11 Lessons

It is well established that various medical conditions and illnesses, especially respiratory tract symptoms, affect elite athletes while they are travelling to and competing in international competitions. 1-3 These medical conditions most commonly affect the ear, nose and throat, respiratory tract, dermatological system, central nervous system and gastrointestinal system. 1-4 Elite athletes are not immune to any of the disease processes that may affect the general population. A descriptive epidemiological study of college athletes found that 21% of the consultations were for problems involving the respiratory tract. 5 There is also some evidence suggesting that the risk of contracting certain medical conditions such as upper respiratory tract (URT) infections may be increased due to regular strenuous activity and that training and competition load is related to the risk of acute illness. 6

In studies of football players during tournaments, the respiratory tract is the most common system affected by illness during the World Cup and the Confederations Cup. 7,8 At the 2009 Confederations Cup, the overall incidence of illness was 16.9 per 1,000 player days, with the respiratory tract (RT) accounting for over 50% of all illnesses (ear, nose and throat = 37%; other respiratory tract = 20%). 7 Similarly, during the 2010 FIFA World Cup, respiratory illness was the most common medical condition affecting football players (40% of all illnesses), and this is a similar finding in many studies across other sporting disciplines. 8-14

In this module, we will discuss some of the most common respiratory conditions seen in football players.

Presented by

Learning outcomes

After studying this topic you should be able to:

  • have an understanding of the effects of exercise on respiratory physiology;
  • be able to conduct a clinical assessment of players presenting with respiratory symptoms;
  • be able to appropriately order, and interpret, common investigations related to the respiratory system;
  • be able to diagnose exercise-induced asthma and bronchospasm and be able to create an appropriate management plan;
  • be able to diagnose upper respiratory infections and be able to create an appropriate management plan;
  • have an awareness of the other common conditions affecting the respiratory system;
  • be able to implement preventative strategies to reduce the risk of developing respiratory symptoms.


  • Review the media content and read the provided text
  • Read the required articles
  • Complete the case-based assessment task

Required reading

F-MARC Football Medicine Manual 2nd Edition
Chapter 4.1.4 (Pages 218-219

Suggested reading

Brukner and Khan’s
Clinical Sports Medicine 4th Edition
Chapter 51 (pages 1038-1055)


  1. Derman W. Profile of medical and injury consultations of team South Africa during the XXVIIIth Olympiad, Athens 2004. SAJSM. 2003;15(4):22-5.
  2. Derman W. Medical care of the South African Olympic team – the Sydney 2000 experience. South African Journal of Sports Medicine. 2003;15(3).
  3. Budgett R, Harries M, Aldridge J, Jaques R, Jennings DE. Lessons learnt at the 1996 Atlanta Olympic games. Br J Sports Med. 1997;31(1):76.
  4. Strauss RH, Lanese RR, Leizman DJ. Illness and absence among wrestlers, swimmers, and gymnasts at a large university. Am J Sports Med. 1988;16(6):653-655.
  5. Steiner ME, Quigley DB, Wang F, Balint CR, Boland AL,Jr. Team physicians in college athletics. Am J Sports Med. 2005;33(10):1545-1551.
  6. Schwellnus M, Soligard T, Alonso JM, et al. How much is too much? (part 2) International Olympic Committee consensus statement on load in sport and risk of illness. Br J Sports Med. 2016;50(17):1043-1052.
  7. Theron N, Schwellnus M, Derman W, Dvorak J. Illness and injuries in elite football players – a prospective cohort study during the FIFA Confederations Cup 2009. Clin J Sport Med. 2013;23(5):379-383.
  8. Dvorak J, Junge A, Derman W, Schwellnus M. Injuries and illnesses of football players during the 2010 FIFA World Cup. Br J Sports Med. 2011;45(8):626-630.
  9. Engebretsen L, Soligard T, Steffen K, et al. Sports injuries and illnesses during the London summer Olympic Games 2012. Br J Sports Med. 2013;47(7):407-414.
  10. Derman W, Schwellnus M, Jordaan E, et al. Illness and injury in athletes during the competition period at the London 2012 Paralympic Games: Development and implementation of a web-based surveillance system (WEB-IISS) for team medical staff. Br J Sports Med. 2013;47(7):420-425.
  11. Schwellnus M, Derman W, Page T, et al. Illness during the 2010 Super 14 Rugby union tournament – a prospective study involving 22 676 player days. Br J Sports Med. 2012;46(7):499-504.
  12. Mountjoy M, Junge A, Alonso JM, et al. Sports injuries and illnesses in the 2009 FINA world championships (aquatics). Br J Sports Med. 2010;44(7):522-527.
  13. Engebretsen L, Steffen K, Alonso JM, et al. Sports injuries and illnesses during the winter Olympic Games 2010. Br J Sports Med. 2010;44(11):772-780.
  14. Alonso JM, Tscholl PM, Engebretsen L, Mountjoy M, Dvorak J, Junge A. Occurrence of injuries and illnesses during the 2009 IAAF World Athletics Championships. Br J Sports Med. 2010;44(15):1100-1105.
  15. Friman G, Wesslen L. Special feature for the Olympics: Effects of exercise on the immune system: Infections and exercise in high-performance athletes. Immunol Cell Biol. 2000;78(5):510-522.
  16. Schwellnus M, Commission IM. The Olympic textbook of medicine in sport. Wiley-Blackwell; 2008.
  17. Nieman DC. Risk of upper respiratory tract infection in athletes: An epidemiologic and immunologic perspective. J Athl Train. 1997;32(4):344-349.
  18. Purcell L. Exercise and febrile illnesses. Paediatr Child Health. 2007;12(10):885-892.
  19. Weidner TG, Sevier TL. Sport, exercise, and the common cold. J Athl Train. 1996;31(2):154-159.
  20. West NP, Pyne DB, Cripps AW, et al. Lactobacillus fermentum (PCC(R)) supplementation and gastrointestinal and respiratory-tract illness symptoms: A randomised control trial in athletes. Nutr J. 2011;10:30-2891-10-30.