Effectiveness of screening examinations to detect unrecognized exercise-induced bronchoconstriction

Objective: To determine if a physician-administered physical examination and screening questionnaire accurately detects exercise-induced bronchoconstiction (EIB) in adolescent athletes. Study design: Cross-sectional study of 256 adolescents participating in organized sports from S suburban high schools. The number of persons screened positive for EIB by physical examination and questionnaire was compared with the number of persons with EIB diagnosed by a "gold standard" test that consisted of a 7-minute exercise challenge followed by serial spirometry. Results: We diagnosed EIB in 9.4% of adolescent athletes. The screening history identified persons with symptoms or a previous diagnosis suggestive of EIB in 39.5% of the participants, but only 12.9% of these persons actually had EIB. Among adolescents with a negative review of symptoms of asthma or EIB, 7.8% had EIB. Among adolescents with no previous diagnosis of asthma, allergic rhinitis, or EIB, 7.2% had EIB diagnosed by exercise challenge. Persons who screened negative on all questions about symptoms or history of asthma, EIB, and allergic rhinitis accounted for 45.8% of the adolescents with EIB. Conclusions: EIB occurs frequently in adolescent athletes, and screening by physical examination and medical history does not accurately detect it.