Exercise-induced asthma shouldn’t stop athletes
Exercise-induced asthma shouldn’t stop athletes
Screening could identify those at risk earlier
Recent studies show that exercise-induced asthma, also called exercise-induced bronchospasm (EIB) is a frequent — and relatively unrecognized — problem among athletes of all ages.
A study of urban high school football players published in a recent issue of Chest (1998; 114:1,613-1,632) reports up to 35% of athletes without known asthma and 90% of all asthmatics experience EIB.
In the study, lead author David Kukafka, MD, of Temple University School of Medicine in Philadelphia, recommended a running test "to identify individuals at risk for EIB and asthma." His report noted that EIB is most closely associated with those who have a history of wheezing and who live in poverty-stricken areas, but these factors can themselves contribute to EIB independently.
Kukafka’s study included 238 high school athletes in the Philadelphia area. Of this group, 214 did not have previously diagnosed asthma. Many of them live in poor areas known to have high rates of asthma morbidity and mortality.
Racial mix was as follows: 92 Caucasians, 140 African Americans, five Hispanics, and one Native American.
Peak expiratory flows were measured before exercise, and five, 15, and 30 minutes after exercise.
Results showed the greatest incidence of EIB occurred among young African Americans from poor neighborhoods and that the incidence of EIB increased during cold, dry weather.
In the report, Kukafka stated, "It is possible that, if during exercise testing, airflow changes can be correlated with clinical disease, it may serve as a tool to study the factors contributing to recent trends in asthma and to screen for asthma in the urban setting."
He urged active field screening for EIB, especially for populations at high risk to improve asthma recognition and treatment.
Don’t let asthma keep kids on the bench
While EIB is a problem, asthma or even asthmatic symptoms should not deter young athletes, cautions Jordan Metzl, MD, assistant attending physician in sports medicine at Manhattan’s Hospital for Special Surgery in New York City.
"It is important that in no way should asthma or EIB discourage young athletes from participating in sports," he says.
Many asthma sufferers have had illustrious athletic careers, Metzl says. "Jackie Joyner-Kersey is a longtime asthma and EIB sufferer, and she is the most accomplished female athlete ever," he adds, referring to the Olympic heptathlon star — a three-time Olympic gold-medal winner.
He cites a study of 597 athletes in the 1984 Olympic Games, which showed 67 had EIB or asthma. Of those, 41 won medals.
Metzl also explains that EIB is not the same as asthma, and peak expiratory flow impairments do not mean a person experiencing EIB has asthma.
More education on EIB is needed
"It can be only a symptom of asthma, since asthmatics usually signal the disease by viral infections and wheezing," he says.
"EIB is a very, very loose term," says Sally Wenzel, MD, a pulmonologist at National Jewish Medical and Research Center in Denver. "It can be a type of asthma or it can be seen in anyone with a more perennial type of asthma."
Whether an athlete has EIB or asthma, he or she can compete — and compete very well, Metzl says, and urges health care professionals to "do a better job of educating parents and coaches" about EIB and the means of addressing it.
Typically, the first symptom of EIB is wheezing shortly after the onset of exercise, particularly in cold, dry weather.
"An athlete will often find no problem in summer practices, but as soon as fall comes and weather turns cold and dry, the wheezing begins," Metzl says. Pollution, smog, and smoke are aggravating factors.
The most obvious preventive measure in cold weather, Metzl says, is an indoor warm-up. For those who have experienced EIB, Metzl recommends jumping rope indoors for 15 minutes before engaging in any strenuous physical activity.
Wenzel recommends a light warm-up — enough to break a sweat — 30 to 45 minutes before the onset of heavy exercise and wearing a mask or scarf when exercising in cold dry weather.
The right medications at the right dosage
Medications have their place and can be very effective, Metzl says. Albuterol and long-acting beta2-agonists can be "most helpful in reducing bronchospasm" if they are taken before exercise. He recommends albuterol 10 to 15 minutes before exercise and beta agonists one hour before.
Wenzel prefers albuterol as a prophylactic 15 minutes before an athletic workout, but warns if an athlete has plans for prolonged exertion, such as an all-day sporting event, the albuterol dosage may have to repeated every three or four hours.
She also recommends that athletes who experience EIB more than twice a week should consider a full asthma treatment and a regimen of inhaled corticosteroids.
A recent study in the New England Journal of Medicine reports that Serevent, an aerosol spray known generically as salmeterol, allows athletes to exercise for six hours or more, rather than just two hours with some other medications. A second study reported in the NEJM last summer says Singulair, known generically at montelukast, is also effective. It is appealing because it involves taking one pill the night before exercise.
Metzl and Wenzel agree that the preparations and treatments can apply to anyone who wishes to participate in sports or to engage in an exercise program, regardless of age and athletic ability.
[For more information on exercise-induced asthma, contact: Jordan Metzl, MD, at (212) 606-1678.
Sally Wenzel, MD, can be reached at (303) 398-1002.]
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