1. Asthma in Sports Participation
Brooke Owens, ATC
McLeod Sports Medicine

2. 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

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

4. Evaluation of Chest and Lungs
History
Inspection
Palpation
Percussion
Auscultation

5. Asthma Identification & Dx
Physicals
History
Spirometry testing
Referral

6. 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

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

8. 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

9. 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

10. 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

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

12. 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

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

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

15. 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.

16. Two Major Theories The cooling/warming hypothesis
The drying hypothesis

17. 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

18. 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.

19. 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.

20. 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.

21. Resources Management of Asthma in Athletes