Asthma is a long term health condition, suffered by around 10% of Australians. During a flare-up (or an asthma attack) the airways in the lungs can swell, tighten, and become quite narrow; and often produce more mucus. When asthmatics suffer an attack, these things can make breathing quite difficult! Asthma affects people of all ages, and is a lifelong condition with no cure. At the moment, there is no known cause of asthma. It is often linked to those with a family history of asthma; and people who suffer from eczema and hay fever sometimes develop asthma.
Symptoms of asthma can vary from person to person, and one person’s individual asthma can change in severity on a regular basis. Sometimes asthma can be well controlled and no symptoms are present at all, while at other times symptoms can occur on a regular basis. Usually, the symptoms asthmatics will suffer from are:
- Breathlessness
- Wheezing
- A tight feeling across the chest
- A continuing cough
Quite often, these symptoms appear at night, early in the morning, or just after physical activity; but they can appear at any time. People with well controlled asthma only experience these symptoms occasionally…….but during an asthma attack, these symptoms can be quite severe. They can make it extremely difficult for a person to breathe properly; and on occasion, some people will need to go to hospital if the asthma attack is severe.
EXERCISE AND ASTHMA
Exercise is one of the biggest triggers for people with asthma. Approximately 80% of people with asthma have the symptoms of their condition triggered by vigorous exercise; and for some people, periods of exercise are the only time their asthma presents itself. This is usually referred to as exercise induced asthma.
On a day to day basis, when we breathe, its usually through our nose. Our sinuses are able to add some warmth and a bit of moisture to the air we are breathing before it enters our lungs. But when we are exercising, especially at a higher intensity, we breathe through our mouths. This means that the air goes directly to our lungs, and is usually a little bit cooler and drier. This combination of cool, dry air can irritate the lungs, and can inflame asthma symptoms for sufferers, often leading to an asthma attack.
Obviously, this is not a great scenario for those who like being active on a regular basis. When uncontrolled, the symptoms suffered by asthmatics can severely restrict the amount and intensity of exercise an individual can undertake. For athletes, this will have a huge impact on the ability to train and compete at their best…….and due to the fact that exercise can sometimes cause a severe asthma attack, many asthmatics become a little reluctant to exercise!
However, with a good asthma management plan and suitable asthma treatment, asthma symptoms and asthma attacks can be kept to an absolute minimum.
TRIGGERS
There are quite a few things that can cause asthma symptoms to become worse and potentially result in an attack. While some of these triggers can be avoided, many of them include regular day to day activities, or things that cannot be controlled! Obviously, you don’t want your asthma to prevent you from doing the things you love….hence the importance of good asthma control and having an asthma management plan in place!
Triggers that you can try to avoid include things such as cigarette smoke, indoor air pollution such as gas or smoke from wood fires, animal dander (if you are sensitive to this…..many people are sensitive to cats) and some medications (such as aspirin and anti-inflammatories). Thunderstorms can also cause an asthma attack in some individuals, due to the increase in dust and pollen in the air…..if you are affected by this, its best to stay indoors with all windows and doors kept closed. Some triggers in the workplace can also affect asthma, such as dust and spray paints on construction sites…..it can be difficult to avoid some of these, but the use of protective equipment can help to minimise any potential problems.
Daily stresses, colds and flu and cold dry air (especially over night) can cause a flare up of asthma; and occasionally result in an asthma attack. Obviously, its difficult to avoid these sorts of things, so having a good asthma management plan is important to help keep your asthma under control in these scenarios.
Foods, such as nuts and some seafood (especially shellfish), as well as some food additives and preservatives, can also result in a worsening of asthma for some people; and may even cause an asthma attack within minutes of eating! Knowing what foods can give you problems is important…and it is easy to avoid potential problems once you know what foods to steer clear of!
Many asthmatics also suffer from hay fever which, when uncontrolled, can also make your asthma worse. Treating your hay fever will help to avoid any issues with this….you can find out more about hay fever and sports here!
