Download 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
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History
Inspection
Palpation
Percussion
Auscultation
Asthma Identification & Dx
 Physicals
 History
 Spirometry testing
 Referral
Asthma Identification & Dx
 Signs and Symptoms
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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:
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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
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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
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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
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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