Vol. 15 •Issue 5 • Page 8
Asthma in Olympians
Proper diagnosis, treatment and medication can help level the playing field for athletes with asthma
The 19th Winter Olympic Games in Salt Lake City have come to a close and the crowds have trickled home, leaving winning smiles, frustrations and vows for better scores in the next events in their wake. Sporting events in Utah are pretty much in a hiatus as the site prepares to host the Paralympics.
While the data are incomplete at this point, it is known a sizeable number of Olympic athletes clutching their coveted medals on the winners’ platforms have asthma or exercise-induced asthma (EIA). Among the most well-known combatants with asthma are Andrea Nahrgang, a biathlete, and Apolo Anton Ohno, a short track speed skater.
Nahrgang and Ohno were just two of about 50 or more U.S. athletes competing despite their asthma or EIA at the games this year.
They faced obstacles beyond their breathing conditions. They faced new restrictions governing their asthma medications as well.
Medal contenders who used a beta2 agonist to combat their asthma symptoms at the Olympics needed to show clinical proof .they have asthma and need to use the drug. It was not a regulation that arrived unannounced. The International Olympic Committee Medical Commission (IOC-MC) announced as early as November 2001 that Olympic athletes would need to seek authorization to use asthma medications during the Olympic Games and would need to provide clinical and laboratory proof of their ailment.
A higher percentage of athletes at the Winter Games have asthma compared to their counterparts in the Summer Games, according to experts.1,2,3 Some of the problems can be traced to heavy exertion in cold weather and the dry air at high altitudes.
At the start of events in Salt Lake City, experts examined the information supplied by the athletes to determine, on a case-by-case basis, whether there was a need to conduct a verification test. When they found insufficient proof of asthma on the initial materials submitted, the IOC-MC had the right to turn down an athlete’s request to use the drugs.
Numerous asthma medications contain beta2 agonists, which are on a list of prohibited substances from the IOC. The IOC-MC reinforced its position on this matter to protect athletes from the dangers of mistaken diagnoses because there has been a documented significant increase in the use of asthma medications containing beta2 agonists during recent editions of the Olympic Games, especially in endurance sports.
The new drug regulation was based on results of ongoing studies and research that have taken place since the 1996 Summer Games to follow the trend of drugs used by Olympic athletes with asthma.
TESTING IN SALT LAKE CITY
Ken Rundell, PhD, senior sport physiologist for Sports Science and Technology for the USOC in Lake Placid, N.Y., said if an athlete seeks permission to use beta2 agonists, there are choices of tests they must go through such as a field exercise challenge or a bronchodialator challenge in order to use the medications.
Prior to the games, the athletes had to provide documentation they had failed one of several tests available to determine asthma or EIA and a letter from the physician. The physician had to be a team physician, a pulmonologist or an allergist. There was reason for the concerns. “Therapeutic inhaled beta2 agonists are not ergogenic aides. If the athletes have airway issues and use the medication, they are on a regular playing field with the non-asthmatics competing. Beta2 agonists help the asthmatic compete closer to being normal,” Rundell said.
A eucapnic voluntary hyperpnea (EVH) test and other options were available at the Olympics to determine whether an athlete has EIA or general asthma. This test indicates whether athletes would be cleared to use beta2 agonists. In an EVH test, an athlete is seated and inhales dry air out of a bottle at 85 percent of maximal voluntary ventilation (MVV) for six to seven minutes. “This test mimics exercise, but does not involve a workout,” Rundell said. Athletes are permitted to use their beta2 agonists if their FEV1 falls 10 percent for their baseline FEV1 taken prior to the test.
That is only one test.
A field exercise challenge requires an athlete to exercise. In this instance, they are tested by spirometry prior to and post exercise to determine whether they have EIA and/or general asthma.
A bronchodialator challenge involves base-line spirometry and taking a few hits of Albutertol and then using a spirometer to test the results. The results are compared and the athlete’s improvement is studied.
If there is a 12 percent improvement of FEV1 they are allowed to use a bronchodialator.
Researchers at the University of Iowa have worked with the United States Olympic Committee (USOC) to collect information from the 1996 and 1998 Olympics to look at the prevalence of asthma in Olympic athletes representing the U.S., according to John Weiler, MD, professor of internal medicine at the University of Iowa. He and his colleagues have developed two criteria for looking at asthmatic athletes. One was that the athletes had been told they had asthma; the second was that the athlete took an asthma medication.
