Exercise-induced asthma is no reason to keep anyone from exercising or participating in competitive sports.
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Everyone gasps for breath after a quick sprint or a long, strenuous workout, but for some the gasping seems to come too soon and without good reason. The symptoms moreover are not those of a winded athlete but rather of a person with asthma: coughing, wheezing, tightness in the chest and shortness of breath.
About 80 to 90 percent of persons with asthma frequently suffer attacks when they exercise. In addition, five to seven percent of persons who do not otherwise have asthma, including 20 percent of competitive athletes, develop an asthmatic reaction either during or immediately after exercise.
Exercise-induced asthma (EIA) is frightening and, if left untreated, can be fatal. A Northwestern University football player died last fall as a result of an asthma attack on the practice field. But EIA is no reason to keep anyone on the sidelines. A child–or adult–with asthma needs regular exercise the same as anyone else. In fact excess weight and lack of fitness may make the condition worse.
James discovered that he had exercise-induced asthma when he went out for the cross country team in high school. His parents were worried and wanted him to quit the team, but their doctor assured them that James could safely compete provided he comply with his treatment regimen. He went on to win second place in the state and won a cross country scholarship to the state university.
At least 10 to 20 percent of Olympic athletes have exercise-induced asthma–including past medalists Nancy Hogshead, Greg Louganis, Jackie Joyner-Kersee and Jim Ryun. National Basketball Association players Hakeem Olajuwon, Dennis Rodman and Dominique Wilkins and University of Illinois basketball center Nick Smith are among numerous other athletes who have excelled despite EIA.
Cold, Dry Air Triggers Attack
The symptoms occur as a result of bronchospasm or sudden contraction of the muscle fibers surrounding the lower airways. As the airways constrict, they make it difficult for air to get out of the lungs, resulting in the wheezing or high-pitched whistling sound.
It’s believed that an attack occurs because the airway muscle fibers of some individuals are sensitive to changes in air temperature and humidity. During normal breathing, air is warmed and moistened as it passes through the nose and nasal passages. Exercise involves much more rapid breathing, and usually through the mouth rather than the nose–hence exposing the airways suddenly to cool, dry air.
Winter athletes have a higher than normal risk. It’s estimated that about half of competitive cross country skiers and ice skaters suffer from exercise-induced asthma. Endurance athletes such as long-distance runners and cyclists also have an elevated risk, regardless of the season.
The bronchospasm usually occurs within the first 5 to 10 minutes of exercise, although some experience it after exercise is over. Those who continue exercising may find that symptoms improve–giving them a refractory period or “second wind.”
An attack occurs when airway muscles contract, usually in response to changes in air temperature and humidity.
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To make use of that refractory period, athletes with EIA are advised to be even more scrupulous than other athletes about warming up before exercise. It’s known that warming up can prevent injury and improve performance, but in the case of a person with asthma both the warmup and cool down periods allow the airways to adjust gradually. The warm up period should be at 50 to 60 percent of maximum heart rate and last for about 10 to 15 minutes.
As long as asthma is properly treated, there is no reason anyone has to forego participation–at even the highest level–in any activity.
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Controlled studies have demonstrated that a 15-minute warmup period can greatly reduce–and in some cases virtually eliminate–symptoms for most individuals suffering from exercise-induced asthma. Persons with asthma are also advised to avoid exercising outdoors when the pollen count or air pollution is high. Breathing through the nose or wearing a mask or scarf over the mouth may reduce exposure to cold, dry air, but these measures aren’t always practical for competitive athletes or for children who are active throughout the day.
Anyone suffering from symptoms resembling exercise-induced asthma should, of course, see a doctor. In the majority of cases, medications are needed to manage symptoms effectively.
First-line therapy usually consists of a short-acting beta agonist inhaler such as albuterol, terbutaline or pirbuterol. Two to four puffs can be taken about 15 to 30 minutes before exercise or, as needed, during or after exercise to reverse the contraction of muscle tissue in the airways. These medications have an effect lasting about four hours.
Long-acting beta agonists such as salmeterol and formoterol, may also be prescribed to protect against bronchospasm. These medications have an effect lasting as long as 12 hours, providing protection throughout the day. When taken continuously over the long term, however, these long-acting medications tend to lose some of their effectiveness.
About 90 percent of patients can be treated effectively using either a short- or long-term beta agonist or a combination of the two.
If additional asthma protection is needed, a doctor may prescribe a mast cell stabilizer such as cromolyn or nedocromil or a leukotriene modifier such as zafirlukast or montelukast. For some patients, inhaled corticosteroids may also be prescribed on a long-term basis.
It’s important, of course, for an athlete to follow the prescribed treatment and to avoid supplements containing ephedra, ma huang or other stimulants. These substances can be dangerous, even life-threatening, when taken at the same time as asthma medications.
Swimming is often considered the ideal activity for a person with asthma because of the warm, humid (as opposed to cold, dry) environment although some asthmatic individuals have an allergic reaction to the chlorine or other agents in the pool. Other activities unlikely to trigger exercise-induced asthma include walking, leisure biking, hiking, downhill skiing, baseball, golf and gymnastics. Although basketball requires high intensity activity, asthma symptoms can often be managed through frequent rests.
As long as the asthma is diagnosed and properly treated, however, there is no reason any individual has to forego participation–at even the highest level–in any activity because of exercise-induced asthma.
REFERENCES:
“AAAAI Urges Coaches, Parents, Players To Recognize Signs of Exercise-Induced Asthma,” Immunotherapy Weekly, September 4, 2002.
“Cold Air/Bad Lungs,” Running & FitNews, January, 2002.
“Exercise-Induced Asthma Common in Athletes,” Immunotherapy Weekly, February 20, 2002.
Jennifer Gollhardt, “Athletes and Asthma,” AAAAI press release, August 6, 2001.
John H. Marks and Douglas N. Homnick, “Opening the Door to Exercise for Teens with Chronic Pulmonary Disease,” Contemporary Pediatrics, March, 2002.
Marty Munson, “Shooting the Wheeze: Continuous Warm-Up May Keep Asthma Away,” Prevention, January, 1995.
Mary Desmond Pinkowish, “Exercise-Induced Asthma,” Patient Care, July 15, 2000.
Monica Preboth, “Causes and Treatment of Exercise-Induced Asthma,” American Family Physicianb, April 1, 2000.
Christopher C. Randolph, “Exercise-Induced Asthma, Part 1: How To Make the Diagnosis; Some Patients May Present with Abdominal Pain,” Journal of Respiratory Diseases, July, 2002.
Christopher C. Randolph, “Exercise-Induced Asthma, Part 2: Treatment Options; Drug Tolerance May Lead To Decreased Bronchoprotection,” Journal of Respiratory Diseases, August, 2002.
A.E. Tattersfield, A.J. Knox, J.R. Britton and I.P. Hall, “Asthma (Seminar),” The Lancet, October 26, 2002.
Miriam E. Tucker, “Undertreated, Mild Asthma Can Be Fatal in Athletes; Monitor Closely,” Family Practice News, July 1, 2002.
Carey Rossi Walker, “Waiting To Inhale: Don’t Let Asthma Slow Down Your Exercise Regimen,” Muscle & Fitness, December, 2001.
Anne D. Walling, “Management of Exercise-Induced Asthma,” American Family Physician, April 1, 2000.
