Exercise Induced Asthma

Mark Hoffman, ATC, PHD & Tedd Girouard MS, LAT, ATC

Thousands of Americans participate in soccer each day. Unfortunately, many of these participants have difficulty due to exercise induced asthma (EIA). For most people, the vision of an asthmatic is not typically a young healthy athlete. However, it has become evident that EIA asthma affects many more athletes than once thought. EIA involves the restriction of airflow resulting in the inability of the lungs to accommodate to the increased demands of exercises like soccer.

During normal resting conditions most of the air that enters the respiratory system enters through the nose. Under most exercising conditions, a large percentage of air enters through the mouth and therefore is not adequately humidified and warmed or cooled before delivery to the lungs. For athletes not hypersensitive to these conditions the body successfully handles these events while those susceptible to EIA may experience the onset of an asthma attack.

Symptoms

The most classic symptoms associated with EIA are shortness of breath and wheezing following exercise. However, care must be exercised not to over emphasize the presence or absence of wheezing. Many other symptoms such as cough, headache, stomach cramps, pain or tightness in the chest, and nausea can also indicate potential EIA. The symptoms typically start 6-8 minutes after the onset of strenuous exercise but may not reach maximum severity until up to 15 minutes after the end of exercise. Typically, the respiratory returns to normal function and symptoms disappear within a 20 to 60 minute period following the end of exercise.

The presentation of symptoms often depends upon the combination of environmental irritants and the air conditions. For example, exercising during hot, dry, smoggy conditions can drastically increase the chances of an attack. Specifically, pollutants, particulates, and allergens in the air can irritate the respiratory system and trigger an EIA attack.

One of the keys to decreasing the effects of EIA is accurate diagnosis. Many athletes only experience symptoms during exercise, and therefore, they are completely fine when they see their doctor. This is why it is very important to pay attention to when the symptoms occur and what was happening at the time. If you are not currently under the care of a physician and you have an attack you should seek medical attention to help prevent further attacks.

Treatment during an attack:

In the unfortunate event that an athlete does experience an EIA attack, the first step of intervention is to immediately stop the strenuous activity. Many athletes will have the feeling of impending doom during an attack which may lead to hyperventilation. Therefore, reassuring and calming them is paramount. If the athlete has a prescribed inhaler assist them in its use.

If an athlete not previously diagnosed with EIA begins to experience symptoms, the immediate steps should be to (a) discontinue exercise and (b) remain calm. Many athletes get extremely anxious and start to hyperventilate. It is very uncommon for an EIA attack, not associated with other medical conditions, to be life threatening. Most often, exercise cessation and removal from the irritating environment allows for the decrease of symptoms. It should be noted that in the event that the athlete does not respond to these measures and does not show significant improvement within a few minutes they should seek immediate medical attention.

Treatment to help avoid an attack:

There are several steps that may be taken to avoid an EIA attack. These include but are not limited to the following:

1. 45 minutes prior to activity have a 10-minute warm up; this should include some light jogging and some light ball work.
2. Start some short runs with or without the ball at 75 % of you maximal speed perform these activities for about 10 minutes.
3. Take your medication 30 minutes prior to your game. This should be your normal dosage.
4. When finished steps 1 - 3 join in with the team pre game warm up.
5. Post game perform a 10 - 15 minute cool down including some light jogging and stretching. As post game time continues slow the jogging to a walk which should be maintained for about 5 minutes.

Non medication treatment: Vitamin C

Recently there has been evidence to suggest that taking vitamin C supplements prior to activity or as part of a daily diet may reduce EIA attacks. This should not be used instead of a physician’s prescription but may work in conjunction with your normal medication. You may want to try taking 1 - 2 grams of vitamin C prior to your game. If this works and you do not have an attack, you may want to try taking 200 — 500 milligrams as a daily supplement. Please note this technique is still being researched and these levels of Vitamin C are substantially higher then the recommended daily allowance. You should contact you physician with regards to this technique and should be used at your own risk.