The results of the Olympics of 1996 showed 16.7 percent of athletes had asthma or EIA. In 1998, the figure was 22.5 percent. “Those are pretty high prevalences,” Weiler said. The 2000 results are not out yet.
Other investigators tested some of the athletes who participated in the 1998 Games for EIA. “The interesting fact is that we came up with almost the same figure for the percent that had positive challenges, ” Weiler said. He added, however, that history is only a fair predictor indicating EIA in an athlete, because some athletes with positive .challenges will not have a positive history and others with a positive history will not have a positive challenge.1 Rundell et al, tested 172 of the 190 athletes and found a very similar prevalence.
“We have also examined whether a history of asthma predicts a positive challenge. I agree that history is an imperfect way to predict whether or not a single athlete will have a positive challenge,” Weiler said.
THE WINTER GAMES OF 1998
Asthma is common even among the nation’s most elite athletes, and it appears that at least one in five American athletes who participated in the 1998 Winter Olympic Games had asthma or EIA.
Asthma is more common among elite American athletes who participate in winter sports than those who participate in summer sports, experts said.
A study analyzed the asthma history and symptoms of the 196 U. S. participants in the 1998 Winter Olympic Games in Nagano, Japan, and compared that study to previous findings from the American athletes in the 1996 Summer Olympic Games in Atlanta.2
Of the 196 U.S. winter athletes, 22.4 percent reported they were currently taking asthma medication, had been diagnosed with having asthma or both.
U.S. winter athletes participating in Nordic-combined cross-country and short track were most likely to have been told they had asthma or taken medicine to control asthma, with nearly 60.7 percent (17 of 28 individuals) reporting one or both of these conditions. In contrast, only one individual of the 36 bobsled, biathlon, luge and ski-jumping athletes had been diagnosed with asthma or taken asthma medication.
More females than males participating in the winter games reported an asthma condition or medication use. But sex of the athlete is not the major concern for those sponsoring the events. “Asthma itself needs to be well treated,” Weiler said.
U.S. athletes without asthma fared somewhat better in the 1998 winter games than those with asthma, with 17.8 percent of the former group winning an individual or team medal and 11.4 percent of the group with asthma taking home an award.
THE SUMMER GAMES IN ATLANTA, 1996
At least one in six athletes representing the U.S. in the 1996 Olympics in Atlanta had a history of asthma.
Researchers at the University of Iowa and the United States Olympic Committee sought to examine how many athletes in the 1996 Olympic Games had a history of asthma, had taken asthma medications or had symptoms that suggested asthma.
To examine the prevalence of asthma in the Olympians, Weiler et al. analyzed responses from an extensive, mandatory medical history questionnaire required of all U.S. Olympic athletes competing in the 1996 Olympic Games.
The U.S. Olympic Committee Sports .Medicine Division designed the questionnaire with input from Weiler and his .colleagues. It included about 60 specific questions regarding allergic and respiratory disorders.
Of the 699 athletes who completed the questionnaire, researchers found that 117 (16.7 percent) of the athletes had a history of asthma, took asthma medications or both. Seventy-three (10.4 percent) of the athletes had active asthma, based on their need for asthma medication at the time of the questionnaire or their need for medication on a permanent or semi-permanent basis.
Nearly 30 percent of the 1996 U.S. Olympians who had asthma or took asthma medications won team or individual medals in their Olympic competitions. They fared about the same as the athletes without asthma (28.7 percent) who earned team or individual medals.
1. Wilber RL, Rundell KW, Szmedra L, et al. Incidence of exercise-induced bronchospasm in Olympic winter sport athletes. Medicine and Science in Sports and Exercise. (2000;32: 732-737.)
2. Weiler JM, Ryan EJ III. Asthma in United States Olympic athletes who participated in the 1998 Olympic Winter Games. J. Allergy and Clinical Immunology (August, 2000).
3. Wilber RL, Rundell KW, Szmedra L, et al. Self-reported symptoms and exercise-induced asthma in the elite athlete. Medicine and Science in Sports and Exercise. (2001; 33: 208-213.
Caroline Crispino can be reached at firstname.lastname@example.org.
