Page 119 - Athletic Health Handbook
P. 119
Northwestern University (Evanston, defined pathophysiology than atopic or prevention of symptoms is inhaled
Ill.) football player, has brought new asthma. EIB is triggered as a result steroids, inhaled long-acting ß2-
levels of attention to asthma and its of the release of inflammatory agonists, and oral leukotriene modi-
management. This article will address leukotrienes in reaction to the fluxes fying agents. Inhaled short-acting
the management of asthma, focusing in heat and water that develop within ß2-agonists, such as albuterol, are
on EIB in particular. the trachea and bronchi during the the backbone of rescue therapy for all
warming and humidification of air.8 asthmatics. The goal of asthma therapy
Pathology of the Disease The understanding of this pathway, is to control the disease, preventing
and the role leukotrienes play in attacks from occurring. Despite
Asthma is a disease with a wide spec- airway inflammation lead to the use preventive measures and excellent
trum of severity, and its clinical mani- of an entirely new class of drugs to control therapy, attacks can and will
festations can vary patient by patient. manage atopic asthma and EIB.9 occur. This is when the rescue medica-
Thus, it is important for a sports tions are used and the activity is
medicine physician to understand the Treating the Disease stopped. The athlete with asthma that
disease and the most current therapies is classified beyond intermittent by
to treat it. Asthma is a disease of the The mainstay of non-pharmacological the NHLBI guidelines should be on
lungs, characterized by airway hyper- asthma therapy has always been to at least one control medication. Some
reactivity, associated with varying avoid known triggers. Typically, this common asthma medications (such
degrees of bronchospasm and airway means avoiding being outside on high as salmeterol) are permitted in inhaled
inflammation. Common symptoms pollen days and not exercising when form only by the IOC, and athletes
include coughing, wheezing, shortness the humidity is high or the air is cold. using these medications may need
of breath, and chest tightness, though This is not always feasible for the written notification from a respiratory
it can present more subtly with symp- athlete, and some triggers can’t be or team physician that the athlete has
toms of general fatigue and decreased avoided. (i.e. the youth soccer player’s asthma or exercised-induced asthma
athletic performance. Asthma is cate- match happens to be on a high pollen, prior to competition (for a complete
gorized into intermittent, mild persist- high humidity day). The degree of list of prohibited substances visit
ent, moderate, and severe. There are symptoms the patient suffers is
multiple triggers for asthma, the most dependent on multiple factors, includ-
common being allergies to pollens, ing type of exercise, strenuousness of There is a sub-set of patients who
high humidity, cold air, and exercise. activity, environmental factors, and have no objective findings of asthma
Unfortunately, almost all forms of underlying severity of their asthmatic at rest and no symptoms of asthma
athletics involve exposure to one disease. For mild exercise, many except when triggered by exercise.
of these triggers. patients may not need medication, These are the “true” EIB patients, and
but vigorous activity increases the risk there is new evidence that treatment
The diagnosis of asthma and EIB of a bronco-constriction event and with leukotriene modifying agents
should be made by a primary care many athletes may need a short break showed significant reduction in asthma
physician or pulmonologist, using a 10 to 15 minutes into their activity. symptoms, as well as significant
combination of spirometry, reversibil- There is also good evidence that a reduction in the amount of decline
ity, exercise, and environmental 10 to 15 minute warm-up period in the athlete’s lung function after
challenges. A study examining the of light exercise prior to the planned exercise.10 These patients still need
“self-reporting” of symptoms by elite strenuous activity can condition the rescue inhalers with them at all times.
athletes failed to show correlation airways, diminishing the leukotriene
between objective measures and response. This allows accommodation Sideline Considerations
the reported symptoms.6 In general, of heat and water in the bronchi
patients with asthma underscore creating a refractory period where For the sports medicine physician
their symptoms. the lungs are unable to broncho- who finds himself or herself with
constrict. Despite these steps, an asthmatic patient complaining of
Atopic asthma, or allergic asthma, symptoms can still occur. trouble breathing, a simple assessment
is the form of the disease most of the patient can detect the extent of
commonly encountered. The 1997 The NHLBI divides asthma the problem and provide immediate
Guidelines by the National Heart, management therapies into “control relief. Though oxygen may help
Lung, and Blood Institute (NHLBI) meds” and “rescue meds.” The main- psychologically to calm the patient
address the management of atopic stay of all asthma therapy for control as he or she feels the air flow, asthma
asthma.7 EIB may have a better-

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