Asthma doesn't have to mean game over for athletes

Posted: 6/11/2012

From State Journal-Register:

Sixteen-year-old basketball standout Larry Austin Jr. is doing what a doctor thought unlikely, given his asthma.

"Actually, my doctor told me awhile ago that I'd never play a sport," says Austin, who has college basketball scholarship offers and plans to compete for a spot on the USA Basketball under-17 team that will play in the World Championships this summer.

Austin, who will be a junior this fall at Lanphier High School, said his asthma symptoms include a lot of sneezing and a nose that is "stopped up." He's battled asthma since he was 3 months old.

Time with a nebulizer and sometimes an inhaler helps Austin before basketball games. He says he hasn't had any problems with asthma this year.

"I started to grow out of it, slowly," he says.

A chronic lung disease that makes air movement in and out of lungs difficult, asthma can be managed but not cured. In asthma, the lungs' airways (bronchi) become inflamed and can spasm, causing shortness of breath and wheezing. The exact cause isn't known, but certain "triggers" (a condition, thing or activity) can make asthma worse.

Some refer to asthma that worsens with exercise as "exercise-induced" asthma. But that term can be misleading, say local medical doctors.

"Usually, the term ‘exercise-induced' asthma is used. Potentially, it's just episodic bronchial constriction, which follows exercising patients who have asthma," says Dr. Anwar Shafi, assistant professor of pediatrics, specializing in pediatric pulmonology, at the Southern Illinois University School of Medicine.

"I think ‘exercise-induced asthma' is potentially misleading because exercise is not an independent risk for asthma. It's just a trigger for bronchial constriction in patients who have underlying asthma."

Initially, it was thought that Austin's asthma was exercise-induced, but it was later learned that allergens are his triggers.

"It took a lot of trips going to the hospital, being admitted into the hospital before they identified what was really causing it," said Larry's mother, Christa Austin, who adds that her son receives allergy shots every 20 days for maintenance.

Other side of the coin

Shafi says exercise can be a trigger for some of his asthmatic patients.

"When we see patients, we take a careful history ... we try to determine if the child has asthma ... (with) typical symptoms of asthma: cough, wheezing, shortness of breath, chest tightness," Shafi says.

"Then we try to ascertain what can be the triggers. It depends on the age. Usually in children, viral infections are the most common cause for triggering asthma symptoms. If they do have significant allergies, then allergens can be a trigger for their asthma as well."

Dr. M. Haitham Bakir, associate professor of clinical medicine, division of pulmonary and critical care medicine at SIU School of Medicine, said two separate conditions should be recognized: the asthmatic whose asthma worsens upon exercising and "exercise-induced bronchospasm."

"It should be called ‘exercise-induced bronchospasm' or ‘bronchoconstriction,' which basically their airways close off as a reaction to the exercise," Bakir says. "That's not really asthma. It's just exercise-induced bronchoconstriction. (It) happens only as a response to the exercise."

People who suffer from exercise-induced bronchospasm may not have asthma otherwise - meaning they sleep well at night and do everything else without symptoms until they start doing exercise, especially outside with the dry air and doing something out of the ordinary, Bakir says.

"It usually happens within 10 to 15 minutes from the exercise. Patients start feeling chest tightness and shortness of breath, and if they continue to do the exercise, it will make it a bit worse, (and) peak within a half an hour of the exercise," Bakir says.

Living normally

Having exercise-induced asthma or exercise-induced bronchospasm aren't reasons to avoid exercise, Shafi and Bakir say.

"We want the children to be as normal as possible like other children. They should be able to exercise," Shafi says.

Medication given to children who have symptomatic asthma triggered by exercise before beginning rigorous activities can help, he says.

"I would say if they have asthma and their asthma is being triggered by exercise, we do try to control their asthma better so that they are able to exercise," Shafi says.

Bakir tells his patients to warm up before exercise.

"Warming up for at least 10-15 minutes helps reduce the response to the exercise, so they'll not have symptoms," says Bakir, who adds that pre-medication to keep airways open can help.

"The last thing they want to do is to stop exercising. They have to do more exercise to build more tolerance to the exercise so over time they'll be able to do more activities with less ventilation, meaning they're not huffing or puffing through their mouths."

Exercising indoors in moist air is preferable to exercising outside in dry, cold air, Shafi and Bakir say. (Sometimes athletes who exercise in the cold, outside air are advised to breathe through loose-fitting masks to prevent cold air from entering their airways.)

Bakir recommends exercising around 4 or 5 p.m.

"If they want to do running, instead of doing it early in the morning, do it in the afternoon. They'll be able to do more," Bakir says.

Larry Austin Jr.'s parents, Larry and Christa Austin, say they have to be aware of older gymnasiums because they could contain mold, which can cause major allergic reactions for their son.

"We've been to most of the gyms, so we kind of know which gyms cause his reaction, so we're more proactive," Christa Austin said.

Parents who have asthmatic children should be proactive, work with their doctors and learn all they can about their children's conditions, making sure they know the triggers, she says. The family makes sure Larry Jr.'s medications are handy at all times when they travel, and they carry his nebulizer.

Shafi says treating and controlling asthma can help control exercise-induced symptoms.

"A lot of world-class athletes have asthma, and they have won Olympic medals and played professional sports in spite of having symptomatic asthma, so they do their exercises, and they work out and they have done a lot of good things and competed in sports," Shafi says.

Exercise-induced asthma

Asthma attacks are caused by some trigger - and in exercise-induced asthma, the trigger is rapid movement of air into the lungs before it is warmed and humidified. It often occurs because of mouth breathing during exercise. The attack is similar to an allergic reaction.

An allergic reaction is a fight response by the body's immune system to an "invader." The reactions cause inflammation, leading to the production of mucus and bronchospasm. The responses cause the symptoms of an asthma attack.

Sports and games that require continuous activity or are played in cold weather are most likely to trigger an asthma attack: long-distance running, basketball, soccer, hockey (ice and field) and cross-country skiing.

Sports that are less likely to trigger an asthma attack are those that require short bursts of activity interspersed with breaks: walking, recreational biking (not racing), hiking, swimming, short-distance running and track/field events, baseball or softball, golfing, football, volleyball, wrestling, gymnastics and downhill skiing.

Famous athletes with asthma
  • Olympic medal winners Jackie Joyner-Kersee (track), Greg Louganis (diving)
  • Mark Spitz (swimming) and Kristi Yamaguchi (figure skating)
  • Football players Art Monk, Jerome Bettis
  • Basketball players Dennis Rodman, Dominique Wilkins
  • Tennis player Justine Henin

Original here.