Biathlon Team Member Lives With Asthma
Minnesota native Andrea Nahrgang, 24, a member of the 2002 women’s biathlon team, has both exercise-induced asthma and asthma. Over the years she has learned to live with both of them, but at a cost.
She started cross-country skiing at age 14 and began competing in biathlons at age 17. She was first tested for asthma by Dr. Ken Rundell who started her on MDIs.
“I would not be able to do this sport without the medications that I am on,” she said. Her regimen of medication currently includes Singulair (montelukast), taken daily, and Intal (sodium chromoglycate), also taken daily, regardless of training workouts or not.
The winter biathlon in which she competed in Utah is a combination of cross-country skiing and rifle shooting. A biathlon is made up of five races (individual, sprint, pursuit, mass start, and relay).
“I don’t have a problem when doing low-intensity workouts. But as soon as my heart rate gets above 170 and my ventilation rate gets high, I have a lot of mucus buildup in my lungs and I basically cannot breathe,” she said while discussing her training for the Olympics in Salt Lake City.
“Since I’ve been being doing all of the tests, studies and research with Dr. Rundell, I’ve been able to get to higher levels in the sport than I would have without the medications. I realize there are some asthma cases that are so severe that people cannot be active. But there are ways to be able to compete in sports even with asthma and exercise-induced asthma,” she said.
Albuterol makes her shaky, and she tries to avoid it as much as possible since it makes her ill. “If it is really cold, then I have to take it,” she said. Currently, she is experimenting with Serevent. In the meantime, Rundell and the team physician have said they might start her on Flovent.
Narhgang started experiencing asthma symptoms when she was as young as age eight, and she took a liquid medication when she was younger to quell the attacks. “I did a lot of sports, but I did not have really bad attacks,” she said. The really bad attacks did not start until after she was older and after very cold races.
“Asthma is an obstacle that I’m overcoming,” she said. “It always depends on the climate and whether the air is dry or wet, warm or cold. It’s an ongoing thing. It is not one time where I feel like it’s fixed. It just depends on the day.”
There is no escape from the breathing problem. “It is always there, after every single race, and I’m coughing constantly and there is mucus in my lungs,” she said. “I have to lie there and the massage therapist has to literally beat on my back to try to break up the mucus in my lungs. It’s not an easy thing, and it’s not a very fun thing.”
Winter Olympics Fly By Tobacco Free
Jonny Moseley of the U.S. ski team zips down mountainsides at speeds comparable to those of a shiny red Corvette on a racetrack. Bobsledders slide down the icy track so fast you can miss them if you blink. Speed skaters look like they have been shot from a cannon as they propel themselves across the finish line.
At the Olympics, the focus is on speed, endurance and perseverance.
Olympic athletes train hard for years just for a chance to compete for a gold medal. For most, it is a once-in-a-lifetime opportunity. Their entrance fee to the winner’s platform comes down to hundredths of a second in a race, a goal in a hockey event, or a judge’s presentation score.
Olympians eat right, perfect their abilities and keep their lungs in perfect shape by not smoking.
That is why lung health became a major concern during the XIX Winter Olympic Games just completed. The Olympians needed all their vital lung capacity. They did not need any of it jeopardized by second-hand smoke.
There were strict rules and restrictions on where smokers could and could not puff this year. In addition, the Centers for Disease Control and Prevention (CDC) used the winter games as a platform to launch its own new Tobacco-Free Sports public education campaign. The effort will continue at the 2002 Paralympic Winter Games and beyond. The program was designed to promote the health benefits of an active tobacco smoke-free lifestyle. And what better place to launch such a program than at a sports program that attracts thousands of fans in person and millions on television.
“Salt Lake Olympic Committee’s tobacco-free policy was adopted in an effort to protect athletes, staff, spectators and journalists from the harmful effects of tobacco,” Mitt Romney, Salt Lake Olympic Committee president and CEO, recently told the CDC.
Smoking and use of other tobacco products was not permitted at any Olympic venue during the 2002 Olympic Games and will not be permitted at the Paralympic Winter Games, except in specific designated outdoor areas.
The tobacco-free policy covered any enclosed place of public access, indoor venues, seating bowls at outdoor venues, enclosed bars or restaurants at venues, living quarters, other enclosed places in the Olympic and villages and any Olympic transport vehicles.
No tobacco products were allowed to be sold at any Olympic site.