What do heptathlete Jackie Joyner-Kersee, marathoner Joan Benoit Samuelson, and one-quarter of the Nordic skiers who competed in 1994’s winter Olympics at Lillehammer have in common?

Answers: (1) They all suffer from asthma. (2) Their condition hasn’t kept them from attaining excellence in their sports.

And the good news is that what world-class athletes and their doctors have learned can be applied by anyone with asthma who likes to participate in sports. Whether you are a high school point guard or a club tennis player, you can take action to minimize the chances that an asthma attack will stop you in the middle of a game or, worse, land you in the hospital.

Exercise and Asthma

An asthma attack brought on by activity is known as an exercise-induced bronchospasm, or EIB for short. It is axiomatic that most asthmatics who play sports or work out vigorously have had or will have EIB at one time or another. But many people who have not been diagnosed with asthma may also experience EIB. According to Dr. Gilbert D’Alonzo, director of the Airways Disease Center at Temple University School of Medicine, asthma in general, and EIB in particular, is “the Rodney Dangerfield of diseases. It gets absolutely no respect.” Dr. D’Alonzo says that asthma, not head and neck injuries, is the leading playing-field killer. Ted Quedenfeld, director of the Exercise-Induced Asthma Research Center, also at Temple, cites a Research Center study that followed 21,000 high school athletes from 1996 to 1999. “We documented 62 asthma-related deaths. None of those kids should have died.”

What to Watch For

The cool-down period after a game or workout is when EIB is most likely to occur. Symptoms include wheezing, coughing, and chest congestion and tightness. Many sufferers feel lightheaded; a few are unable to take a deep breath. The absence of obvious breathing problems, however, is not enough to rule out EIB. Sometimes, the first sign of trouble is an athlete complaining of “just not feeling right.”

Aggravating Factors

Existing medical conditions–chronic asthma that is not under control, a respiratory tract infection, a history of allergies, and even poor general health–may contribute to EIB. Where and when you work out is important: Polluted air and cold, dry air are potential irritants for people susceptible to EIB. The kind of exercise you are doing is also important. The activity most likely to induce EIB is outdoor running (for example, football, soccer, or fast jogging). The least likely is pool swimming. In between, from more to less aggravating, are treadmill running, cycling, and walking. So instead of running during rush hour on city streets in subfreezing weather, try summer cycling in the park, or play indoor tennis.

What to Do

The treatment goal for people with EIB is the same as for athletes who suffer from chronic asthma: full participation in their sport or workout of choice at a good performance level without breathing problems. The following list of Do’s and Don’ts for high school athletes with asthma is partially based on guidelines issued by Asthma Watch, a national initiative sponsored by the Temple University Sports Medicine and Pulmonary Critical Care units. It is equally valid for the intermittent exerciser:

• If you have chronic asthma, you and your physician must have worked out a program of medication that has stabilized the condition. Quedenfeld, one of the developers of Asthma Watch, says that “an athlete with asthma who has to resort to rescue medication more than once during an exercise session, or more than three times a week, is unstable and needs to see his or her doctor for reevaluation.”
• Give yourself time to warm up properly. A number of studies have shown that short, intense exercise bursts during warm-up decrease the risk of EIB. If the outdoor temperature is very cold, however, you may want to warm up at a lower intensity than you would in warmer weather, and preferably indoors.
• Make sure your inhaler is within easy reach during exercise, play, or practice.
• Take two puffs of a short-acting airway relaxer 15-20 minutes before beginning your workout. [Dr. D'Alonzo recommends albuterol, but says that a longer-acting airway relaxer (salmeterol) should be used when a workout is likely to last for hours. For example, kids at a sports camp who will be playing three or four games in the course of 1 day need the longer-acting medication.]
• Never skip your cool-down–and take your time doing it!

Beating EIB: The Key Is Education

Both Dr. D’Alonzo and Quedenfeld agree that the key to success in the fight against EIB is EDUCATION–getting the word out nationally to parents, athletes, physicians, coaches, and athletic directors. The Asthma Watch Guidelines are being used by high school athletic departments throughout the Philadelphia area as well in as other parts of Pennsylvania, Delaware, and New Jersey. Even the National Football League is taking notice, says Quedenfeld, and is considering adapting the Temple program for use by NFL players.

This article was reviewed by a physician who practices in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center, Boston, and is a faculty member of Harvard Medical School.