807 FO67 – Airway dysbiosis in elite athletes: a focus to prevent infection?

Background Prevention of respiratory tract infection (RTi) is a priority in elite athlete care. Airway microbial dysbiosis may be relevant in underpinning propensity to RTi in this context. Objective To evaluate airway microbial carriage in a cohort of elite athletes and evaluate relationships with other pulmonary factors. Design Prospective cross-sectional evaluation. Setting Elite athlete performance programme. Patients Adult female and male athletes. Interventions Observational study. Main Outcome Measures Report of bacterial microbial communities from posterior oropharyngeal swabs were quantified by sequencing of the 16S_RNA gene. Respiratory health, including measurement of exhaled nitric oxide (FeNO) and spirometry (FEV1 and FVC) with indirect bronchoprovocation testing (eucapnic voluntary hyperpnoea (EVH)). The presence of laryngeal dysfunction was assessed by the Pittsburgh Vocal Score Dysfunction questionnaire (VCD). A positive diagnosis of asthma was defined via spirometry, FeNO and EVH. The number of respiratory infections in the last 18 months was recorded. Results We studied 127 athletes (n=59, 47% female), partaking in a wide range of Olympic sports. A total VCD score was elevated (>=4) in 20 athletes (9.4%). Approximately one third (30.7%) of the cohort were diagnosed as asthmatic and 38% had more than 2 respiratory illnesses in the previous 18 months. Asthma and VCD positive groups were quite distinct; in a backwards stepwise multiple regression, asthma was associated with bacterial biomass (β =0.121, p=0.02) and Haemophilus spp. abundance (β=0.128, P=0.016). On the other hand, frequency of respiratory infections in the last 18 months was positively predicted by the presence of VCD (β=-0.345, P=0.000), sinusitis (β=-0.219, P=0.014) and wheeze β=-0.182, P=0.04), without any clear association with bacterial microbiota. Conclusions The presence of asthma-related issues in athletes is associated with a distinct pattern in their airway microbiome. Susceptibility to RTI however, seems more closely related to laryngeal dysfunction, highlighting an important clinical target.