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Asthma and the Athlete

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The Official Publication of AAN - MA

Asthma and the Athlete

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By Thomas J. Kallstrom,
BS, RRT, AE-C, FAARC

A few years ago I became intimately aware of a young man—an active and energetic 13 year old who loved football. He was on a community recreation league and, of course, on the football team. During one of the practices he had a respiratory arrest, collapsed, and died. An autopsy revealed that his death was the result of a fatal asthma attack. Unfortunately, he had never been diagnosed with asthma and, therefore, never took necessary precautions before exerting himself on the football field. This young teen was one of the 4,000 who die from asthma every year. Had he been diagnosed and properly treated, the story might have had another ending.

Recognizing the symptoms
In the United States there are more than 4 million high school athletes and 30 million under the age of 18 who participate in organized sports.1 The prevalence of emergency room visits and deaths from exercise-induced asthma is significant. When drilling down deeper into the statistics, we find that asthma deaths during sports generally happen more with white athletes by a 2-to-1 margin. These deaths among males are predominate usually between the ages of 10 and 20. It is also noteworthy that many of these deaths were with people who had already been diagnosed with mild or persistent asthma.2 So the assumption that only people with severe asthma die is a myth—a misconception that our patients and their parents and/or caregivers must understand.

Asthma deaths run the full spectrum. Keeping this in perspective, the absolute magnitude of an increase in risk of death from asthma during sports is relatively small. Patients with asthma should not be discouraged from participating in sports but rather should be controlling it so that they can.3

Minimally, it is essential that athletic trainers and coaches be educated on how to recognize the signs and symptoms of an asthma attack in order to take immediate action. It is also important that they know who these patients are. When considered on the whole, shortness of breath (SOB) is common with any athlete; and depending on the outdoor weather conditions (if the sporting event takes place outdoors), SOB could present as exercise-induced asthma in as many as 50% of all winter sport activities.4 However, other researchers have shown that only 15% to 25% of those who display breathing difficulties may have signs that are suggestive of asthma, including exercise-induced bronchospasm.5 It is, therefore, imperative that trainers and coaches or anyone in authority be educated to recognize asthma symptoms as well as provide immediate medical intervention.

Identifying those at risk
Asthma screening that identifies undiagnosed and poorly controlled asthma is a logical consideration. If we can identify students at risk, we can ensure that they receive the care of a physician. We did such a screening in Ohio a couple of years ago with elementary and middle school students. All students who received parental permission to be part of the study were given a 20-question American Academy of Asthma, Allergy & Immunology validated questionnaire. In addition, we also measured forced expiratory volume in first second (FEV1) of all students in the study. If the child had an FEV1 of less that 80% and at least one affirmative answer in the symptom-based questionnaire, they were considered a “positive.”6 This screening of 381 school children identified 18.5% positives.

That was the easy part of the exercise. Getting the parents to act upon this important information about their child and to take necessary steps was much more difficult. In fact, with follow-up phone calls to the parents and caregivers, we found that only 10% of the parents had their child seen by a physician. Therein lies a challenge in such efforts: If a parent or caregiver refuses to have their child seen by a physician, the asthma screening will not be of much value.

This brings us back to the young man at the beginning of the article. His death tore apart the community in which he lived. The prevailing sentiment was that something needed to be done that would provide a glimmer of light to his family and community. The family sought to make sure that something like this never happened again. With his family’s perseverance and with the agreement of the recreation league—as well as the mobilization of local churches, respiratory therapists, nurses, physicians who donated their time, and a pharmaceutical company that donated money to come to Columbus the following summer for a day-long intervention—we screened every child who had signed up for any recreation league sport, including cheerleaders.

Any child found to have a positive screen was referred to the recreation league that would not allow the child to play sports unless they seen by a physician, were appropriately diagnosed, and started an asthma management plan. There were more than 1,000 children screened that day, and approximately 40% were found to have a positive screen.

Positive screenings can have positive endings
In many ways this boy’s story did have a positive ending. It was because of this screening that children who might not have otherwise known that they had asthma were diagnosed, treated, and allowed to participate in their chosen sport. Sports are an important part of our culture, and even asthma should not be a deterrent. We just need to make sure that those who participate take the necessary precautions if they have asthma. •

References
1. Hong G, Mahamitra N. Medical screening of the athlete: how does asthma fit in? Clin Rev Allergy Immunol 2005; 29(2):97-111.
2. Becker JM, Rogers J, Rossini G, et al. Asthma deaths during sports: report of a 7-year experience. J Allergy Clin Immunol 2004; 113(2):264-267.
3. Lang DM. Asthma deaths and the athlete. Clin Rev Allergy Immunol 2005; 29(2):125-129.
4. Butcher JD. Exercise-induced asthma in the competitive cold weather athlete. Curr Sports Med Rep 2006; 5(6):284-288.
5. Miller MG, Weiler JM, Baker R, et al. National Athletic Trainers’ Association position statement: management of asthma in athletes. J Athl Train 2005; 40(3):224-245.
6. Kallstrom TJ. School based asthma intervention and screening: does it work? Open Forum abstract. Respir Care 2004; 49(11):1363.

Thomas J. Kallstrom, BS, RRT, AE-C, FAARC, is associate executive director and chief operating officer of the American Association for Respiratory Care. He is a long-time member of the National Asthma Education Prevention Program Coordinating Committee.

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