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Published on August 3rd, 2011 | by Papa Doc

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Ask A Doctor: Exercise Induced Bronchiospasm

This column provides a general overview of Roller Derby medical problems and their initial treatment, and it is not intended for advice for an individual. Therefore, you must consult appropriate medical professionals for advice in treating any injury or medical problem that you specifically have. This manual is not intended to be a complete or final guide to medical treatment of anyone’s individual medical injury or problem.

Q: What is wrong? I exercise for a while and, though I am in good condition physically and practice regularly, I feel out of breath and can’t keep up.

A: It is possible you suffer from exercise-induced bronchospasm, a fairly common airway condition in athletes.

What is EIB?

EIB is a respiratory condition in which excessive narrowing of the bronchial tubes occurs during exercise due to abnormal constriction of the muscles encircling the bronchial tubes. Although often called “exercise induced asthma,” this name is technically incorrect, since it happens in people who do not have asthma (an inflammatory reaction in the lungs). EIB is not an allergic response itself, but EIB occurs more often in a skater with allergies, a past history of allergies, or a family history of allergy.

Why does it occur?

Cold and/or dry air (not sufficiently warmed and humidified by the nasal membranes) entering the lower respiratory tract (bronchial tubes and lungs) causes a chemical reaction of incompletely-defined nature that results in constriction of the muscles that encircle the bronchial tubes. There are two theories of causation: cold air changes bronchial temperature or dry air changes lung humidity. Either cause leads to changes in blood flow to the bronchial tubes. The chemical reaction occurs and causes the encircling muscles to contract excessively and narrow the airways. Actually, these muscles normally slightly constrict the airways during exercise to speed the air flow through them, but in EIB, the constriction is excessive and impedes the air flow.

Although EIB does occur in 80 – 90% of people with asthma, it also occurs in 20 – 30% of athletes without asthma. EIB is more common in people with allergies even if they don’t have asthma. Because it can occur in people without asthma or with undiagnosed allergies, EIB is probably under-diagnosed. The condition is most frequent in aerobic sports, such as roller derby, because of the need to mouth breathe which bypasses nasal warming and humidification.

Aggravating factors which make EIB more likely to occur are: uncontrolled nasal allergies, poorly controlled actual asthma, inhaled allergens, dust, strong fumes, respiratory infections (especially viral ones), and abnormalities in the upper respiratory tract which limit nasal breathing, for example, a deviated septum. The respiratory tree is one system from the nose to the lungs. Nasal obstruction makes it more likely you will mouth-breathe. Further, irritations in the upper tract (nose and throat) increase the irritability in the tissues of the lower tract.

EIB can occur as an immediate or delayed response. EIB occurs within 5 – 10 minutes of beginning exercise and usually resolves in 15 – 30 minutes after stopping exercise (the immediate response). However, especially in people with a strong allergic history and/or asthma, the reaction may become self-perpetuating and last for several days, becoming gradually worse (delayed response).

What symptoms are you looking for?

Symptoms do not usually start until 5 – 10 minutes of exercise. If symptoms occur earlier than 5 minutes, consider a different diagnosis.

-Fatigue – out of proportion to the training level of the skater
-Cough – and if the person has allergies or underlying asthma, the cough may occur in between times of exercise
-A feeling of shortness of breath or tightness in chest (chest pain is rare)
-Wheezing
-Upset stomach or stomach ache, and
-Sore throat

How is EIB diagnosed?

1. With good history of symptoms occurring with exercise, a therapeutic (good response to treatment) trial with a short-acting bronchodilator 10 – 15 minutes before starting exercise is often enough.

2. Measurements of respiratory function, such as a peak flow measurement, may be needed if the diagnosis in doubt or if the response to a therapeutic trial is not good.

3. Allergies are best managed through your own doctor or an allergist.

Treatment

1. Proper management of any nasal allergies or asthma will help reduce the likelihood of EIB occurring.

2. An exercise regimen taking advantage of the “refractory period” may work for some skaters. The “refractory period” is the time period after the bronchial constriction stops with rest and during which the constriction may not re-occur for minutes to hours. A warm up for 15 – 20 minutes followed by short bursts (2 – 5 minutes) of intense exercise – such as wind sprints repeated several times – may induce the refractory period long enough to compete effectively in the bout.

3. Covering the nose and mouth with a scarf or mask (to warm and moisten air ) reduces the likelihood of EB, but is generally impractical for roller derby.

4. Short-acting bronchodilators (medicines that relax the encircling bronchial muscles) are the most effective and commonly used treatment. Albuterol and similar drugs are given by inhalation 10 – 15 minutes before starting exercise and usually last 4 hours. They prevent the bronchial muscles from contracting excessively. These medicines are be used before each exercise period involving aerobic activity and are likely to be needed as long as the athlete is in sports. The side effects – shakiness, increased heart beat, dizziness – are mild and short lived (15 -20 minutes) and generally are not dangerous, just troublesome, if they occur.

5. A group of medicines called controller medications are more likely to be used if the person has major allergies, especially asthma. These do not eliminate the need for the short-acting medicines but make them more effective. This group includes inhaled corticosteroids, long-acting bronchodilators, cromolyn sodium, Singulair, and ipatropium.

6. Maintaining adequate hydration (haven’t we heard that many times before?!) will reduce the occurrence to some degree.

Prognosis

Since EIB is not always diagnosed, the prognosis depends on making the diagnosis. Once this is done, the treatments are usually very effective. Many high level athletes who have EIB, compete successfully.

Whether or not you are in tip-top shape, if you are having the symptoms described above, seek help from your medical personnel. Your skating stamina may be better than you think!

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