Athletes With Asthma Can Find Relief

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.

Although asthma 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.

But most 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.

Olympic athletes 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."