MILWAUKEE (AAAAI) -- This weekend, Northwestern University starting safety Rashidi Wheeler died of an asthma attack. Wheeler collapsed during practice after running sprints. Wheeler had a history of asthma and team officials were aware of his condition. There are 10 other asthmatics on the Northwestern football team.

"It is critical that we screen athletes from asthma and educate athletes and coaches about asthma," Christopher Randolph, MD, FAAAI, Chair of the American Academy of Allergy, Asthma and Immunology (AAAAI) Sports Medicine Committee said. "The tragic story of Rashidi highlights the Academy's concern over preventable deaths due to asthma. Proper diagnosis and management can prevent most, if not all deaths."

Asthmatic Athletes

Whether you play in a community softball league or on an NFL football team, chances are some of your teammates are asthmatic. Twenty years ago, a diagnosis of asthma meant the end of a sports career, but medical advancements allow asthmatic athletes to compete at a high level, according to the AAAAI.

A study in the November 1998 Journal of Allergy and Clinical Immunology showed that one in six athletes representing the United States in the 1996 summer Olympics in Atlanta had asthma. Thirty percent of the asthmatic athletes took home team or individual medals. They fared as well as athletes without asthma (28.7%) who took earned team or individual medals.

"Yes, athletes who have asthma can compete at high levels," Randolph said. "However, in order for these athletes to remain healthy and competitive, they must be diagnosed with asthma and take proper steps to control their condition."

What is Exercise Induced Asthma?

Approximately 7% of the population, or about 18 million Americans, are reported to suffer from asthma. With strenuous physical exercise, most of these individuals experience asthma symptoms. In addition, many non-asthmatic patients (about 11%), often those who have allergies or a family history of allergy, experience asthma associated with exercise.

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

Symptoms of EIA can include:
* Breathing difficulty within 5-20 minutes after exertion begins;
* Prolonged shortness of breath, often beginning 5-10 minutes after brief exercise;
* Wheezing;
* Chest tightness;
* Coughing;
* Chest pain.

"It is crucial for coaches and referees at all levels of competition to be on the look out for these symptoms," Randolph said.

Managing asthma in athletes

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 ("reliever") medication. This medication relieves acute asthma symptoms.

"It is important for asthmatics to take their medications as prescribed, especially if one of those medications is a long-acting medication," Randolph said. "Asthmatics also must be able to recognize their acute symptoms and take the appropriate reliever medication at the onset of symptoms. Taking a break from practice to take your reliever medication may not be a 'macho" thing to do, but it may save your life."

Inhaled medications taken prior to exercise are helpful in controlling and preventing exercise-induced bronchospasm, according to Randolph. The medication of choice in preventing EIA symptoms is a short-acting beta 2 agonist bronchodilator spray used 15 minutes before exercise. These medications are effective in 80 to 90 percent of patients, have a rapid onset of action, and last for up to four to six hours.

In addition to medications, a warm-up period of activity before exercise may lessen the chest tightness that occurs after exertion. 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 may prevent EIA 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, according to Randolph.

"If you suspect you have asthma that is triggered by exercise, it is important that you see an allergist," Randolph said. "Allergists can diagnose your condition and work to develop a management plan that will keep you healthy and on the playing field."

To find an allergist in your area, call the Academy's toll-free Physician Referral and Information Line at 1-800-822-2762.