Know the signs of exercise-induced asthma

Jackie Joyner-Kersee recovers from an asthma attack after the 800-meter at the 1994 Goodwill Games  Credit: Phil Cole/Allsport
You are the coach of a youth soccer team. A player on your team develops a persistent cough within the first five to 10 minutes of exercise and has trouble keeping up with their teammates.

They may complain of some difficulty breathing and a tight chest during exercise, especially when the weather is cold and dry. Smoke, smog, car exhaust and other air pollutants also aggravate the problem, especially if you train in the late afternoon when air pollution rises.

However, things improve after exercise. These symptoms never happen when the player's at rest. You ask Mom, and she says the player "grew out of childhood asthma," but that her child couldn't have asthma because there has never been any wheezing.

The coach is on the right path thinking the player has asthma, but the perception that wheezing is a required symptom is as common as the belief that you have to be unconscious to have had a concussion.

Exercise-induced asthma (or the more proper term exercise-induced bronchospasm or EIB) is a fairly common condition. With the number of kids in sports, soccer included, it is likely that most coaches are going to have a player with EIB. As such, it is important for the coach to be familiar with the signs, symptoms and treatments.

EIB in athletes reflects the general population. About 7 percent of asymptomatic children and around 10 percent of U.S. Olympians have been diagnosed with EIB. In sports, the prevalence varies by sport (e.g. basketball: 12 percent, cross-country skiing: 55 percent). There is no published data on its occurrence in soccer.

The proportion of medal winners in the Olympics with and without EIB is the same, so EIB need not be a limit to performance, if properly treated. With 7 percent of children having EIB, the odds are that a coach with a team of 14 to 15 kids will have one player with EIB, so be aware.

When air is inhaled, it passes through an intricate network of increasingly narrower tubes on its path deep into the lungs. One class of tubes is called the bronchioles. These have muscle surrounding them, allowing the tubes to narrow or expand depending the on the body's needs. In some people, these muscles spasm (thus the term) narrowing the bronchioles more than necessary and trapping air in the lungs. The wheezing of an asthmatic is their difficulty exhaling trapped air.

Certain activities are more likely to trigger EIB. Higher-intensity exercises with little rest are a problem, such as distance running, cycling, basketball and soccer. Cold-weather activities like cross-country skiing, speed skating and ice hockey also trigger EIB because of the temperature.

Activities with longer rest periods, like baseball, golf, tennis, football and others are less likely to trigger EIB. Swimming is a good activity because the air is usually pretty warm and humid.

A family physician, allergist, or pulmonary (lung) specialist can make the diagnosis of EIB. A detailed history of breathing episodes with or without activity is critical to the diagnosis. The doctor may order some tests to see if the symptoms can be reproduced, like a controlled exercise test followed by some breathing tests. More provocative tests may be ordered as needed.

The concept of treatment is well-established: pre-medicate with a drug that inhibits the bronchiolar spasm. Most drugs are somewhat short-acting in the form of an inhalant that is used in the10 to15 minutes before exercise and last for about two hours (these drugs include Proventil, Ventolin, Maxair, Intal or Tilade).

Newer, longer-acting medicines, like Serevent, last for up to six hours, and Singulair is a pill taken at night. New drugs are continually being introduced. The player who knows they have EIB rarely is without their inhaler. Some of these drugs have substances that are banned by various sporting governing bodies, so in the event that an athlete gets to the collegiate or international level, it is important to notify the medical supervisors.

EIB can be controlled and should not be a limit to participating in sports at any level. The full measure of successful treatment of EIB is participation in recreational and competitive sports.

A final word: Don't self-diagnose based on a short summary like this. See a physician. For more information, a good, readable medical summary of EIB can be found at http://www.physsportsmed.com/issues/1999/11_99/lacroix.htm

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