The Free Running Athletic Screening Test as a Screening Test for Exercise-Induced Asthma in High School

As part of a multicenter study envisioned by the American College of Allergy Sports Committee to screen for exercise-induced asthma, 303 high school students, freshman and sophomore gym classes, completed a questionnaire concerning exercise-related asthma, chronic asthma, and atopy. The study group included 124 females (41%) and 179 males (59%) with an average and median age of 15 years and a range of 13–17 years, and included 99% Caucasian and 1% nonCaucasian students, all attending the same parochial high school. After obtaining informed consent, 112 (37%) agreed to a free running test with initial challenge on an outdoor cinder track during April–June 1995. All challenges were conducted between 8:00 A.M. and noon with relative humidity 59% and average temperature 15°C. The challenge consisted of 7 minutes of continuous running on the cinder track with a doubling of pulse rate to 160/min during the run. Peak expiratory flows were taken at baseline, 0, 5, and 10 minutes postexercise. Twenty nine of 112 (26%) of the students were initially assessed as positive challenges, defined as a 15% decline in peak flow following exercise on the first challenge. However, four students self-recovered; thus 25 of 112 (22%) were qualified as true positives. Of these 25, 20 (80%) agreed to be reexercised. Fourteen of 20 (70%) were positive, yielding a prevalence rate of 14/112 (12.5%). Sixteen of these 20 (80%) were then exercised a third time using spirometry pre- and postexercise. Eight were positive, yielding a prevalence rate of 8/112 (7%). The questionnaire correlated significantly with the challenge, particularly when read by section (p = 0.000001) rather than globally positive or negative (p = 0.00008), with a specificity of 64%, sensitivity of 94%, positive predictive value of 44%, and negative predictive value of 97%. In summary, inexpensive and familiar free-running tests can be a useful screening test to confirm the questionnaire which is sensitive (94%) in ruling in, but has low specificity (64%) in ruling out, exercise-induced asthma.