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J Asthma. 2015;52(9):897-904. doi: 10.3109/02770903.2015.1067321. Epub 2015 Sep 17.

Two distinct phenotypes of asthma in elite athletes identified by latent class analysis.

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a Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine , University of Porto, Portugal and Serviço de Imunoalergologia, Centro Hospitalar São João E.P.E. , Porto , Portugal .
b Norwegian School of Sport Sciences , Oslo , Norway .
c Portuguese National Anti-Doping Organization , Lisbon , Portugal .
d Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine , University of Porto , Porto , Portugal .
e Department of Pediatrics , Oslo University Hospital , Oslo , Norway , and.
f Institute of Clinical Medicine, University of Oslo , Oslo , Norway.



Clusters of asthma in athletes have been insufficiently studied. Therefore, the present study aimed to characterize asthma phenotypes in elite athletes using latent class analysis (LCA) and to evaluate its association with the type of sport practiced.


In the present cross-sectional study, an analysis of athletes' records was carried out in databases of the Portuguese National Anti-Doping Committee and the Norwegian School of Sport Sciences. Athletes with asthma, diagnosed according to criteria given by the International Olympic Committee, were included for LCA. Sports practiced were categorized into water, winter and other sports.


Of 324 files screened, 150 files belonged to asthmatic athletes (91 Portuguese; 59 Norwegian). LCA retrieved two clusters: "atopic asthma" defined by allergic sensitization, rhinitis and allergic co-morbidities and increased exhaled nitric oxide levels; and "sports asthma", defined by exercise-induced respiratory symptoms and airway hyperesponsiveness without allergic features. The risk of developing the phenotype "sports asthma" was significantly increased in athletes practicing water (OR = 2.87; 95% CI [1.82-4.51]) and winter (OR = 8.65; 95% CI [2.67-28.03]) sports, when compared with other athletes.


Two asthma phenotypes were identified in elite athletes: "atopic asthma" and "sports asthma". The type of sport practiced was associated with different phenotypes: water and winter sport athletes had three- and ninefold increased risk of "sports asthma". Recognizing different phenotypes is clinically relevant as it would lead to distinct targeted treatments.


Asthma; athletes; clusters; exercise-induced bronchoconstriction; latent class analysis; phenotypes; sports; training environment

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