By Jon Heck, MS, ATC
Coordinator of Athletic Trainer
The purpose of this update is to give you a brief overview on
asthma relating to athletics. This update will also outline
our Asthma Watch Program that we will implement this year.
We are attempting to give you a better understanding of asthma
problems, help your athletes maximize their performance, and decrease
the medical risk to those athletes.
EIA is a condition where the bronchial airways constrict from
vigorous exercise. Breathing becomes so difficult that athletic
performance declines significantly. Most athletes affected
will have chronic asthma that worsens with exercise. But
some athletes will only have asthmatic symptoms associated with
exercise. Surveys suggest that up to 23% of athletes have
EIA that is unrecognized.
EIA can become a medical emergency and has lead to death on the
playing field when mismanaged. Preventing this type of emergency
is obviously our primary goal. However, if recognized, and
managed appropriately athletes with EIA can compete at the highest
levels. As an example, 33% of the 1996 US Olympic Team with
EIA won medals. Proper medication is the key to successful
management of EIA.
A Typical Attack
An attack normally begins after 5-12 minutes of strenuous exercise.
In most cases the attack begins immediately after the exercise,
but it may also begin during this exercise period. Once
it begins the attack peaks in 6-8 minutes (by now effecting performance).
The severity of the attack will vary. The frequency of the
attacks will vary too. The symptoms then gradually resolve
over the next 30-60 minutes and the athletes performance returns
to normal. This resolution period is often referred to as
the "second wind" phenomenon. A late phase attack occurs
3-6 hours later in 30% of athletes with EIA.
The obvious symptoms are, wheezing, chest tightness, and difficulty
breathing. The subtle symptoms are coughing, chest congestion,
athlete feels "out of shape", exercise fatigue, inconsistent performance,
poor tolerance of long exercise periods while short periods are
tolerated well. Certain sports are also higher risk for
EIA episodes based on the type of exercise they involve.
The high risk sports at Stockton are: cross country (and middle
distance running), basketball, lacrosse, rowing, and soccer.
The low risk sports are: baseball, softball, and volleyball.
Intermittent training with low intensity aerobic activities decrease
the risk of EIA. Environmental conditions also contribute
to the risk. Attacks are more likely to occur in cold, dry
air. Warm, humid weather decreases the risk of an EIA episode.
The following procedure can help reduce or eliminate episodes
of EIA. As the coach you are in an excellent position to
ensure your athletes are following it.
1) Premedicate using their prescribed asthma inhaler 15-30
minutes before competition.
2) 30 minutes before competition begin 10 minutes of stretching
and warm-up activities.
3) Begin moderate aerobic exercise (running, jogging).
Sustain this level for 5-10 minutes.
The objective is to induce a mild EIA episode to get the athlete
to the "second wind" period.
4) Follow with a 10 minute cool-down of gradually decreasing
exercise (walking, stretching).
- During their physical, all athletes with suspected EIA will
have their lung capacity measured with a Peak Flow Meter.
This will be their "normal" score.
- Each head coach will receive a list of all asthmatic athletes
on their team.
- The coach will ensure no athlete will be permitted to play
or practice without their asthma inhaler immediately available.
An athlete who forgets their inhaler will be sent home to get
it before they are permitted to practice. Note, an inhaler
in their bag while they are distance running through campus
does them no good. It should be on their person during
- An athlete that has an attack at practice will be retested
with the Peak Flow Meter by the student athletic trainers.
The athlete must score within 10% of their normal score to return
- Acceptable Asthma Management. The athlete that
uses an inhaler to premedicate before competition and only once
during competition to manage symptoms is in an acceptable treatment
- Ineffective Asthma Management. The athlete that
needs their inhaler more than once during practice represents
ineffective treatment. Competition will be terminated
that day for any athlete that uses their inhaler twice during
the exercise session (excluding premedication). This athlete
should be brought to my attention so we can seek alternate and
more effective medication treatments through our physician.
The objective of the Asthma Watch Program is to have the asthmatic
athlete obtain maximum performance under the safest conditions.
If you feel you have an athlete with symptoms of EIA please bring
them to my attention ASAP. We then can begin the process of
obtaining medication through a physician to treat the condition
- Asthma Emergency. An athlete who has an attack
and their inhaler does not alleviate the situation in 5-7 minutes
should be transported to the emergency room by the EMS or Stockton