There are many things that can trigger a flare up of your asthma symptoms. The best thing you can do is recognize what can cause problems for you personally, and avoid it if possible…..as long as you don’t let this affect your enjoyment of life! Where the things you enjoy lead to problems for your asthma, the smartest thing is to keep your asthma well managed, and have an up to date asthma management plan!
ASTHMA MANAGEMENT PLAN
Having an asthma management plan is important to know how to keep control of your asthma. These plans outline:
- What medications you are using
- How to tell if your asthma is getting worse
- What to do when your symptoms get worse
- What to do if you have an asthma attack
Asthma management plans are available here, and your doctor can help you to fill them out. They may seem simple, but they have been shown to reduce the need for doctor and hospital visits as a result of your asthma, improve your lung function, and limit the amount of time your asthma affects your day to day life….including your sporting endeavours!
Its also important to know what to do in case of an asthma flare up or an attack. Signs of an asthma attack include:
- Worsening of asthma symptoms
- Your reliever puffer not working; or lasting less than 4 hours
- Difficulty eating, speaking or sleeping
- A sore stomach or chest
- Feeling like you can’t catch your breath
In the case of an asthma attack, you should start Asthma First Aid as soon as possible!
MEDICATIONS
There are many different medications that are used to help people effectively manage their asthma, but they can be divided into two main classes…….relievers and preventers.
Relievers
Asthma relievers are known as short acting bronchodilators. They are designed to ease breathing problems when somebody’s asthma is worsening, or they are having an asthma attack. They work quickly, and once they take effect, should help to relieve the symptoms of asthma for up to 6 hours.
The most commonly used relievers are Salbutamol (Ventolin®, Asmol®, Airomir®) and Terbutaline (Bricanyl®). Both are available as an inhalation, or as a liquid; but the liquids are rarely used, as they take a lot longer to work (30-60 minutes), and more commonly result in side effects….so its best to stick to the inhaled versions!
Preventers
There are quite a few different types of asthma preventer medications available, which are designed to keep asthma symptoms under control and reduce the amount of asthma attacks people experience….if well treated, hopefully none! These medications have an anti-inflammatory effect, so they are used to try and keep the airways open and stop the symptoms of asthma from appearing. Preventers are not designed to have an immediate effect on worsening asthma symptoms or an asthma attack; so it is important to always have a reliever handy, just in case!
Corticosteroids are the most commonly used preventers. Beclomethasone (Qvar®), Budesonide (Pulmicort®) and Fluticasone (Flixotide®) are available as single ingredient products. They are usually used twice a day, as their effects typically last for about 12 hours. Ciclesonide (Alvesco®) is a once daily corticosteroid inhaler, which some people find easier to use, due to its longer action. These medications can sometimes cause a fungal infection in the mouth, so it is important to rinse your mouth out after using them!
Non-steroidal anti-inflammatory preventers are sometimes used in place of corticosteroids; but they are also used as an addition, instead of increasing the steroid dose if somebody’s asthma is not well controlled. Cromoglycate (Intal®) and Nedocromil (Tilade®) are both available as inhalations….however, they are not effective for everybody; and they can take a while to start working, so a short trial over a couple of weeks is usually recommended.
Monteleukast (Singulair®) is an oral tablet which is sometimes used as a preventer medication. Again, they are used as either an alternative to corticosteroids, or in addition to them. These tablets are taken once a day, but they don’t work for everybody.
Combination products also exist, which contain a corticosteroid, and a long acting bronchodilator; which works in the same way as reliever medications, but last longer and are slower to take effect. Seretide® and Symbicort® are both available here in Australia. The long acting bronchodilators usually stay in the body for about 12 hours; and these products are usually used in people who suffer from more severe forms of asthma. Salmeterol (Serevent®) is a single ingredient long acting bronchodilator, but it is rarely used anymore.
Oral corticosteroids
Occasionally, due to a severe flare-up of symptoms or an asthma attack, some people may need to take a short course of oral corticosteroids….usually Prednisolone. This is an anti-inflammatory which will open up the airways and get your asthma back under control, so you can go back to living a normal life.
