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Definition of Asthma Asthma is a chronic inflammatory disorder of the airways within the lungs. Description of Asthma The lung is the main organ of the respiratory system and its main function is respiration (exchange of gases between the environment and the body). Air enters the nose where it is filtered, warmed and humidified. After passing through the trachea (windpipe), the air travels into the lungs through the bronchi. An asthma attack occurs when these airways narrow and the muscles around them tightly contract (this is called bronchospasm). The membranes lining the inner walls of the airways become swollen and inflamed, and the glands within these walls produce excess mucus. An asthma attack can be brief or it can last for several days. Causes and Risk Factors of Asthma The two main factors that contribute to asthma are inflammation of the airway passages and hyperreactive bronchi. When triggered by stimulus, certain cells lining the airways release chemical substances called mediators that lead to inflammation. This inflammation causes the airway passages to swell, the cells lining the passages to produce excess mucus, and the airway opening to narrow. Hyperreactivity means that when the bronchi are exposed to stimulus they respond in an exaggerated way by constricting the airway muscle and making it difficult to breathe. The stimulus or "triggers" that can induce an asthma attack are: • allergens • respiratory infections • too much exertion • emotional stress • weather conditions • medications • menstrual cycle • nighttime Symptoms of Asthma Airway inflammation and resulting narrowing air passages lead to the following symptoms of asthma: wheezing cough - chronic or recurring (worse particularly at night and in the early hours of the morning) pain or a tight feeling in the chest shortness of breath flaring of the nostrils when breathing in (especially in children) interrupted talking agitation hyperinflation (appearance of hunched shoulders, hunching forward or preferring not to lie down) Diagnosis of Asthma Asthma is sometimes hard to diagnose, because it can resemble other respiratory problems such as emphysema, bronchitis and lower respiratory infection. Therefore, the diagnosis of asthma is based on: 1. repeated careful measurement of how efficiently the patient can force air out of the lungs 2. a thorough medical history and physical examination 3. chest x-rays 4. laboratory tests Treatment of Asthma Asthma cannot be cured, but it can be controlled with proper asthma management. • The first step in asthma management is environmental control. Asthmatics cannot escape the environment, but through some changes, they can control its impact on their health. Listed below are some ways to change the environment in order to lessen the chance of an asthma attack: - Clean the house at least once a week and wear a mask while doing it. - Avoid pets with fur or feathers. - Wash the bedding (sheets, pillow cases, mattress pads) weekly and in hot - Encase the mattress, pillows and box springs in dust-proof covers. - Replace bedding made of down, kapok or foam rubber with synthetic - Consider replacing upholstered furniture with leather or vinyl. - Consider replacing carpeting with hardwood floors or tile. - Use the air conditioner. - Keep the humidity in the house low. The second step is to monitor lung function. Asthmatics use a peak flow meter to gauge their lung function. Lung function decreases before the symptoms of an asthma attack - usually about two to three days prior. If the meter indicates the peak flow is down by 20 percent or more from your usual best effort, an asthma attack is on the way. The third step in managing asthma involves the use of medications. There are two major groups of medications used in controlling asthma - anti-inflammatories (corticosteroids) and bronchodilators. Anti-inflammatories reduce the number of inflammatory cells in the airways and prevent blood vessels from leaking fluid into the airway tissues. By reducing inflammation, they reduce the spontaneous spasm of the airway muscle. Anti-inflammatories are used as a preventive measure to lessen the risk of acute asthma attacks. Zafirlukast (Accolate) and zileuton (Zyflo), are a class of anti-inflammatories Other inhaled anti-inflammatory drugs include cromolyn sodium (Intal) and nedrocromil (Tilade). Corticosteroids are given in two ways - inhaled via a metered dose inhaler (MDI) or orally via pill/tablet or liquid form. Bronchodilators work by increasing the diameter of the air passages and easing the flow of gases to and from the lungs. They come in two basic forms - short-acting and long-acting. The short-acting bronchodilators are Ventolin. These drugs are inhaled and are used to relieve symptoms during acute asthma attacks. The long-acting bronchodilators, Serevent and Alupent are inhaled and theophylline is taken orally. These drugs are sometimes used to control symptoms in special circumstances, such as during sleep or when intensive exposure to a particular irritant can be predicted (i.e. pollen season). Some people cannot control the symptoms by avoiding the triggers or using medication. For these people, immunotherapy (allergy shots) may help. Immunotherapy involves the injection of allergen extracts to "desensitize" the person. The treatment begins with injections of a solution of allergen given one to five times a week, with the strength gradually increasing. Note: Asthmatics vary considerably in their responses to different types, combinations and amounts of medicines so therapy must be carefully tailored to the individual. Even medication that may work well with some asthmatics may not be effective for others. Exercise-induced asthma Exercise-induced asthma is asthma that is triggered by vigorous or prolonged physical activity. Most people who have chronic asthma will experience symptoms when they exercise. However, many people without chronic asthma develop symptoms only during exertion. During normal breathing, the air we breathe is first warmed and moistened by the nasal passages. During exercise, people tend to breathe through the mouth, which means that they inhale colder and drier air. In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity of the inhaled air and react by contracting (or spasming), which narrows the airway. This results in symptoms of asthma, which include: Coughing Tightness in the chest Wheezing Unusual fatigue while exercising Feeling short of breath while exercising Inhaled medications taken prior to exercise can control and prevent exercise-induced asthma symptoms. The preferred medications are the short-acting beta 2 agonist inhalers (i.e. albuterol); taken 15-20 minutes before exercise, these medications can prevent the airways from spasming and can provide control of exercise-induced asthma for as long as 4 to 6 hours. In addition to medications, a warm-up phase before exertion and a cool- down period afterward can help prevent exercise-induced asthma. Exercise should be limited during high pollen days (if allergic) or when temperatures are extremely low and air pollution levels are high. The presence of viral upper respiratory infections can also increase symptoms, so you should restrict exercise if you have such an infection. For people with exercise-induced asthma, some activities are better tolerated than others. Activities that involve short, intermittent periods of exertion, such as volleyball, gymnastics, baseball, walking, and wrestling are generally well-tolerated. Activities that involve long periods of exertion (soccer, distance running, basketball, and field hockey), as well as cold weather sports (ice hockey, cross-country skiing, ice skating), may be less well-tolerated . However, many people with asthma are able to fully participate in these activities. Swimming, which is a strong endurance sport, is generally well-tolerated by asthmatics because it is usually performed in a warm, moist air environment. It is also an excellent activity for maintaining physical fitness. Maintaining an active lifestyle is important for both physical and mental health. The goal of treating exercise-induced asthma is to allow full participation in sports and activities. Asthma in the Athlete
New help in dealing successfully with athletes who have asthma
When a young athlete experiences an asthma attack, it can be frightening and dangerous. Depending upon its severity, the attack may range from wheezing and tightness of the chest to extreme breathlessness that can progress to full respiratory failure. Asthma is a disease that is characterized by hypersensitivity of the airways to allergens and irritants known as triggers. For people who have exercise-induced asthma, exercise itself is a trigger. When a person with asthma is exposed to a trigger, muscles in the walls of the air passages tighten, shrinking the airways. Breathing passages are further blocked when the lining of these airways swells and produces thick mucus. Asthma is now the most common chronic childhood illness, with 4.8 million American youngsters suffering from it. So it is vital for coaches, trainers, parents and athletes to be prepared. Many athletes are reluctant to report asthma symptoms to a coach out of fear that they will no longer be allowed to play. So, when discussing asthma with athletes, it is important for them to be reassured that with accurate diagnosis and proper management, they can still participate, even at the highest levels of competition. It may help them to keep in mind that one in six athletes representing the United States in the 1996 Olympic Games had a history of asthma. And studies show that almost 22% of the athletes who participated in the 1998 Olympic Winter Games for the United States had a previous diagnosis of asthma. Yet, the USA team captured 143 medals that year. Exercise Induced Asthma: What Coaches and Trainers Need to Know Exercise-Induced Asthma: Symptoms include persistent cough, wheezing, chest
tightness or pain associated with exercise or vigorous activity. Questions to Ask the Athlete Do they have an asthma action plan? Do they use a rescue inhaler for quick relief of symptoms? (i.e. albuterol [Ventolin] or
pirbuterol [Maxair]) Exercise – Running or playing hard, especially in the cold

