Introduction
The aquatic environment is considered advantageous for physical activity in patients with airway
problems. However, studies have shown that when practiced regularly, aquatic sports are also
associated with an increased prevalence of respiratory issues such as asthma, exercise induced
bronchoconstriction, exercise-induced laryngeal obstruction, or allergic rhinitis compared to non-
aquatic sports. Limited research has been focusing on aquatic sports other than swimming, particularly
in children and adolescents. The aim of this study is to describe the prevalence of respiratory symptoms
in a population of young aquatic athletes (swimming, artistic swimming, diving, water polo), to
compare it between aquatic sports and document their medical management.
Method
Use of an adapted web-based questionnaire in French (AQUA©) validated in healthy adolescents.
Answers prospectively collected from March to December 2022. Inclusion criteria: aquatic athletes
aged 12 to 18 years (± 2 years). Exclusion criteria: athletes under 10 and above 20 years, trouble
understanding French, unable to give consent. Recruitment via emails and at poolside during
competitions.
Results
A total of 189 athletes were included (mean age 13.8 years SD±2.1 years, 55.6% females). In the
population, 14% reported being diagnosed with respiratory allergic disease(s) by a physician (asthma
8%, rhinitis 6%). Concerning symptoms, 33% experienced regular nose irritation, 32% had breathing
difficulties, wheezing, or coughing in the last year. In addition, 54% reported symptoms during or after
training sessions. Regarding these diagnosis and symptoms, no significant difference was found
between the aquatic sports. In specific intensity subgroups, athletes with training sessions longer than
2 hours reported a diagnosis of respiratory allergic disease more often than those who trained for
lesser time (19% vs 7%, p = 0.01). Athletes practicing an aquatic sport for longer than 3 years reported
more respiratory symptoms in the last 12 months than those who practiced for less than 3 years (35%
vs 15%, p = 0.03). Endurance athletes (swimmers, water poloists) reported more respiratory symptoms
during and after training (59% vs 41%, p = 0.04) and within the past year (36% vs 20%, p = 0.03). Thirty-
one percent had used anti-allergic medication(s) (antihistaminics 50%, nasal/inhaled corticosteroids
45%/ 29%). Interestingly, 13% of them reported using them despite not being medically diagnosed
with an allergic disease. Moreover, 62% of all athletes were unaware of anti-doping regulations.
Conclusion
This observational study is the first to focus on young athletes in the four main aquatic sports.
Respiratory symptoms are frequent in young aquatic athletes. No significant difference between
aquatic sports was found. Symptoms during/after training seem to be increased in sports requiring
higher endurance. Objective measurements are needed to further explore the prevalence of allergic
diseases and respiratory symptoms in this population. To prevent auto-medication and guarantee
health for performance, systematic-screening as well as information on medications and anti-doping
regulations should be largely offered.