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But you see a heck of a lot of athletes with puffers, which seems statistically unlikely because for somebody to become a world-class athlete they probably wouldn't start out with a puffer.

Some of it can be training induced asthma, though. At least it was quite common when I grew up that the cross country skiers all had breathing problems from training hard in cold weather. (There is better knowledge and guidelines and regulations around this now, at least, avoiding exposing kids to this too much).

I've heard before that elite athletes have higher rates of asthma. Iirc a hypothesised explanation is that asthma in developmental years causes psychological resilience to intense training, thus increasing the chances of reaching advanced levels, especially if the asthma becomes milder over time.

I just did a bit of Googling and found this study of athletes from the 2008 Beijing Olympics: https://scholar.google.com/scholar_lookup?journal=Allergy&ti...

Incredibly, nearly 60% of endurance athletes are recorded as being asthmatic. Compared to 5-10% of the general population.

The introduction does corroborate your point:

It has been proposed that asthma among endurance athletes could arise from prolonged mechanical stress of the airway surface and increased ventilation causing airway remodeling. This could indicate that a specific underlying pathomechanism exits, most likely related to endurance sport.
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