eMedicine Specialties > Sports Medicine > Introductory Topics in Sports Medicine

Exercise-Induced Asthma: Follow-up

Author: Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School
Contributor Information and Disclosures

Updated: Jun 15, 2009

Follow-up

Return to Play

The severity of an EIA attack varies greatly. Although cases of respiratory arrest and even death have been reported, the usual scenario is of a mild respiratory difficulty during play, which either spontaneously resolves or immediately responds to inhaled albuterol. Oftentimes, the athlete self-medicates and never leaves play or alerts the trainer or doctor. Although no clear-cut guidelines exist, a player who is removed from play for an asthma attack should be kept out of play until his or her respiration has normalized. This should occur within 5-10 minutes of medication administration. The athlete should be monitored closely for signs of relapse over the next several hours. If the symptoms do not completely resolve with sideline medication, the athlete should not return to play and should be referred for further treatment. Depending on the severity of the patient's symptoms, this may require transportation via ambulance.

Complications

Complications of an untreated asthma attack include status asthmaticus, respiratory failure, and even death. More commonly, an anxiety attack can be precipitated secondary to dyspnea.

Prevention

The optimal treatment of EIA is to prevent the onset of symptoms. See the Medication section for a discussion of drugs used to prevent EIA.

Prognosis

The prognosis is excellent for athletes with asthma. With proper interventions, most symptoms can be prevented, and performance should not be limited by EIA if this condition is treated properly. Newly diagnosed young athletes need to be educated that this condition should not be perceived as an insurmountable disability. Using examples of the numerous elite athletes (eg, Jackie Joyner-Kersee [perhaps the world's greatest athlete]; Amy Van Dyken [Olympic swimmer]; Jerome Bettis [former running back for the Pittsburgh Steelers]) with this condition can help young impressionable athletes continue in their endeavors without fear of failure or medical distress.

Education

Patient education is a critical part of the treatment of EIA. Once the diagnosis is made, athletes should be encouraged to continue in their activities with the reassurance that proper treatment can allow for an unhampered performance for most individuals. In addition to reassurance, it is also important to teach individuals to recognize the signs of an impending attack. Once recognized, individuals should be taught to remove themselves from the aggravating activity and initiate treatment as necessary. This includes education about the proper choice of agents to abort an acute attack (ie, albuterol), but not cromolyn, salmeterol, or an inhaled steroid. Teaching the proper mechanics of inhalant medication administration is also important, along with, if needed, teaching and demonstrating the proper use of a spacer device to the patient; without the proper mechanics in using such devices, the medication does not reach the area of pathology and does not benefit the athlete.

For excellent patient education resources, visit eMedicine's Asthma Center. Also, see eMedicine's patient education articles Asthma, Asthma FAQs, and Exercise-Induced Asthma.

Miscellaneous

Medicolegal Pitfalls

  • Downplaying of symptoms: The common pitfalls occur with downplaying of symptoms or patient complaints. Education of the coaching staff is crucial because coaches need to know that shortness of breath in athletes does not always indicate poor conditioning and that the consequences of ignoring an asthma attack can be serious.
  • Missed diagnosis: The physician, trainer, or other medical staff must always consider bronchospasm in athletes with the previously described complaints. A high index of suspicion diminishes the possibility of missed diagnoses. A thorough knowledge of the differential diagnosis (see Differentials) and how to work up the possibilities are also important (see Workup).

Special Concerns

  • Pregnancy: Although most of the commonly used drugs are in pregnancy category C, these agents are often used for asthma, which is a common condition of pregnancy.
  • Pediatric population: Many of the agents used for asthma are not indicated for children younger than 2 years; other agents are not indicated for children younger than 6 years. However, these medications have been used successfully for decades in the management of childhood asthma and should be used for children with EIA.
  • Other/general: The highly driven, high-performing adolescent athlete, especially the female athlete, is at high risk for vocal cord dysfunction. This condition can be confused with EIA but does not respond to the same treatment. Professionals caring for athletes must keep a high index of suspicion for vocal cord dysfunction.
 


More on Exercise-Induced Asthma

Overview: Exercise-Induced Asthma
Differential Diagnoses & Workup: Exercise-Induced Asthma
Treatment & Medication: Exercise-Induced Asthma
Follow-up: Exercise-Induced Asthma
References
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References

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Further Reading

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Keywords

EIA, exertional asthma, exercise-induced bronchospasm, EIB, asthma, exercise-induced urticaria, allergic rhinitis, bronchoconstriction, exercise-related respiratory symptoms, wheezing, chest tightness, shortness of breath, dyspnea, difficulty breathing, aerobic exercise, environmental factors, allergic asthma, asthmogenic agents

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Contributor Information and Disclosures

Author

Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, FACSM, FAAFP,, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD, FACSM, FAAFP, is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, and North American Primary Care Research Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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