By Robert Grabko, R.P.F.T., B.S.

The best way to manage airway tightening is through prevention. That said, despite best efforts most athletes with asthma will experience airway tightening at some time. What are some strategies to manage the inevitable? 

Managing Airway Tightness When It Occurs
First, track your normal peak flow rates over a period of time to better understand your body. Use a simple hand-held peak flow meter daily over a two-week period to measure and graph airflow. When peak flow drops 25 percent from your normal, the airway is considered to be in “a tightening mode.” Athletes can often “feel” this and report symptoms that include shortness of breath, wheezing, cough, and chest pain or tightness. Recognizing your symptoms will help you better manage tightening when it occurs.

When peak flow drops 25 percent from normal, use a “rescue” inhaler, or Albuterol. While many athletes experience relief, nearly 50 percent will not. Because the airway can be very stubborn or slow to respond, a preventive medication such as a corticosteroid or “Cromolyn” may be more helpful. However, this needs to be taken every day for a couple weeks before it works well.

When airway tightening occurs and is not responsive to the rescue inhaler, perform pursed-lip breathing and muscle relaxation exercises, alternating for several minutes. During this time, perform a peak flow measure. If there is a 25 percent drop from normal, take two puffs from the rescue inhaler. If the airway tightening is accompanied by coughing, try to suppress it as much as possible; continued coughing can increase tightening. Peak flow should be measured after 10 minutes to determine if the rescue inhaler opened the airway. Strenuous exercise should be halted if there is no improvement.

Airway Tightening on the Playing Field: the Role of Coaches, Parents and Health Care Providers
Coaches, parents and health care providers have an important role to play in helping athletes manage their asthma. Communication between the three is imperative to the safety of the athlete, particularly those who are younger and may not understand the seriousness of the condition. Too, multifaceted medical treatment programs that draw on the expertise of respiratory therapists, physicians, nutritionists and others are important to athlete safety. Last, coaches should be aware of athletes who have asthma. Often, airway tightening can be misinterpreted as de-conditioning and coaches may spur athletes to higher exercise intensities, which can lead to a “serious status asthmaticus” situation. Each year there are reports of athletes with asthma who have died because his/her symptoms were not properly recognized.

The athlete with asthma should be able to perform safely and at the highest level of performance and fitness levels with proper management and recognition of symptoms.