Background Pre-race respiratory tract symptoms (RTS) in Ironman triathletes appear to be common but the incidence and risk factors for pre-race RTS have not been well studied.

Objective The objectives of this study were to determine the incidence of RTS in triathletes preparing for an Ironman Triathlon and to establish the risk factors associated with pre-race RTS.

Setting International Ironman Triathlon competition.

Participants 304 triathletes entering the Ironman triathlon were recruited.

Assessments All the subjects completed a validated questionnaire in the 1–3 days before the race that contained sections on demographics, training and previous competitions, and a detailed section pertaining to RTS and allergies. Data on race performance were collected after the race. Subjects were divided into the following groups, based on their self-reported history of RTS in the 6 week and 1 week period prior to the race: no RTS, all RTS, only upper respiratory tract symptoms (URTS), lower respiratory tract and/or systemic symptoms (LRT+SS).

Measures of outcome Incidence (%) of triathletes with RTS in the 6 weeks and 1 week before the race and factors associated with pre-race RTS.

Results The main findings in this study were that 49% of the Ironman triathletes reported RTS in the 6-week period before competition. There was a strong association between self reported RTS in Ironman triathletes and a history of self reported allergies rather than training volume (in the 15 weeks before the race). Self-reported LRT+SS but not URTS in triathletes were associated with decreased training in the 6 weeks before the race.

Conclusion Triathletes, in preparation for a race, report a high incidence of RTS, which appear to be related to allergies rather than other factors including training volume or the calibre of the athlete.