Winter Athletes Wrestle with Asthma

Vol. 11 •Issue 2 • Page 13
Winter Athletes Wrestle with Asthma

By Caroline Crispino

Olympic cross-country skier Andrea Nahrgang, 24, plows through snowdrifts for miles at a time. With each swoosh of her skis she takes a deep, frosty breath that aggravates her asthma.

“After every single race, I’m coughing constantly,” Nahrgang said. Once she crosses the finish line, she heads straight to the team’s massage therapist. “I have to lie there, and the massage therapist literally beats on my back to break up the mucus in my lungs. It’s not an easy thing, and it’s not a very fun thing.”

Nahrgang is one of approximately 50 top American athletes with asthma and/or exercise-induced asthma (EIA) who are competing for the gold in the 2002 Winter Games in Salt Lake City.

Breathing problems are common for winter athletes because they train for prolonged periods of time at high ventilation rates in adverse environments, said Ken Rundell, PhD, senior sports physiologist at the United States Olympic Training Center at Lake Placid, N.Y.

Dr. Rundell studied the 1998 winter games in Nagano, Japan and found that 50 percent of the cross-country ski team, 43 percent of the short-track speed skating team, 35 percent of the figure skating team, and 30 percent of the hockey team competed with EIA or asthma.1 He expects to see similar prevalence rates of asthma or EIA at the 2002 games.

Winter Exposure
Chronic exposure to cold, dry air saps airways’ surface liquid. Inflammation results in a susceptible individual, and the athlete’s airways become hyperreactive, Dr. Rundell explained.

It will be especially hard for athletes to perform in Salt Lake City, which is 4,372 feet above sea level. Skiers face mountain peaks up to 11,500 feet on the east side of the valley. The air at high elevations has less oxygen than at sea level. If an athlete’s arterial oxygen saturation is lower than it should be, which can be the case with a person with asthma, his or her performance will be hindered, Dr. Rundell said.

Athletes who participate in a skating venue also have to contend with pollutants from ice resurfacing machines. “Both the gas and the propane machines emit carbon dioxide and nitrogen dioxide and ultra-fine particles (that carry charged metals). The charged particles will get into the airway and cling like lint, unlike uncharged ultra-fine particles that move freely in and out of the airways, causing little damage,” Dr. Rundell said. “We see about 30 percent to 50 percent of skaters have reactive airways. This can be irreversible if left uncontrolled.”

Testing and Monitoring Athletes
Dr. Rundell and his colleagues perform EIA evaluations for elite athletes and work with the team physicians to determine medication regimens that control each athlete’s symptoms while keeping him or her at peak performance levels.

Spirometry can be used to measure athletes’ asthma severity. Dr. Rundell gets a baseline reading prior to exercise, and then the athletes perform a six- to eight-minute high-intensity exercise challenge specific to their sport while breathing dry air. They are tested again at five, 10 and 15 minutes after the challenge.

“We study the exhalation flow rates,” Dr. Rundell said. “The forced expiratory volume in the first second of exhalation (FEV1) reading is the most reliable. When the post exercise spirometry levels of FEV1 are greater than a 10-percent fall from the baseline, the athlete is considered positive for EIA.”

A second test that Dr. Rundell administers is eucapnic voluntarily hyperventilation (EVH). This test confirms an athlete’s EIA and/or asthma in a stress-free way prior to a competition. The athlete is seated and inhales dry air out of a bottle at 85 percent of maximal ventilation for six to seven minutes. “This test mimics exercise ventilation but does not involve a workout,” Dr. Rundell said.

Olympics athletes also can use a peak flow meter daily to monitor their lung function and alter their training routine accordingly, said James Rogers, ATC, director of special programs for Temple University Sports Medicine Centers and co-director of the Temple Sports Asthma Center at Temple University in Philadelphia.

“The athlete cannot feel deterioration until it hits them in the form of an attack, which is why I think peak flow readings would help for prevention purposes,” Rogers said.


An athlete with diagnosed asthma or EIA can take precautions to avoid exacerbations, including pretreatments with a beta2-agonist 20 minutes before exercise. Athletes who suffer from bronchospasm also may benefit from a seven- to 12-minute warm-up at a lower rate and for a longer period than athletes without EIA or general asthma, Rogers said.

“Hydration is another important factor,” he added. Taking in fluids helps airways to be “more forgiving” when exposed to cold, dry air.

Nahrgang said adhering to her daily medication regimen has helped her achieve better performance. “I would not be able to do this sport without the medications that I’m onÉ Asthma is an obstacle that I’m overcoming.” n


1. Wilbert RL, Rundell KW, Szmedra L, et al. Exercise-induced bronchospasm in Olympic athletes. Med Sci Sports Exerc. 2000;32(4):732-37.

Caroline Crispino is editorial asistant of ADVANCE.

Prohibited Substances

Controlling athletes’ asthma may require a combination of bronchodilators to treat ex-acerbations and anti-inflammatories for long-term maintenance. However, many of these medications are on the International Olympic Committee’s restricted list, and the IOC recently announced tougher rules for athletes to get permission to take them.

Athletes must have laboratory documentation of their diagnosis and may be required to submit to on-the-spot testing (eucapnic voluntary hyperventilation or exercise) to prove that they experience exercise-induced asthma.

The following list is based on the IOC’s September 2001 guidelines for prohibited substances:


Amineptine, amiphenazole, amphetamines, bromantan, caffeine, carphedon, cocaine, empedrines, fencamfamin, formoterol*, mesocarb, pentetrazol, pipradrol, salbuta-mol*, salmeterol*, terbutaline* and related substances.

• Salmeterol is permitted by inhaler only to prevent and or treat asthma and exercise-induced asthma.

• Written notification by a respiratory or team physician that the athlete has asthma and/or exercise-induced asthma is necessary to the relevant medical authority prior to competition. At the Olympic Games, athletes who request permission to inhale a permitted beta agonist will be assessed by an independent medical panel.


Bambuterol, clenbuterol, fenoterol, formoterol*, reproterol, salbutamol*, salmeterol*, terbutaline* and related substances.

• Authorized by inhalation as described above.

• For salbutamol, the definition of a positive under the anabolic agent category is a concentration in urine greater than 1,000 nanograms per milliliter.

The systemic use of glucorticosteroids is prohibited when administered orally, rectally, or by intravenous or intramuscular injection. When medically necessary, local and intra-articular injections of glucorticosteroids are permitted. Where the rules of a responsible medical authority so provide, notification of administration may be necessary.

* Common asthma medications

–Caroline Crispino