy in male vs. female athletes; (3) a higher prevalence of atopy in athletes with EIB; (4) a significantly higher rate of atopic EIB in male vs. female athletes. Our analysis indicates that the physiological changes that occur during exercise may differentially affect male and female athletes, and suggest an interaction between male sex, exercise, and atopic status in the course of EIB. Understanding these sex differences is important to provide personalized management plans to athletes with underlying asthma and/or atopy.

Equipment Became Better in Backcountry Skiing-Did Severity of Injuries Decrease? An Analysis from the Swiss Alps

Background: Large technical developments in avalanche transceivers as well as in ski–shoe-binding units should make backcountry skiing a safer sport and as a consequence, yield to a decrease in the number and severity of mountain emergency events. Methods: From 2009–2018, a total of 3044 mountain emergencies (953 females and 2091 males) were identified from the SAC (Swiss Alpine Club) central registry while backcountry skiing. These were classified descriptively by cause, whereby the severity of the mountain emergency was quantified with a NACA-Score (National Advisory Committee for Aeronautics Score). Results: A total of 1357 falls (44.6%), 558 emergencies caused by avalanches (18.3%), 408 cases of blocking (13.4%), 214 cases of illnesses (7.0%), 202 cases of losing way (6.6%), 138 cases of a crevasse accident (4.5%), and material failure in 30 cases (1%) were registered. For the remaining 137 cases (4.5%), no classification or rare forms were detected. No substantial sex differences were found in severity of injury, however looking at the two endpoints of the observed time frame, a significant increase in NACA-Score from 2009 to 2018 (2.1 ± 1.8 up to 2.6 ± 2.1, p < 0.01) was detected. Conclusions: The increase in the severity of mountain emergencies while backcountry skiing in the last decade might be due to the fact that too many inexperienced absolve backcountry tours. The tendency might be promoted by the improved material in the way that it seems easier to absolve a tour while underestimating potential hazards.

[Injuries from Falls in Backcountry Skiing - an Analysis from the Swiss Alps]

Injuries from Falls in Backcountry Skiing - an Analysis from the Swiss Alps Abstract. Ski mountaineering is becoming increasingly popular. In addition to positive aspects, there are also dangers involved whereby falls must be mentioned particularly. Using the central register of the SAC (Swiss Alpine Club), a total of 756 male and 593 female cases of falls in the ten-year period from 2009-2018 were analyzed using the NACA score and case reports. It was found that around 90 % of the analyzed cases in women concerned the lower extremity with the knee (55 %) as the most common localization. Similarly, in men around two thirds were affected by the lower extremity, with the knee being the most common location with around 43 %. This could be caused by an unoptimized binding behavior, which is why it is recommended not to set the bindings too hard and to test the correct release behavior regularly.

Respiratory Health Benefits and Risks of Living at Moderate Altitude

Grissom, Colin K., and Barbara E. Jones. Respiratory health benefits and risks of living at moderate altitude. High Alt Med Biol 19:109-115, 2018.-The respiratory system plays a critical role in the series of physiologic responses that occur at high altitude and allows individuals to adapt to and tolerate hypobaric hypoxia. Persons with underlying lung disease may have complications, but sometimes derive benefits, related to residence at high altitude. This review will focus on health benefits and risks of patients with underlying asthma, chronic obstructive pulmonary disease, pulmonary hypertension, or obstructive sleep apnea, who live at altitudes of 1500 to 4500 m. We will also discuss maladaptive responses of the respiratory system at high altitude in previously healthy persons, including development of pulmonary hypertension and sleep-disordered breathing.

Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.

Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation

High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer.

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.

Exercise-induced respiratory symptoms and allergy in elite athletes: Allergy and Asthma in Polish Olympic Athletes (A(2)POLO) project within GA(2)LEN initiative

INTRODUCTION

Exercise-induced respiratory symptoms are often reported by professional athletes, but asthma and allergy are underdiagnosed. Few studies used standardized questionnaires combined with clinical assessment to investigate asthma and allergy among athletes.

OBJECTIVES

Assessment of the prevalence of allergy and asthma symptoms among Polish professional athletes and confronting it with clinical data.

METHODS

Two hundred twenty-two Olympic athletes participated in the project being part of the Global Allergy and Asthma European Network (GA(2) LEN) Olympic study. Allergy and asthma status was determined using Allergy Questionnaire for Athletes (AQUA), spirometry, reversibility test, methacholine challenge and skin prick testing. Final diagnosis was established by an allergist.

RESULTS

At least one exercise-induced asthma (EIA) symptom was reported by 28.4% athletes, and finally asthma diagnosis was established in 11.3% while only 5.9% of athletes had history of asthma. Reversibility test was positive in 36% of athletes finally diagnosed with asthma. Allergic rhinitis (AR) symptoms were reported by 27%, and the diagnosis was confirmed in 21% of athletes while only 9% had previously diagnosed AR. No significant differences in frequency of asthma and AR were observed between endurance and non-endurance athletes.

