The Olympics are a big deal in my house, especially to my wife, whose obsession with the Olympics is well documented. Personally, I love the Winter Olympics because I love the aesthetics, and the variety of the sports. Not coincidentally, the spectacle of athletes performing in the cold air makes me think of my asthma patients, who frequently have symptoms in the wintertime.
I frequently see children with asthma or suspected asthma in my pulmonology practice. When I make the diagnosis in children, their parents are crestfallen, and I can understand why. Asthma is a chronic disease. Many of these parents are around my age and remember friends with asthma (or were asthma sufferers themselves) and remember a time before the routine use of controller medications when children with asthma were frequently sick. (Although inhaled steroids were first produced in the 70s, they were not in wide use until the early 90s). Also, many parents are uncomfortable with using daily medications in their children which is necessary for many children with asthma.
The fact is, most children with asthma can easily be managed with available medications. The goal of treatment is minimal symptoms (less than twice a week). I routinely tell children and families that many athletes in the Olympics suffer from asthma, and that asthma will not prevent them from doing sports either.That’s why I was so pleased to read two articles by Alex Hutchinson on precisely this topic.
- In his article in the Globe and Mail he explores asthma in elite athletes. More specifically, a disorder called “exercise induced bronchospasm (EIB)” which is quite common in athletes. [Essentially, EIB is narrowing of the bronchi (tubes carrying air throughout the lungs) occurring during exercise.] It used to be thought that albuterol, the classic rescue medication used for asthma symptoms, was a performance enhancing substance, but more recent research suggests that this is not the case. It seems that EIB may actually confer a competitive advantage after warm up for a period of time called the refractory period.
- Mr. Hutchinson provides more background information on the Sweat Science blog at Runner’s World, he references data from a study in the Clinical Journal of Sports Medicine suggesting that asthmatic athletes are more likely to medal than non-asthmatic athletes.
In the Globe and Mail article he also offers some good advice on warming up for athletes with asthma:
If you suffer from exercise-induced asthma, a proper warm-up can trigger a “refractory period,” which prevents your airways from narrowing during exercise. Some key elements:
Total duration should be at least 20 to 30 minutes.
Start with a gentle jog, cycle or swim, and gradually increase the pace.
Include several bursts at 80 to 90 per cent of maximum intensity, each lasting two to five minutes.
One extra layer I would add is that there seem to be certain sports which predispose athletes to asthma because of certain exposures. The lungs are exposed to the outside every time you take a breath; athletes breathe more deeply and rapidly and have more exposure. Thus cross-country skiing (cold air exposure), swimming (chlorine exposure) and sports occurring on an ice rink (nitrogen oxide exposures) may be associated with increased risk of asthma. (For an excellent review of this topic, I highly recommend this article by K.H. Carlsen: European Respiratory Journal 2011 CarlsenThe breathless adolescent asthmatic athlete).
Finally, here are some examples of athletes competing with asthma:
- Jordan Malone is an American short track speed skater with a history of childhood asthma and ADHD.
- Marit Bjoergen is a Norwegian cross country skier with seven prior Olympic medals. Note that her rival alleged that her asthma medications allowed her to win, but asthma medications when used as prescribed do not provide an unfair advantage. (For a more detailed review of this topic you can read this article).
Does anyone out there have any experience in participating in sports as an asthmatic, or as the parent of an asthmatic child?