Upper Respiratory Infections – Colds or flu

 Laughing or crying hard

 Allergens – Pollen, mold, dust, animal dander, cockroaches

Irritants – Cold air, weather changes, cigarette and tobacco smoke, strong smells and
chemical sprays including perfumes, paint, cleaning solutions, chalk dust, lawn and turf
treatments Acute Symptoms Requiring Prompt Action Coughing or wheezing

Difficulty in breathing

Chest tightness or pressure reported by the athlete

Other signs, including low peak flow readings as indicated on the asthma management
plan. Actions to Take Stop the athlete’s current activity.

Follow the athlete’s asthma management/action plan.

Help the athlete use his/her inhaled medication.

Observe for effect. Get Emergency Help If: The athlete fails to improve.

Any of the symptoms listed on the athlete’s asthma plan as emergency indicators are
present.

Any of the following symptoms are present. Consider calling 9-1-1.

- The athlete is hunched over, with shoulders lifted and straining to breathe.
- The athlete has difficulty completing a sentence without pausing for breath.
- The athlete’s lips or fingernails turn blue. When to Return To Play Participation in a practice session or competitive event should only resume if the athlete
can breathe easily and is free of symptoms. If symptoms do not go away immediately, or
if they return upon resumption of the activity, the athlete should be excused from
practice for that day or be pulled from competition.

Suspension of practice or competition should be presented to the athlete as a question
of safety – not of punishment. Reassure the athlete that they can participate in sports.
 However, this flare-up of their disease must be evaluated to insure they can practice
and compete safely. Avoid ex in cold/dry environment Avoid vigorous ex with chest infection Prolonged warm up Cool down and monitor after ex Take prophylatic meds 5-10 mins prior to ex (as prescribed by Dr)

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