It has become
important to note the distinction between huffing and puffing and coughing and
wheezing. Contrary to popular belief, it is not normal to cough and wheeze
after exercising. If you're short of breath or coughing, or both, you, like 12%
of the people in the U.S., may have asthma caused by exercise.
Asthma is a
narrowing of the breathing tubes in the lungs. As the lining of the tubes
swells and the muscles surrounding them constrict, it becomes difficult to
force air out of the lungs. The air that does get through the constricted tubes
as a person exhales creates a wheezing sound. No one knows what causes asthma,
but doctors have noted what triggers an attack. Infections, some medicines and
allergies can do it. So can cigarette smoke, smog, stress and exercise.
Exercise-induced asthma, or EIA, kicks in about six to 12 minutes into
continuous strenuous activity. If you had EIA, around the time your heart rate
reached 80% of its maximum capacity, your airways would start to constrict and
you would feel a tightness in your chest. You would have a coughing spasm, and
while hacking you would realize that you were more tired than the other people
you had been exercising with. If you stopped exercising, your symptoms would
probably peak in about five to 10 minutes, but would most likely disappear
within an hour.
If you didn't
know you had EIA you would think you were experiencing normal fatigue, and you
might assume, like Olympic gold medal winner Nancy Hogshead, that you just had
"small lungs." Hogshead figured that if she wanted to be a successful
swimmer, she would have to live with coughing and wheezing at the finish of
every race. After the 200-meter butterfly at the 1984 Olympics, Hogshead, who
had finished fourth, was short of breath, and she began to cough, as usual. A
doctor saw her and asked if she always coughed like that after a race. "I
said yes," says Hogshead. "I thought that was normal." What
Hogshead had wasn't normal; it was EIA.
still calls to mind a scrawny kid sitting on the side of his junior high
phys-ed class with a note that excuses him from dodgeball, many notable
athletes besides Hogshead suffer from EIA, including Jackie Joyner-Kersee, Jim
Ryun, Danny Manning and Sam Perkins. And 67 of 597 members of the 1984 U.S.
Summer Olympic team indicated on a questionnaire prepared by the American
Academy of Allergy and Immunology that they had experienced the symptoms of
EIA, and many never knew they had it. To diagnose the disorder, a suspected EIA
sufferer runs on a treadmill for 10 to 15 minutes. Respiratory function is
measured before the exercise and at several intervals after it. The airflow out
of the lungs will be reduced in those with EIA.
Athletes are most
likely to notice the symptoms of EIA when they're participating in endurance
sports, like distance running and cross-country skiing. As a runner or skier
exerts himself, he rapidly inhales air through his mouth. Most adults, when not
exercising, breathe through the nose. The nose warms and humidifies the air on
its way to the lungs. Air taken in through the mouth during exercise is cool
and dry. The breathing tubes of someone with EIA react to this cool, dry air by
constricting. Many physicians recommend swimming as a sport for people with EIA
because the air just above the surface of the water is humidified.
athletes, including those with EIA, would not be particularly receptive to a
doctor's suggestion that they 1) find a new sport, or 2) begin breathing
through their nose. Fortunately, they can still be helped.
Everyone with EIA
can be treated. Some sufferers can reduce their symptoms merely by warming up
in a few five-minute exercise periods before beginning strenuous exercise. For
others, there are several medications that are usually taken before exercise.
Inhaled mists like albuterol (Proventil, Ventolin), terbutaline (Brethaire) and
cromolyn sodium (Intal) should be taken 20 minutes before exercising. Albuterol
works within minutes and lasts six hours. Joyner-Kersee uses her inhaler as
part of her warmup.
must be careful not to use medicines on the International Olympic Committee's
banned-drug list. Each of the previously mentioned inhalers is approved, but
the only oral medication that's acceptable is theophylline (Theo-Dur, Slo-bid).
Usually the medications are illegal because they contain some kind of
stimulant. Nasal decongestants such as phenylpropanolamine, pseudoephedrine
( Sudafed, among others), and the asthma medicines ephedrine (Marax) or
epinephrine (Bronkaid and Primatene) are not permitted for this reason.
Over the years
Olympic team doctors have become more diligent about consulting the IOC
scorecard to discover which drugs are permissible. But in 1972 at least one
physician was confused. Rick DeMont lost the gold medal he had won in the
400-meter freestyle at the Olympics in Munich because he tested positive for
ephedrine, a banned component of the medication he had been taking for his
asthma since he was a child. At those same Olympics, Ryun fell in his
1,500-meter heat. However, had Ryun gotten a medal, he, too, might have been
disqualified, because all medal winners are tested for drugs. "I arrived in
Munich before my allergist did," says Ryun. "My asthma started
bothering me, so I went to the U.S. team tent and was given something similar
to what DeMont had taken. It just showed the miscommunication and
misunderstanding that went on."
Some of the
confusion continues. Joyner-Kersee endorses Primatene Mist. The mist, which is
less effective than most prescription inhalers, contains the IOC-banned
epinephrine. Why does Joyner-Kersee endorse a product that would have cost her
a gold medal if she had taken it before the heptathlon in Seoul? "It's
something we're always worried about," says Bob Kersee, Jackie's husband
and coach. "Jackie started taking Primatene Mist because we were stuck in
an airport, she had an asthma attack, and it was all we could get. She knows
she can't use Primatene before any competition, but she is able to sustain her
performance when she is using her prescribed asthma medication."