EXERCISE-INDUCED ASTHMA

Too often, the ability of an athlete to push beyond physical discomfort is seen as a sign of strength. While this may lead to memorable performances, in some instances this may lead to devastating consequences and even untimely death of an athlete. One potentially fatal condition is exercise-induced asthma- a condition that if often trivialized, as some athletes attempt to compete and ignore their active symptoms. The role that exercise plays in inducing an asthma attack in some individuals had been observed centuries ago by the ancient Greek physician, Aretaeus of Cappadocia, when he wrote “If from running, gymnastic exercises, or any other work, the breathing becomes difficult, it is called asthma…”. 
To better understand this process, here is the basic structure of our respiratory system:

• As we breathe air in through our mouth or nose, it subsequently travels through a tube-like structure in our neck called the trachea, or “windpipe”.
• The trachea then branches off into two shorter tubes- the right bronchus and the left bronchus, which enters the right lung and left lung respectively.
• Both the right and left bronchi continue to branch off into even smaller tubes, that eventually traverse the entire area of the respective lung, providing it with air from which it may extract oxygen. 
• Importantly, these air tubes are fitted with muscles at various points along its length- muscles that have the ability to tighten under certain circumstances.

Now Imagine the scenario where a rubber band is fitted circumferentially around a straw- the tighter the rubber band becomes, the harder it becomes to move air or liquid through the straw. The muscles around the air tubes have the potential to cause this same effect under certain circumstances. Additionally, the air tubes can also start to secrete excess mucus which clogs up the space within the air tube needed for air to pass freely.  Together, these factors contribute to the feeling of “chest tightness” that patients invariably experience during an asthma attack.  Unfortunately, these series of events can be triggered by strenuous exercise, the so-called “exercise-induced asthma”. 
Roughly 90% of people with asthma have exercise-induced asthma, but the condition can also occur in those who do not have asthma.  It is also important to note that this process is even more common in high-level athletes. Signs and symptoms of exercise-induced asthma may include any of the traditional symptoms associated with an asthma attack (eg: wheezing, chest tightness, coughing etc). If you should experience any of these symptoms and you are an asthmatic with a pump close by, definitely take a few puffs while you make your way to seek medical attention. If you are not an asthmatic and do not own a pump, it is important to immediately cease strenuous activity, and attempt to take deep breaths as you make your way to seek medical attention. Never attempt to compete and ignore your symptoms. Competing in the face of a medical ailment may lead to hero status amongst fans and teammates, but it may also lead to an unfavorable health outcome; your wellness always takes priority.

Dayne Ashman is a medical doctor, and a Diplomate of the American Board of Pathology.