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Winning the Gold, Despite the Asthma

 

Improved medications, revised rules about what drugs Olympic athletes can take and sheer determination are what enabled Arlington swimmer Tom Dolan to overcome his asthma and capture a gold medal last week, according to his doctor.

“I think that Tom’s achievements will be quite an inspiration for a lot of people and may be a stimulus for addressing these kinds of health problems better,” said Martin C. Hurwitz, a University of Michigan pulmonologist and Dolan’s physician. “We certainly have the wherewithal to treat asthmatic children and help them to function at a very high level.”

Winning_the_Gold,Despite_the_Asthma

Asthma afflicts 12 million Americans and costs $6 billion annually to treat, according to the American College of Allergy, Asthma & Immunology. The condition occurs when the lining of the airways become swollen for reasons that are often not well understood. Muscle spasms reduce airflow to the lungs, resulting in labored breathing, chest tightness, coughing and wheezing. Asthma attacks can be life-threatening if treatment is not sought soon enough. Nonetheless, with proper treatment it can managed well and patients can lead normal lives. Indeed, a number of Olympic medal winners other than Dolan suffer from asthma, including Amy Van Dyken, who captured four gold medals in swimming last week, Tom Malchow, another swimmer who won a silver medal, and track and field star Jackie Joyner-Kersee.

Dolan has this type of chronic asthma. But his condition is more complicated than that. He is also one of many people who suffer from exercise-induced asthma, also known as thermal asthma. This milder condition is triggered by physical activity and can appear in chronic asthma patients as well as those who have no other symptoms of asthma. Unlike chronic asthma, it is rarely, if ever, life-threatening.

Exercise-induced asthma has been reported since antiquity and seems to occur with the heat and water loss that accompanies exercise. During workouts, each breath replaces hot, moist air normally found in the lungs with cooler, drier air. “That causes a tightness and spasms in the lungs of sensitive people,” said Gail Shapiro, a Seattle physician who helped draft new guidelines on exercise-induced asthma for the National Heart, Lung and Blood Institute. The exercise-induced asthma causes coughing, wheezing and chest tightness.

Whether allergens, such as air pollution, cigarette smoke or chlorine fumes found around swimming pools, can also help trigger exercise-induced asthma is a matter of debate. However it occurs, experts agree that two main groups are afflicted with exercise-induced asthma.

Estimates are that 40 percent of people with allergies, such as hay fever, experience exercise-induced asthma when they work out, said Shapiro. The condition is even widespread among elite athletes. A study of all members of the 1984 U.S. Olympic team found that 14 percent had symptoms of exercise-induced asthma when they engaged in physical activity.

In many cases, the condition “is like the very beginning of the asthma spectrum,” Shapiro said, noting that the majority of sufferers will never progress to full-blown, chronic asthma. “They don’t really have asthma, but they have this mild asthma tendency that comes out with exercise,” she said.

Because exercise-induced asthma can affect an individual’s athletic performance and desire to engage in physical activity, there is a growing effort to diagnose and treat the disorder. “The condition can generally be managed quite well,” said Richard Waldhorn, chief of pulmonary medicine at Georgetown University Medical Center. “These people can lead very productive lives and have very good athletic careers, as this Olympic star shows us.”

In Dolan’s case, doctors diagnosed asthma and a narrowed windpipe when he was a teenager and warned that the combination diminished his oxygen intake and hampered his chance of success in the pool. But Dolan’s drive and a growing array of improved asthma medications helped him stay in active competition.

So did a change in Olympic rules approving the use of a wide variety of bronchodilators and inhaled steroids that were developed in the 1980s. Also approved are standard antihistamines that don’t enhance athletic performance but may help minimize asthma symptoms in those people who seem to be sensitive to allergens. “The newer medications are more specific for the lungs; they don’t stimulate the heart,” said Georgetown’s Waldhorn.

Still not acceptable, however, are oral steroids and derivatives of methamphetamines that have been banned because of their potential for performance enhancement. In 1972, U.S. swimmer Rick DeMont lost his gold medal after tests showed evidence of ephedrine, a drug related to methamphetamines, in his urine. DeMont said he had taken the prescription drug for his asthma.

Dolan’s asthma has been controlled with “a lot of medications,” Hurwitz said, “more than he needs for pulmonary function so that he can achieve the kind of goals that he has set.”

In addition to bronchodilators and inhaled steroids, Dolan also takes three medications to control the gastric reflux that was helping to trigger his exercise-induced asthma. During swim practices, Dolan had considerable difficulty with coughing. Hurwitz went to the pool to measure Dolan’s lung function and noticed that the coughing was at its worst when Dolan swam the freestyle and breast stroke. The lung irritation and coughing was much less when Dolan did the back stroke, yet lung measurements showed that flow rates — a measure of oxygen consumption — were not significantly different for the three strokes. That’s when Hurwitz suspected gastric reflux.

Because there are so many effective treatments today for exercise-induced asthma, one of the biggest challenges for patients is getting a proper diagnosis. Experts said that many pediatricians and family physicians don’t recognize the problem and pass off the condition as unimportant. But some experts said it can have lifetime repercussions if it keeps youngsters from exercising and may play a role in some cases of childhood obesity, since some overweight youngsters dislike the asthmatic consequences of working out — perhaps even without knowing that the coughing spurts and gasping for breath is a symptom of a disease.

Coughing during exercise and in the 15 to 20 minutes after a workout is one of the most common symptoms. Lack of endurance can be another tipoff. So can chest tightness and wheezing. Doctors usually confirm the diagnosis by measuring lung function during an exercise test on a treadmill.

Detecting exercise-induced asthma in elite athletes can be difficult, however, since the condition doesn’t usually show up until people reach 80 percent of their maximum heart rate — a difficult feat for well-conditioned people to achieve on a lab treadmill. At Georgetown University, Waldhorn and his colleagues find they go out to the athletes during their workouts to detect the condition. “We have had a couple of student athletes whose symptoms were suggestive of it,” he said, “but we couldn’t measure it until we did it out on the track.”

Asthma is a chronic lung condition that results in breathing problems, such as wheezing, coughing, chest tightness and shortness of breath.

In an attack, the bronchioles narrow and become clogged with mucus. The alveoli, the lungs’ tiny air sacs, don’t work properly, and it becomes hard to exhale.

Asthma episodes can be mild, moderate or life-threatening, which is why doctors urge immediate medical attention.

 

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