By Jon Heck, MS, ATC
Coordinator of Athletic Trainer
3/99


The purpose of this update is to give you a brief overview on asthma relating to athletics.  This update will also outline our Asthma Watch Program that we will implement this year.  We are attempting to give you a better understanding of asthma problems, help your athletes maximize their performance, and decrease the medical risk to those athletes. 

Exercise Induced Asthma (EIA) 
EIA is a condition where the bronchial airways constrict from vigorous exercise.  Breathing becomes so difficult that athletic performance declines significantly.  Most athletes affected will have chronic asthma that worsens with exercise.  But some athletes will only have asthmatic symptoms associated with exercise.  Surveys suggest that up to 23% of athletes have EIA that is unrecognized. 

EIA can become a medical emergency and has lead to death on the playing field when mismanaged.  Preventing this type of emergency is obviously our primary goal.  However, if recognized, and managed appropriately athletes with EIA can compete at the highest levels.  As an example, 33% of the 1996 US Olympic Team with EIA won medals.  Proper medication is the key to successful management of EIA. 

A Typical Attack 
An attack normally begins after 5-12 minutes of strenuous exercise.  In most cases the attack begins immediately after the exercise, but it may also begin during this exercise period.  Once it begins the attack peaks in 6-8 minutes (by now effecting performance).  The severity of the attack will vary.  The frequency of the attacks will vary too.  The symptoms then gradually resolve over the next 30-60 minutes and the athletes performance returns to normal.  This resolution period is often referred to as the "second wind" phenomenon.  A late phase attack occurs 3-6 hours later in 30% of athletes with EIA. 

The obvious symptoms are, wheezing, chest tightness, and difficulty breathing.  The subtle symptoms are coughing, chest congestion, athlete feels "out of shape", exercise fatigue, inconsistent performance, poor tolerance of long exercise periods while short periods are tolerated well.  Certain sports are also higher risk for EIA episodes based on the type of exercise they involve.  The high risk sports at Stockton are: cross country (and middle distance running), basketball, lacrosse, rowing, and soccer.  The low risk sports are: baseball, softball, and volleyball.  Intermittent training with low intensity aerobic activities decrease the risk of EIA.  Environmental conditions also contribute to the risk.  Attacks are more likely to occur in cold, dry air.  Warm, humid weather decreases the risk of an EIA episode. 

EIA Management 
The following procedure can help reduce or eliminate episodes of EIA.  As the coach you are in an excellent position to ensure your athletes are following it. 

1) Premedicate using their prescribed asthma inhaler 15-30 minutes before competition. 
2) 30 minutes before competition begin 10 minutes of stretching and warm-up activities. 
3) Begin moderate aerobic exercise (running, jogging).  Sustain this level for 5-10 minutes. 
The objective is to induce a mild EIA episode to get the athlete to the "second wind" period. 
4) Follow with a 10 minute cool-down of gradually decreasing exercise (walking, stretching). 

Asthma Watch Program 

• During their physical, all athletes with suspected EIA will have their lung capacity measured with a Peak Flow Meter.  This will be their "normal" score. 

• Each head coach will receive a list of all asthmatic athletes on their team. 

• The coach will ensure no athlete will be permitted to play or practice without their asthma inhaler immediately available.  An athlete who forgets their inhaler will be sent home to get it before they are permitted to practice.  Note, an inhaler in their bag while they are distance running through campus does them no good.  It should be on their person during such training. 

• An athlete that has an attack at practice will be retested with the Peak Flow Meter by the student athletic trainers.  The athlete must score within 10% of their normal score to return to practice. 

• Acceptable Asthma Management.  The athlete that uses an inhaler to premedicate before competition and only once during competition to manage symptoms is in an acceptable treatment range. 

• Ineffective Asthma Management.  The athlete that needs their inhaler more than once during practice represents ineffective treatment.  Competition will be terminated that day for any athlete that uses their inhaler twice during the exercise session (excluding premedication).  This athlete should be brought to my attention so we can seek alternate and more effective medication treatments through our physician. 

• Asthma Emergency.  An athlete who has an attack and their inhaler does not alleviate the situation in 5-7 minutes should be transported to the emergency room by the EMS or Stockton Police.