Dear Doctor Column, October 22, 2001

Question:

My son, who is in high school, made the varsity football team. He also has asthma. I'm scared to let him play after hearing about the sudden death of Northwestern Linebacker Rashidi Wheeler due to asthma. Is it safe for my son to play? If so, should his coach be on the lookout for any specific signs of symptoms during practice or a game?

Answer:

You should discuss this with your son's physician. Twenty years ago, a diagnosis of asthma meant the end of a sports career, but medical advancements now allow most asthmatic athletes to compete. A study in the November 1998 Journal of Allergy and Clinical Immunology showed that one in six athletes representing the U.S. in the 1996 summer Olympics in Atlanta had asthma. Thirty percent of the asthmatic athletes took home team or individual medals, faring as well as athletes without asthma who earned team or individual medals.

With strenuous physical exercise, most of the estimated 18 million Americans suffering from asthma will experience asthma symptoms. Additionally, many non-asthmatic patients (often those who have allergies or a family history of allergy) experience asthma associated with exercise.

Individuals with exercise-induced asthma have airways that are overly sensitive to sudden changes in temperature or humidity. During strenuous activity, people tend to breathe through their mouths, allowing cold or dry air to reach the lower airways without passing through the warming, humidifying effect of the nose. In addition air pollutants, high pollen counts, and viral respiratory tract infections also can increase the severity of wheezing with exercise.

Symptoms of exercise-induced asthma can include difficulty breathing within 5 to 20 minutes after exertion begins; prolonged shortness of breath, often beginning 5 to 10 minutes after brief exercise; wheezing; chest tightness; coughing; and chest pain. Coaches and referees at all levels of competition should be on the look out for these symptoms.

A warm-down period, including stretching and jogging after strenuous activity, may prevent air in the lungs from changing rapidly from cold to warm, and prevent exercise-induced asthma symptoms that occur after exercise. Athletes should restrict exercising when they have viral infections, when temperatures are extremely low, or - if they are allergic - when pollen and air pollution levels are high.

Most asthmatics, whether athletes or not, take two medications. One is a daily, long-acting medication that controls the bronchial inflammation at the root of asthma. The other is an inhaled, short-acting medication that relieves acute asthma symptoms, which is what Rashid Wheeler regularly used.

You should discuss your son's condition and sports participation with his doctors. Physicians who specialize in treating asthma stress the importance of having a "quick-reliever" inhaler available when exercising and to use it immediately at the onset of symptoms. Physicians also emphasize that asthmatics must be able to recognize their acute symptoms and have an "action plan" in place with their coaches and their doctor, so everyone knows how to deal with any difficulties that may arise.