Asthma and Respiratory Symptoms in Finnish Competitive Cross-Country Skiers

Research output: Book/ReportDoctoral thesisCollection of Articles


Competitive cross-country skiers, due to their exposure to extreme cold conditions during training and competition, are subjected to significant strain on their airways. This unique situation leads to a high prevalence of asthma among with a possible impact on their performance. The prominence of acute respiratory infections (ARinf), which hinders their ability to train and compete, is another significant concern for these athletes.

The aim of this thesis was to compare the differences in the prevalence of asthma, use of asthma medication, onset age of asthma and asthma control in Finnish cross- country skiers compared to controls and to study the types of respiratory symptoms and prolonged cough in cross-country skiers and controls. In cross-country skiers only, the burden of acute illness or respiratory tract infection in asthmatic and non- asthmatic skiers on competition success and possible effects of asthma on days of absence from training and competition were studied.

To investigate these issues, a postal survey was conducted involving competitive Finnish cross-country skiers (n = 1282) who participated in the national championships in their respective age category from 13 years to seniors in the season 2018/2019. The control group (n= 1754) was matched in terms of age, gender, and region. The total response rate in the current study was 27.4% (n = 351) in skiers and 19.5% (n = 338) in controls. In skiers and controls, the median age was 16.5 vs.

17.0 years (interquartile range 14.3–21.5 vs. 15–22.5) and 58.1% vs. 69.5% were women.A higher prevalence of asthma was found among skiers (25.9%) compared to the controls (9.2%), with the median age of the first asthma-related symptoms being higher in skiers (13.0 years) than controls (8.0 years). The Asthma Control Test (ACT) score median was 22.0 in both groups, but skiers had better asthma control with 89.0% achieving well-controlled asthma (ACT score ≥20), compared to 77.4% of controls. Among the skiers with asthma, 82.4% used regular inhaled corticosteroids (ICS), and 80.2% used bronchodilators. A fixed combination of ICS and long-acting β2-agonist was regularly used by 47.3% of the skiers and 22.6% of the controls with asthma.

In the most successful quartile of skiers, the prevalence of asthma was the highest (56.1%) in. Asthma in skiers was more often non-allergic (60.1%) compared to the controls (38.7%). Being a skier showed a higher risk for non-allergic asthma (OR 5.05, 95% CI 2.65 to 9.61) than allergic asthma (OR 1.92, 1.08–3.42). High training volume was a significant risk factor for non-allergic asthma in skiers.

In terms of exercise-related symptoms, skiers showed a higher prevalence of cough after exercise (60.6% vs. 22.8% in controls) and phlegm production during and after exercise. Symptoms provoked by exercise were similar in asthmatics and non-asthmatics, but symptom prevalence was higher in asthmatic individuals. Chronic cough lasting more than eight weeks was rare, reported by only 4.8% of controls and 2.0% of skiers.

A larger proportion of asthmatic skiers (76.9%) than non-asthmatic skiers (62.2%) had to refrain from competitions due to ARinf. The median duration of a single ARinf episode was longer for asthmatic skiers (5.0 days) compared to non- asthmatics (4.0 days), leading to more days of absence due to ARinf throughout the season (median 15 days vs. 10 days).

Competitive cross-country skiers, especially the most successful ones, demonstrate a high prevalence of non-allergic, well-controlled asthma. Skiers also experience a greater burden of exercise-related respiratory symptoms and a more significant impact of acute respiratory infections, leading to training and competition absences. These findings underscore the importance of effective asthma management and ARinf reduction strategies in this specific athlete population. Although skiers have a high prevalence of asthma and high prevalence of respiratory symptoms, it seems it does not prevent a successful and triumphant athletic career.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic)978-952-03-3277-8
Publication statusPublished - 2024
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028


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