HOW TO USE A PUFFER
One of the most important things you can do to manage your asthma effectively is learn to use your puffer correctly! There are many different types of asthma devices on the market…..inhalers, turbuhalers, autohalers and accuhalers. Asthma Australia has some short videos on the proper use of each one; but you should always talk to your GP or pharmacist, as they can check to see if you are using your device correctly or not. With the number of different devices on the market, there is no need to worry if you are struggling to use what you have been prescribed…..simply tell your GP you would like to try one of the different devices!
WHICH MEDICATION SHOULD I BE USING?
Well, this one depends on the severity of your asthma! After determining how severe your asthma is, your doctor will decide what medication you will need to help manage your asthma most effectively. People with mild asthma will usually be able to get away with just using a reliever medication every now and then; while those with slightly more severe asthma may require a preventer containing a corticosteroid, or a combination puffer, in addition to their reliever.
At some times of the year, you may only need to be using your reliever; while at other times may need to be using a preventer on a daily basis. Over the course of your life, you may find that your asthma worsens or becomes less severe, so your medications could change over time…make sure you have regular asthma checks with your doctor to keep your asthma under control!
WHAT ELSE CAN YOU DO?
One of the best things you can do to help improve your asthma management is to use a spacer with your puffer. Studies have shown that when you don’t use a spacer, not much of the medication from your puffer actually makes it into your lungs….most of it ends up at the back of your throat! But by using a spacer, most of the medication gets where it needs to be, so your asthma puffer will be much more effective and your asthma management will improve! Ultimately, you should always be using a spacer with your Ventolin® or Asmol® reliever medications, and its a good idea to use with with your preventer medication too……so be sure to have a spacer with you whenever possible! (Just remember, spacers can only be used with Metered Dose Inhalers, similar to the Ventolin® device. Turbuhalers, autohalers and accuhalers will not work with a spacer)
Some people find that using a vaporizer or humidifier overnight can assist with their asthma management. These devices add moisture to the air; which can often be of benefit, especially in the case of cold, dry conditions.
ASTHMA MEDICATIONS IN SPORT
While the corticosteroids found in preventer medications are all perfectly fine to be used in sports at their prescribed doses, you will need to be careful with many of the other ingredients found in asthma puffers. Athletes have gotten into trouble in the past by either not obtaining a Therapeutic Use Exemption (TUE), or for using too much of their medication!
Terbutaline (Bricanyl®), is currently banned for use both in and out of competition. It is classed as a beta-2 agonist, which is banned for use. Elite athletes need to apply for a TUE if they have been prescribed this medication. Here in Australia, some athletes are able to obtain a retrospective TUE if necessary (refer to ASADA, or ask me for a bit more information!)
Salbutamol (Ventolin®, Asmol®) is also on the banned list. However, it can be used in its inhaled form, up to a maximum of 1600 micrograms in 24 hours without a TUE……this equates to about 16 puffs of your reliever in a day. If you find that you need to be using your reliever this often, its probably a good idea to get an asthma review anyway!
Salmeterol (Seretide®, Serevent®) and Eformoterol (Symbicort®) are both also on the banned list. But these can also be used at their prescribed doses without the need for a TUE…..Salmeretol can be used up to 200 micrograms in 24 hours, while Eformoterol can be used up to 54 micrograms every 24 hours.
In the case of an asthma attack where oral steroids have been prescribed for a short period, athletes need to be very careful. These medications are banned for use in competition, so require a TUE, but they are okay to use out of competition. However, if you have had an asthma attack severe enough to require these medications, it might be a good idea to have a bit of a rest!
Of course, if you are unsure if you can use your medication as an athlete, be sure to check your substance for yourself; or ask your coach, doctor or pharmacist to be make sure it is okay!
While there is no known cure for asthma, with a good asthma management plan and the right amount of education, you can keep your asthma under control. There is no reason why it has to stop you from being active and enjoying the sports you love!
The Sports Pharmacist 