Why Asthma Won’t Keep Your Child Out Of the Olympics

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.

London 2012 Olympic medals made by The Royal M...
London 2012 Olympic medals made by The Royal Mint, Llantrisant / Medalau Llundain 2012 wedi’u cynhyrchu gan y Bathdy Brenhinol, Llantrisant (Photo credit: Welsh Government / Llywodraeth Cymru)
  • 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?

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  1. Sarah says

    I’m a black belt in martial arts, avid hiker and sometimes runner and swimmer. I also have well-controlled moderate allergic asthma. As a kid, I had poorly-controlled severe asthma, but thankfully my control has improved and my asthma has become less severe as I’ve aged. I have an exercise-induced bronchospasm aspect to my asthma, so I usually premedicate with Ventolin if I know I’m going to be doing something strenuous.

    The only issue I have with exercising with asthma is that first, it’s a bit bulkier – I have to make sure that I’ve got something to carry my inhaler and spacer in (I have a hard time using an inhaler properly without a spacer if I’m having trouble breathing, plus I read about those studies that showed inhaler + spacer is almost twice as good as inhaler alone, even controlling for inhaler technique) – and that I have to choose when and where I exercise a bit more carefully. In spring, I avoid wooded areas because tree pollen sets me off. If I was living in the country, I’d have to avoid areas with a lot of hay, since I’m really allergic to hay. I don’t exercise along busy roads, either. Other than that, if I’m not flaring, I can exercise how I want and when I want, so long as I warm up adequately.

    For me, at least, exercise helps my control, and vice versa. They feed into each other, either positively (when I’m working out and staying on top of my breathing) or negatively (if I slip up on my medicines, it makes it harder to exercise, and if I slip on exercise, my asthma tends to flare more).

  2. says

    Thanks for the great article. It is really nice to hear that there is science out there that proves the naysayers wrong regarding asthmatics and sports.

    I was diagnosed as a Chronic Bronchial Asthmatic at a very young age and so it was thought that I was going to spend my life stuck in the house watching the rest of the world go by. However, in high school I lettered in Varsity Cross Country and Track, and since then have also gone on to set records in powerlifting as well. Asthma has never been something to stop me when I am active. It actually isn’t even a consideration with anything I do except for times I will be exposed to allergens that will cause extreme reactions.

    Do I still have to watch for flares? Yes, but they don’t actually have to stop me from participating in life, and I have medication to help me control the situation.

  3. says

    Be sure that everyone involved with your child knows about his or her asthma and knows where to find “rescue medications” and how to administer them in the event of a severe asthma attack. Also, understand that in the majority of states, children do have the right to carry their rescue medications in school.


  1. […] Winning Post: Probably the best word to describe Dr. Canapari’s blog is “uplifting.” This post embodies that word. Parents of children with asthma often fear their child won’t be able to succeed in athletics, or even compete against non-asthmatic kids. In this post, inspired by the major success of Olympic athletes with respiratory issues, Dr. Canapari explains exactly why asthma won’t keep your kids out of the Olympics. […]

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