212 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
- Must exclude other diagnoses such as vocal cord dys-
function, vascular rings, and reflux disease, if spirom-
etry is normal.
•Classification of asthma severity is based on history
and spirometry (see Table 36-1) - Management should focus on patient education, envi-
ronmental control, and objective monitoring. - Patient education:Patients and their families should
understand signs and symptoms of an asthma exac-
erbation, the chronicity of the disease, and potential
triggers of an attack. A written plan should be
reviewed and instruction on proper use of inhaled
medications and peak flow monitoring should be
provided. - Environmental control:Avoidance of exposure to
precipitating factors is paramount. Potential triggers
include, pollen, mold, ozone, exercise, and cold air.
Athletes should exercise indoors on bad weather days,
or use measures such as masks to decrease chance of
attack. Indoor swimming is considered an excellent
option secondary to the warm, moist environment at
the pool.- Monitoring: Athletes need to be monitoring their
peak flows on a daily basis to recognize decline in
function as well as response to treatment. Formal
spirometry is recommended for initial diagnosis, after
treatment and peak flows have stabilized, and then
every 1 to 2 years when asthma is stable, more often
when unstable (Consensus Guideline, Expert opinion
NHLBI). - Pharmacologic therapy should be instituted to control
inflammation and treat episodes of bronchoconstriction.
Use a stepwise approach to treatment as outlined in
Table 36-2.
TABLE 36-1 Stepwise Approach for Managing Asthma in Adults and Children Older Than 5 Years of Age