Recognition, Prevention & Management of Asthma in Athletics
Asthma is commonly seen in athletes in all levels of competition. For a majority of people who have chronic asthma, exercise is a trigger. Certified athletic trainers (ATCs), as well as other allied health care professionals, are in a unique position to help coaches, parents and athletes, recognize, prevent and manage asthma. The National Athletic Trainers’ Association (NATA) has issued its first ever position statement on Management of Asthma in Athletics, which will appear in its entirety in the September issue of the Journal of Athletic Training. NATA offers the following recommendations for ATCs and other health care professionals to follow: I. Be aware of the major asthma signs and symptoms:
- Tightness in the chest (or chest pain in children)
- Shortness of breath (dyspnea)
- Breathing difficulty at night
- 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 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
- Family history of asthma
- Personal history of atopy (where the reaction or allergy can be found in other areas of the body, e.g. ingesting something and then breaking out in a rash) including atopic dermatitis/eczema or hay fever (allergic rhinitis)
II. Provide guidelines for referral so athletes with asthma and/or those suspected of having it, can receive a thorough evaluation. Athletic trainers and other health care professionals should:
- Devise an asthma action plan for managing and referring athletes who may experience significant or life threatening attacks, or breathing difficulties, into their existing emergency action plans.
- Have pulmonary function measuring devices, such as peak expiratory flow meters (PFMs), at all athletic venues, and be familiar with how to use them.
- Encourage well-controlled asthmatics to engage in exercise to strengthen muscles, improve respiratory health and enhance endurance and overall well being.
- Refer athletes with atypical symptoms; symptoms that occur despite proper therapy; or other complications that can exacerbate asthma (e.g. sinusitis, nasal polyps, severe rhinitis, gastroesophageal reflux disease [GERD] or vocal cord dysfunction), to a physician with expertise in sports medicine. Such doctors include allergists, ears, nose and throat physicians, cardiologists and pulmonologists trained in providing care for athletes.
III. Describe management plans to prevent and control asthma attacks when they occur. ATCs and coaches should:
- Consider providing alternative practice sites for athletes with asthma. Indoor practice facilities that offer good ventilation and air conditioning should be taken into account for at least part of the practice.
- Schedule practices during times at which pollen counts are lowest (e.g. in the evening during the peak of ragweed pollen season).
- Encourage players with asthma to have follow-up examinations at regular intervals with their primary care physician or specialist. These evaluations should be scheduled at least every six to 12 months.
IV. Educate ATCs and athletes about pharmacological and non-pharmacological therapies and techniques to help control asthma:
- Athletes with exercise-induced asthma (EIA) may benefit from use of short- and long-acting b2-agonists. These agents can be used for prophylaxis during practice and game participation.
- When used to prevent EIA, a short-acting b2-agonist, such as albuterol, should be inhaled 10 to 15 minutes prior to exercise.
- The excessive need for short-acting b2-agonists therapy during practice or an athletic event should cause concern. A physician should evaluate the athlete before returning to participation.
- Long-acting b2-agonists should, in general, only be used for asthma prophylaxis and control. Usually, the long-acting agents are combined with an inhaled steroid. Athletes with past allergic reactions or intolerance to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) should be identified and provided with alternative medicines, such as acetaminophen.
About the NATA: Certified athletic trainers (ATCs) are unique health care providers who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that occur to athletes and the physically active. The National Athletic Trainers' Association represents and supports 30,000 members of the athletic training profession through education and research. www.nata.org. NATA, 2952 Stemmons Freeway, Ste. 200, Dallas, TX 75247, 214.637.6282; 214.637.2206 (fax). Asthma in athletics tips