{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T17:17:13Z","timestamp":1791652633215,"version":"4.3.4"},"reference-count":68,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2023,1,19]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Systematic review with sensitivity and specificity meta-analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Data sources<\/jats:title>\n                  <jats:p>PubMed, EBSCOhost and Web of Science (1 January 1990\u201331 December 2021).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Eligibility criteria<\/jats:title>\n                  <jats:p>Original full-text studies, including athletes\/physically active individuals (15\u201365 years) who underwent assessment for LAD by symptom-based questionnaires\/history and\/or direct and\/or indirect BPTs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42020170915.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjsports-2022-106059","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T13:22:09Z","timestamp":1675084929000},"page":"481-489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Diagnostic approach to lower airway dysfunction in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on \u2018acute respiratory illness in the athlete\u2019"],"prefix":"10.1136","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8184-0607","authenticated-orcid":false,"given":"Tonje","family":"Reier-Nilsen","sequence":"first","affiliation":[{"name":"The Norwegian Olympic Sports Centre, Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway"},{"name":"Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Sewry","sequence":"additional","affiliation":[{"name":"Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa"},{"name":"International Olympic Committee (IOC) Research Centre of South Africa, University of Pretoria, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6619-6577","authenticated-orcid":false,"given":"Bruno","family":"Chenuel","sequence":"additional","affiliation":[{"name":"Centre Hospitalier R\u00e9gional Universitaire de Nancy, Department of Lung function and Exercise Physiology - 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