Asthma in Sports Participation Brooke Owens, ATC McLeod Sports Medicine

Respiratory Concerns Asthma: chronic inflammatory disorder of the airways characterized by variable airway obstruction and bronchial hyperrepsonsiveness Exercise-Induced Bronchospasm (EIB): a temporary narrowing of the airways (bronchospasm) induced by strenuous exercise in which the patient has no symptoms Exercise-Induced Asthma (EIA): EIB with symptoms of asthma

Other Suspects Airway Disease Exercise-induced laryngeal obstruction Respiratory Tract Infection Allergy & Rhinitis Pneumothorax Exercise-induced oedema “Out of Shape”

Evaluation of Chest and Lungs History Inspection Palpation Percussion Auscultation

Asthma Identification & Dx Physicals History Spirometry testing Referral

Asthma Identification & Dx Signs and Symptoms Chest tightness Coughing Dyspnea Wheezing Use of accessory muscles to breathe An athlete who is well conditioned but does not seem to be able to perform at a level comparable with other athletes who do not have asthma

Asthma Identification & Dx Referral!! Pulmonary function testing Records of episodes, etc

Asthma Management Asthma can be triggered by many stimuli, including: Allergens (pollen, dust mites, animal dander) Pollutants (carbon dioxide, smoke, ozone) Respiratory Infections Aspirin NSAIDS Inhaled Irritants (cigarette smoke, household cleaning fumes, chlorine) Particulate Exposure (ambient air pollutants) Exposure to Cold Exposure to Exercise

Asthma Treatment Pharmacologic Nonpharmacologic Controller vs Reliever Leukotriene modifiers Inhaled or parenteral corticosteroids *Banned substances Nonpharmacologic Nose breathing Limiting exposure to allergens or pollutants Air filtration systems Proper Warm-up

Asthma Management All athletes with asthma should have a rescue inhaler available during games and practices. Athletic trainers should also have an extra rescue inhaler for each athlete to administer during emergencies. Nebulizer on site Athletes with asthma should have asthma management examinations at regular intervals, as determined by the PCP or specialist; to monitor and possibly alter therapy. Proper warm-up before exercise may lead to a refractory period of as long as 2 hours, which may results in decreased reliance on medications by some athletes with asthma. Alternative practice sites

Asthma Action Plan Check Peak Flow Give medications as listed Re-check Peak Flow See emergency if:

Asthma Management Emergency Management: Referral to ED or PCP for respiratory distress Significant increase in wheezing or chest tightness Respiratory rate greater than 25 breaths per min Inability to speak in full sentences Uncontrolled cough Significantly prolonged expirations phase of breathing Nasal flaring Paradoxic abdominal movement

Asthma Management Emergency Management: Immediate ED referral: Impending respiratory failure Weak respiratory efforts Weak breath sounds Unconsciousness Hypoxic seizures

Contraindications Cold ambient temperatures Moderate to severe No vigorous (limit performance)

Exercise Induced Asthma (EIA) A temporary narrowing of the airways induced by exercise in which the patient has asthma symptoms. EIA is commonly seen in athletes in all levels of athletic competition. EIA can occur in patients who do not otherwise have asthma. EIA can be a significant disability for an athlete. This is especially true in regards to endurance athletes. EIA is believed to be present in 12-15% of the general populations and as high as 23% in athletes. Can be more common in urban environments than in rural areas.

Two Major Theories The cooling/warming hypothesis The drying hypothesis

EIA Treatment One goal of management is to enable patients to participate in any activity they choose without experiencing asthma symptoms. EIB should not limit either participation or success in vigorous activities Recommended Treatments for EIB include: Beta2-agonists will limit EIB in more than 80 percent of patients. Short acting inhaled beta2-agonists used shortly before exercise (or as close to exercise as possible) may be helpful for 2 to 3 hours. Other medications may be considered as well. A lengthy warm-up period before exercise may benefit patients who can tolerate continuous exercise with minimal symptoms. The warm-up may preclude a need for repeated medications

Reducing EIA Attacks Breathe through your nose. This will help warm and moisten the air before it reaches the bronchial tubes Stay out of cold, dry air. If you do exercise outdoors, wear a face mask or scarf to help warm the inhaled air with heat and moisture from your skin.

Additional Workout Strategies EIA loophold: Refactory period This period lasts up to two hours after an EIA attack. During this time your lungs are less likely to react as strongly. If you warm up 45 minutes to an hour before your workout, you may be able to exercise without too many symptoms. Some athletes have found they can exercise easier by alternating work and rest periods.

Encouragement Patients with asthma should be encouraged to engage in exercise as a means to Strengthen muscles Improve respiratory health Enhance endurance Improve overall well-being.

Resources Management of Asthma in Athletes http://www.nata.org/sites/default/files/MgmtOfAsthmaInAthletes.pdf