Athletes & Asthma

Here are some highlights from this Session at the 2015 ACSM Fall Summit.

Asthma- chronic inflamation of the airway, variable airflow obstruction, and airway hyper-responsiveness.

Asthma is more prevent in males than females in regards to children under 10.

Asthma is the only single chronic disease in the federal budget with a budget of 2.7 billion dollars.

Hygiene Hypothesis 

It is hypothesized that due to the reduction in early environmental infections over the years and the recent overuse of antibiotics, there is an increase in asthma occurence.  

Early exposure - Such as majority living on farm lands in the past or Daycare exposure  

Wheeze Early= Stronger as an adult

Vitamin D hypothesis 

Vitamin D elicits anti-inflammatory response

Deficiency of Vitamin D is associated with worse asthma severity and Vitamin D has decreased since the 1980s

Acetaminophen Tylenol Hypothesis 

Aspirin use has decreased with the historic APAP Reyes Sydnrome Epidemic

Many studied found association with APAP and Asthma  

Diagnosing Asthma 

Asthma can come and go without treatment

Symptoms: coughing, wheeze, Shortness of breath, chest tightness (can have all or none) 

Many times you have periods with/without symptoms years in between

Asthma Myths 

- I had it yesterday but not today ( Did you know if you see 1 roach there are a minimum of 1000 there)

-Smoking doesn't bother me or my child's asthma

In Athletes 


Frequent symptoms, Daily Therapy required, airway hyper-responsiveness and exacerbation 

Exercise Inducted Asthma  (EIA)

Can be part of chronic asthma

Can occur in isolation such as only with exercise; not associated with airway hypersensitivity

Symptoms can occur 6-8 minutes after physical activity (vigorous)

 Epidemiology of EIA

50% of those with negative history of EIA have a positive response to exercise

Individuals with allergy: 40% have allergic rhinitis  

Individual without asthma/allergy: 9% have EIA in high school and !2% have positive response to EIA overall

Olympians: 9-16% in Summer; 17-50% Winter


Exercise increases our aerobic capacity and with greater activity can lead to less ventilation

2 Theories 

Hypermolar- Water loss from airway surface

Airway Rewarming- Exercise hyperventilation leads to heat exchange from pulmonary vascular bed & cooling of airway service cells

 Asthmogenic Activities

-polluted indoor out door - continuous hard exercise - cold enviroments (during infection) - pollen season

High-  Long distance running, cycling, soccer, rugby, basketball, ice hockey

Less- Team games, swimming, tennis, gymnastics, golf, karate, wrestling, boxing, downhill skiing, water polo, intermittent exercise, warm humid air

Swimming and Asthma 

+high humidity +prone position +slow exhalation & Rhythmic breathing +immersion of water (chlorine may exacerbate symptoms)

Skiers/Hockey & Asthma 

-very high prevelance -extreme cold may damage epithelium

-even asymptote tic have evidence

Challenge Testing for Diagnosis 

Step Testing, outdoor running (parking lot? B/c its polluted), treadmill tests, athletic-specific tests, dry air breathing on bike


Change to less Asthmogenic activity

Avoid exercise in cold or high pollen

Warm up before could hold of symptoms upwards 45 minutes

Cool down after - Mask/Scarf over mouth when running

Pharmacological Therapy 

Most effective- Short acting beta agonist 15minutes before 

Leukotriene modifiers hours after

LABAS- protect up to 12hrs, not available for asthmotherapy in US  

Failure to Respond 

Vocal cord dysfunction, Exercise Induced Broncospasm


  Presented by Michelle Cloutier MD. Please share with someone you know who has Asthma and like this and my website of course :) !