Use Olympic athletes as role models for your patients
Their motivation to manage asthma is as good as gold
Patients with asthma can do anything — including win Olympic medals. In fact, according to a University of Iowa study, the number of asthma sufferers among world-class athletes is higher than the estimated prevalence in the general population.
The study of 699 U.S. athletes who competed in the 1996 Summer Olympics in Atlanta showed that one in six had a history of asthma and one in 10 had active asthma.
Yet the study’s lead author, John M. Weiler, MD, a sports medicine and allergy specialist and professor of internal medicine at the University of Iowa in Iowa City, found that 10.4% of the U.S. Olympic athletes were taking asthma medications on a permanent or semi-permanent basis.
Asthma numbers may have been higher
Weiler says he thinks the actual incidence of asthma among the 1996 Olympic athletes was actually closer to 20% if symptoms of exercise-induced asthma were taken into account, including wheezing and coughing with exercise. The only athletes categorized as having asthma for purposes of Weiler’s study were those who had been told they have asthma or who have taken asthma medications. Researchers found their performance was in no way impaired by their asthma.
Slightly more of those who had been diagnosed with asthma or who had taken asthma medications — 29.9% — won individual or team medals, while 28.7% of the non-asthmatic team members won medals. Those with active asthma did even better, with 32.9% winning medals.
What does this mean to anyone who did not compete? "Doctors shouldn’t discourage patients from exercising," Weiler says. "In fact, this shows that the presence of asthma should not prevent patients from vigorous exercise, even on a world-class level."
Treat the asthma, says Paul Thompson, MD, president of the American College of Sports Medicine and director of preventive cardiology at Hartford (CT) Hospital, but don’t prohibit participation in sports. "It’s a very, very rare kind of kid, with all the drugs that are available today, who can’t be fixed enough to participate in sports," he says.
Solid data to study
Weiler studied the detailed medical questionnaires submitted by the athletes to determine how many suffered from allergies and asthma and how many required medications.
"We looked at the actual questions they answered as a requirement for Olympic participation," says Weiler, author of Allergic and Respiratory Disease in Sports Medicine (1997, Marcel-Dekker). "It was real data because if they misrepresented anything on the questionnaire, they would be disqualified."
Sixteen of the 60 medical questions on the 1996 questionnaire were related to allergy and asthma. Among them:
Have you ever been told you have had asthma or exercised-induced asthma? Yes — 15.3%. Do you take any prescribed medications on a permanent or semi-permanent basis (steroids, birth control pills, anti-inflammatories, antibiotics, etc.)? Yes — 37.8%. On further questioning, 13.9% said they had taken an asthma medication. Do you ever have chest tightness? Yes — 8.4%. Do you ever have wheezing? Yes — 10.2%. Does running ever cause chest tightness, coughing, wheezing, or prolonged shortness of breath? Yes — 7.9%. Have you ever had chest tightness, cough, wheezing, asthma, or other chest (lung) problems that made it difficult for you to perform in sports? Yes — 10.2%. Have you ever missed school or work or practice because of chest tightness, coughing, wheezing, or prolonged shortness of breath? Yes — 3%.Asthma affected 19.9% of the female athletes, compared to 14.9% of the males. The vast majority (68 of 117 or 58% of those with a diagnosis of asthma or a history of using asthma medication) used short-acting ß2-agonists and 31 (26%) used inhaled corticosteroids. Other used cromolyn, antihistamines, long-acting ß2-agonists; only two athletes used prednisone or ipratropium.
Enigmatic events
Weiler also studied the events in which asthmatic athletes competed. His findings surprised him; he has no real explanation why 45% of those with asthma or taking asthma medications were cyclists or mountain bikers, both sports that provide wide exposure to allergens and potential asthma triggers.
Not as surprisingly, Weiler says, swimming was the second-favorite event, attracting 25% of the asthma sufferers. Water events like canoeing, kayaking, rowing, and sailing attracted 13.8% of asthma sufferers, followed closely by track and field events with 12.6%.
"The warm, moist environment of swimming and other water events are good ones for kids with asthma," says Thompson. None of them chose diving or weight lifting, and only about 9% were basketball players.
Results hold true for 1984 athletes
Members of the U.S. Olympic team in 1984 had equal or even greater asthma-related challenges, Weiler says. Based on their responses to the medical questionnaire given at the time, of 597 athletes on the U.S. delegation to the Los Angeles games, 67 or 11.2% were described as having exercise-induced bronchospasm with:
a history of asthma (38.8%);use of a bronchodilator (61.2%);
a request to the International Olympic Committee for approval of medications (19.4%);
a history of chest tightness, wheezing or cough related to strenuous exercise (62.3%).
Performance among the 1984 asthmatic athletes was even better than in 1996: 41 or 61.2% won medals.
While Weiler studied only U.S. athletes because that were the only data available to him, international studies have reflected similar results.
A Finnish study published in the February 1997 issue of Thorax concluded, "The prevalence of physician-diagnosed asthma is high in elite athletes. "A Swedish study noted that "asthma may be even more prevalent among those engaged in endurance sports (than in the general population). And a 1992 Australian study concluded that the use of asthma medications did not give an athlete any advantage, "but merely removes the respiratory disadvantage under which he/she competes."
Those results lead some experts to believe that youngsters with asthma are particularly motivated to overcome their shortcomings.
Before the 1996 Games, the Allergy Clinic of Milwaukee published a study in the Wisconsin Medical Journal that concluded, "Education, warm-up exercises, and pre-treatment with the appropriate medications can enable an athlete to excel and even win a gold medal in the 1996 Olympic Games."
IOC rules
While the International Olympic Committee permits athletes with asthma to use the general range of medications used to treat the disease and prevent exacerbations, there has recently been some discussion that the IOC might consider banning inhaled corticosteroids and perhaps even ß2-agonists, Weiler says.
"To the international Olympic movement, I would say, Don’t play around with drugs that don’t have any impact on performance," says Weiler.
On the other hand, Thompson notes, the IOC is now considering permitting the use of long-banned sympathomimetics, the drugs that caused U.S. swimmer Rick Damont to lose his gold medal in swimming at the 1972 Munich Olympics.
Several high-profile Olympic athletes with asthma have gone public to show their asthma did not hinder them in any way. Among them, Amy Van Dyken, who won four gold medals in swimming events in 1996.
The message is clear for health care professionals treating patients with asthma or even those 3% to 4% who have exercise-induced asthma, says Weiler: "Don’t tell them to sit on the sidelines and root for their favorite team. Tell them to get out there and participate in their favorite sport."
The next step, according to both Weiler and Thompson: a survey of asthmatic athletes participating in the Winter Olympics and their performance, since it is well-documented that vigorous exercise in cold air aggravates breathing difficulties.
[John Weiler can be reached at (319) 356-1616 and Paul Thompson at (860) 545-5000.]
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