Asthma and exercise-induced asthma (EIA) among athletes are common, but athletic performance need not be hindered if your child takes an active role in controlling the condition and follows good practice and control measures. Indeed, if your child has asthma, he or she should be encouraged to exercise as a way to strengthen muscles, improve respiratory health, enhance endurance, and otherwise improve overall well-being.
Asthma identification and diagnosis
Asthma is a "chronic inflammatory disorder of the airways characterized by variable airway obstruction and bronchial hyperresponsiveness."1 Asthma can be triggered by pollen, dust mites, animal dander, pollutants (eg. carbon dioxide, smoke, ozone), respiratory infections, aspirin, nonsteroidal anti-inflammatory durgs, inhaled irritants (cigarette smoke, household cleaning fumes, chlorine in swimming pool), particulate exposure (eg. ambient air pollutants, hockey rink pollution), and exposure to cold and exercise.1
Does your child have asthma?
The importance of listening to your child's complaints about breathing difficulties cannot be emphasized enough. The chief complaints are difficulty getting air in and feeling light-headed.
The following are the major signs and symptoms suggesting asthma, as well as the following associated conditions:
- Chest tightness (or chest pain in children)
- Coughing (especially at night)
- Prolonged shortness of breath
- Difficulty sleeping
- Wheezing (especially after exercise)
- Inabilty to catch one's breath
- Physical activities affected by breathing difficulty
- Breathing difficulty upon awakening in the morning
- Breathing difficulty when exposed to certain allergens or irritants
- Exercise-induced symptoms, such as coughing or wheezing
- An athlete is well-conditioned but does not seem to be able to perform at a level comparable with other athletes who do not have asthma
- Family history of asthma
- Personal history of atopy, including atopic dermatitis/eczema or hay fever (allergic rhinitis).
Asthma testing
If you suspect your child has asthma, you should consult a doctor for proper medical evaluation and to obtain a classification of asthma severity. The evaluation should include pulmonary function testing.
More often than not, asthma is diagnosed using a peak flow meter in a doctor's office, before and after a treatment of albuterol. This is especially helpful if the child presents to the doctor's office with breathing diffulties.
An exercise challenge test is recommended for athletes who have symptoms of exercise-induced asthma (EIA) to confirm the diagnosis.
If the diagnosis of asthma remains unclear after the above tests have been performed, then additional testing should be performed to assist in making a diagnosis. Your child's physician should be encouraged, when possible, to test your child using a sport-specific and environment-specific exercise-challenge protocol, in which the athlete participates in his or her venue to replicate the activity or activities and the environment that may serve to trigger airway hyper-responsiveness.
In some cases, testing for metabolic gas exchange during strenuous exercise to determine fitness should be performed, especially to rule out the diagnosis of asthma or to rule in another diagnosis (eg, pulmonary fibrosis) for a patient with an unclear diagnosis.
Asthma management: checklist for parents
- Does your child have a rescue inhaler available during all games and practices?
- Has your child been educated about asthma, especially about:
- exercise-induced asthma
- signs and symptoms of uncontrolled asthma
- using spirometry recording device to monitor lung function away from the clinic or athletic training room
- methods of limiting exposure to primary and secondary smoke and other recorgnized or suspicious asthma triggers (e.g. pollens, animal allergens, fungi, house dust, and other asthma sensitizers and triggers)
- the need for increased use of rescue inhaler as a signal for asthma flare-up; and
- proper techniques for using meter dose inhalers (MDIs), dry powder inhalers, nebulizers, and spacers to control asthma symptoms and to treat flare-ups.
- Does the athletic trainer or coach have an extra rescue inhaler and nebulizer to administer during emergencies?
- Have you encouraged your child to use a metered dose inhaler with a spacer to help insure the best delivery of inhaled therapy to his lungs?
- Has the athletic trainer/school incorporated an asthma action plan into the existing emergency action plan for managing and referring all athletes who may experience significant or life-threatening attacks of breathing difficulties?
- Is immediate access to emergency facilities during practices and games available. Referal to an emergency room or personal physician for further evaluation and treatment should be sought for any athlete who is experiencing any degree of respiratory distress (difficulty breathing), including:
- a significant increase in wheezing or chest tightness;
- a respiratory rate greater than 25 breaths per minute;
- inability to speak in full sentences
- uncontrolled cough
- significantly prolonged expiration phase of breathing
- nasal flaring
- paradoxic abdominal movement (chest and abdomin moving in opposite directions)
- Is the athletic trainer or coach familiar with appropriate community resources for emergency?
- Does the athletic trainer or coach have a fully functional mobile phone, pre-programed with emergency medical care access numbers (e.g. ICE or in case of emergency)? Indeed, the NATA statement says a "telephone may be the single most important device to have on the practice field for a patient who is experiencing an asthma [attack]."
- Is a peak flow meter or portable spirometer available, and is someone present who is familiar with how to use these devices?
- Because an asthma attack can be triggered by indoor and outdoor allergens or irritants, tobacco smoke, and air pollutants, does the sports program provide alternative practice sites (such as indoor facilities offering good ventilation and air conditioning) or limit exposure by scheduling practices when pollen counts are lowest (eg. in the evening during ragweed pollen season). Pollen information can be accessed from the National Allergy Bureau.
Periodic evaluations required
Finally, if you have an asthmatic athlete in your family, make sure to take him/her for follow-up examinations at regular intervals, as determined by your child's primary care physician or specialist, to monitor and alter therapy, if necessary. In general, the evaluations should be scheduled at least every 6 to 12 months, but they may need to be more frequent if your child's symptoms are not well controlled.
1. National Athletic Trainers' Association Position Statement: Management of Asthma in Athletes, Journal of Athletic Training 2005;40(3): 224-245.
Revised May 15, 2013
