Asthma in Sports Participation
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Transcript Asthma in Sports Participation
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
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
1. Check Peak Flow
2. Give medications as
listed
3. Re-check Peak Flow
4. 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
1. The cooling/warming hypothesis
2. 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/MgmtOfAsthm
aInAthletes.pdf