CONCLUSIONS

High prevalence of exercise-induced respiratory symptoms among top athletes is not reflected by asthma diagnosis. As it was expected, our data confirm that - in diagnosis of EIA - lung function testing alone is not useful, whereas reversibility tests are of limited value.

Wilderness and adventure travel with underlying asthma

Given the high prevalence of asthma, it is likely that providers working in a pretravel setting will be asked to provide guidance for asthma patients about how to manage their disease before and during wilderness or adventure travel, while providers working in the field setting may need to address asthma-related issues that arise during such excursions. This review aims to provide information to assist providers facing these issues. Relevant literature was identified through the MEDLINE database using a key word search of the English-language literature from 1980 to 2013 using the term "asthma" cross-referenced with "adventure travel," "trekking," "exercise," "exercise-induced bronchoconstriction," "high-altitude," "scuba," and "diving." We review data on the frequency of worsening asthma control during wilderness or adventure travel and discuss the unique aspects of wilderness travel that may affect asthma patients in the field. We then provide a general approach to evaluation and management of asthma before and during a planned sojourn and address 2 particular situations, activities at high altitude and scuba diving, which pose unique risks to asthma patients and warrant additional attention. Although wilderness and adventure travel should be avoided in individuals with poorly controlled disease or worsening control at the time of a planned trip, individuals with well-controlled asthma who undergo appropriate pretravel assessment and planning can safely engage in a wide range of wilderness and adventure-related activities.

Lung disease at high altitude

Large numbers of people travel to high altitudes, entering an environment of hypobaric hypoxia. Exposure to low oxygen tension leads to a series of important physiologic responses that allow individuals to tolerate these hypoxic conditions. However, in some cases hypoxia triggers maladaptive responses that lead to various forms of acute and chronic high altitude illness, such as high-altitude pulmonary edema or chronic mountain sickness. Because the respiratory system plays a critical role in these adaptive and maladaptive responses, patients with underlying lung disease may be at increased risk for complications in this environment and warrant careful evaluation before any planned sojourn to higher altitudes. In this review, we describe respiratory disorders that occur with both acute and chronic exposures to high altitudes. These disorders may occur in any individual who ascends to high altitude, regardless of his/her baseline pulmonary status. We then consider the safety of high-altitude travel in patients with various forms of underlying lung disease. The available data regarding how these patients fare in hypoxic conditions are reviewed, and recommendations are provided for management prior to and during the planned sojourn.

Ski mountaineering competition: fit for it?

OBJECTIVE

To examine the physiological characteristics of experienced ski mountaineers and to determine the physical demands of ski mountaineering competition.

DESIGN

Descriptive field study.

SETTING

An international ski mountaineering competition characterized by 20 400 m distance and 1869 m altitude difference that took place in March 2009 in the South Tyrolean Alps (Italy).

PARTICIPANTS

Nine healthy and experienced male ski mountaineers.

INTERVENTIONS

Bioimpedance measurements for body composition definition; maximal exercise testing (Bruce protocol) to determine maximal heart rate (HRmax), maximal oxygen uptake (.VO2max), and ventilatory thresholds (VT1 and VT2) and to define individual exercise intensity zones; HR registration during competition.

MAIN OUTCOME MEASURES

Exercise intensity distribution, occurrence of respiratory symptoms.

RESULTS

Ventilatory thresholds were found on average at 70.5% ± 5.0% (VT1) and 90.9% ± 2.6% (VT2) of .VO2max (68.18 ± 6.11 mL·kg⁻¹·minute⁻¹). The overall exercise intensity, defined by the ratio between mean HR during competition and maximal HR in the laboratory (0.87 ± 0.02), was high. Partial times (% of race time) spent competing in 4 defined performance zones were on average 20.4% ± 17.0% (maximal intensity), 59.8% ± 12.5% (high intensity), 12.8% ± 5.6% (moderate intensity), and 7.0% ± 5.9% (low intensity). Five participants reported respiratory discomfort during competition, with cough being the most frequent symptom. Statistical analysis revealed percent body fat mass to correlate with the partial time performed above VT2 (r = 0.782, P < 0.05); the latter was associated with a worse final placement (r = 0.734, P < 0.05).

CONCLUSIONS

Competitive ski mountaineering is characterized by an important cardiopulmonary strain and requires a high degree of physical fitness.

[Exercise-induced bronchoconstriction in non-asthmatic athletes]

INTRODUCTION

A new clinical entity, exercise-induced bronchoconstriction (EIB), has been recently defined which describes bronchoconstriction occurring in association with exercise in susceptible non-asthmatic persons.

