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Table 1 Objective testing accepted by the World Anti-Doping Agency to diagnose asthma in athletes

From: Anti-doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations

Diagnostic methods Criteria
Bronchodilator reversibility ≥ 12% increase in FEV1a
Bronchoprovocation challenge(s):  
 Direct  
  Methacholine/histamine ≥ 20% reduction in FEV1
 Indirect  
  Exercise challenge (laboratory and field-based) ≥ 10% reduction in FEV1c
  Eucapnic voluntary hyperpnoea (EVH)b ≥ 10% reduction in FEV1c
  Dry powder mannitol ≥ 15% reduction in FEV1
  Hypertonic saline (4.5%) ≥ 15% reduction in FEV1
  1. FEV1 forced expiratory volume in one second, IOC-MC International Olympic Committee—Medical Commission
  2. aSupports asthma diagnosis
  3. bOptimal test to detect asthma in athletes (IOC-MC)
  4. cSustained reduction in FEV1 required (i.e. two consecutive timepoints) to confirm diagnosis