STATE OF ART

There is considerable evidence that the pathogenesis of this condition is related to airway injury, due to prolonged hyperventilation and aggressive environmental factors. If the objective diagnostic tests are identical for the diagnosis of exercise induced asthma and EIB, the diagnoses are established differently, according to the high sensitivity of provocation by exercise "in the field" or the eucapnic voluntary hyperventilation provocation test.

PERSPECTIVES

Current pharmacological treatment is based upon the inhalation of ß2-agonists prior to exercise, but to be granted permission to use them, athletes are required to provide documentation of objective evidence of EIB. Therefore, the diagnostic pathway in athletes is essential and respiratory physicians need to know the specific features of this new clinical entity.

CONCLUSIONS

EIB distinct from the presence of asthma is prevalent in elite athletes and its determinants should be well known by their health care providers to assure an optimal management of this peculiar disease, in respect to drug doping regulations.

Bronchial asthma: advice for patients traveling to high altitude

This article examines the possibility of traveling to altitude for patients suffering from bronchial asthma. The mountain environment, the adaptations of the respiratory system to high altitude, the underlying patho-physiologies of asthma, and the recommendations for patients, according to altitude, are discussed. In summary, staying at low altitude has a significant beneficial effect for asthmatic patients, due to the reduction of airway inflammation and the lower response to bronchoconstrictor stimuli; for staying at moderate altitude, there is conflicting information and no clinical data; at high altitude, the environment seems beneficial for well-controlled asthmatics, but intense exercise and upper airway infections (frequent during trekking) can be additional risks and should be avoided. Further, in remote areas health facilities are often difficult to reach.

Exercise-induced bronchoconstriction in athletes-should we screen?

The fact that exercise-induced bronchoconstriction (EIB) may be both over- and underdiagnosed in athletes has led to calls for widespread screening for the condition. This article assesses such a strategy by employing the standard framework used when evaluating any screening policy. This approach highlights a number of concerns and allows recommendations to help optimize the success of such a strategy if it were to be implemented.

The ski camp doctor’s role in the the prevention of winter sport accidents

A tavalyi év több halálos végű téli sportbaleseteinek száma, mely különösen a gyermekkorúak síelésével volt kapcsolatos, felvetette azt a gondolatot, hogy a síelő csoportokat olyan kiképzett orvosok kísérjék, akik alkalmasak arra, hogy a téli sportokkal kapcsolatos sürgősségi helyszíni ellátást elkezdjék, és ezáltal a balesetek és megbetegedések következményeit enyhítsék. Mivel hasonló kezdeményezésről még nem számol be a szakirodalom, a jelen közlemény megpróbálja összefoglalni a sítábororvosokkal szemben támasztott szakmai követelményeket, valamint felméri a tábororvosok feladatkörét. A sítábororvos, bármely diszciplína művelője is, jártas kell hogy legyen az utazási orvostan alapkérdéseiben és a sürgősségi betegellátás készségszintű művelésében. Prevenciós feladatai között szerepel az utazás előtti egészségfelmérés, a szokványos megbetegedések felismerése és kezelése a helyszínen, az orvosi elsősegély nyújtása a sípályán, valamint a beteg ellátásának és hazaszállításának megszervezése. Az elképzelés helyességét bizonyította az első sítábororvos-képzés sikere, melynek folyamán a résztvevők nemcsak az orvosi elméleti alapokat sajátították el, hanem hivatásos síoktatók is javították az orvosok sítechnikai tudását. A képzés része volt még a síbalesetek jogi és biztosítói oldalról való elemzése is. A nagy érdeklődésre való tekintettel a sítábororvosi tanfolyamot rendszeressé kell tenni, a képzésbe belevonva a külföldi hegyi mentőszolgálatokat is. Az iskoláscsoportok síbaleseteinek megelőzésében nagy szerepe lehet a kiképzett tábororvosoknak, akik névsora az utazási irodák rendelkezésére bocsátható. Remélhető, hogy a kezdeményezést az utazási biztosítók is felkarolják, mert a sítábororvos jelenléte nagyban csökkentheti a kárhányadot és a károsodás mértékét.

Exercise-induced asthma in the competitive cold weather athlete

Exercise-induced asthma (EIA) is a very common condition that affects winter sport athletes at rates as high as 50%. It has become clear that the main etiologic factors in EIA are the extremely low humidity and high respiratory rates in these athletes, which lead to extreme airway drying. New developments in objective testing for this condition have been recently described and are reviewed here. EIA is easily treated with oral and inhaled medications. These medications are closely regulated by the antidoping agencies; therefore, care must be taken by the treating physician to ensure compliance with the latest restrictions.