Young Athletes Warned of Asthma's Dangers

Study linked 61 deaths to sudden attacks during play

SUNDAY, July 31, 2005 (HealthDay News) -- For kids and teens, summer is peak time for outdoor fun, whether it be on the gridiron, the basketball court, the track or in the pool. But for young people with poorly controlled asthma, sports can be a dangerous game.

In fact, a study last year by doctors at St. Christopher's Hospital for Children in Philadelphia counted 61 U.S. deaths over the past decade linked to sudden asthma attacks during sporting events -- most involving victims between 10 and 20 years of age.

"There is nothing more horrifying than seeing a young athlete running and dying on the sports field," said Dr. Jack M. Becker, author of the study, which appeared in the February 2004 Journal of Allergy and Clinical Immunology, and chief of allergy and asthma at St. Christopher's.

Such deaths are rare considering how many young athletes have asthma -- as many as 6 percent to 18 percent, according to Becker. But they highlight a crucial issue for asthmatic children and their physicians, parents and coaches: awareness and control of asthma, not just asthma attacks. That means chronic therapy to keep respiratory symptoms under control at all times.

Most of the fatalities in his study involved "mild asthmatics who were not on chronic therapy," Becker pointed out. "Rarely does someone have a severe attack for the first time," he said.

According to the American Academy of Allergy, Asthma & Immunology, over 5 million American children have asthma, which is caused by a swelling and closing of the airways, usually in response to specific triggers such as pollen, mold and cigarette smoke. Exercise can also trigger asthma attacks, as can exposure to cold air. Symptoms include coughing, wheezing, shortness of breath, and chest pain or tightness.

If immediate treatment is not available, a severe asthma attack can be fatal.

In the study, Becker's team combed through news reports for suspected cases of sports-related asthma deaths occurring over the previous seven-and-a-half years.

They report that white males between the ages of 10 and 20 were at highest risk, with deaths for whites outnumbering blacks two-to-one. Boys were twice as likely to die from asthma during sports than girls.

Basketball and track made up the bulk of fatalities, although asthma claimed the lives of those engaged in football, swimming, cheerleading and other athletic activities. "Any aerobic sport can do it," Becker said.

A player's physical prowess didn't seem to protect him or her, either, the study found. In fact, those who played professionally or on a school team were more at risk of asthma-related death than those who played recreationally.

The issue gained national attention four years ago when Northwestern University football player Rashidi Wheeler collapsed during a preseason workout and died soon after. His death was blamed on bronchial asthma.

Early recognition of asthma and effective, chronic control may be key to reducing sports-related deaths, Becker said. "If we don't treat this disease early we can affect their entire lives," Becker said.

Asthma control means "maintenance therapy" -- medication that's taken chronically, even when asthma symptoms aren't there.

"There are two components to asthma treatment, rescue medication and maintenance medication," explained Dr. Michael Light, director of clinical service in pediatric pulmonary at the University of Miami Medical School. Of the two, maintenance therapy, also called controlling therapy, is far trickier to comply with, even though it is the most effective way to stay symptom-free.

"The problem is that when you feel well, you don't stay on the medication," he said.

People also get used to their symptoms, such as a tight chest or coughing during the night, he said. Too often, they assume these troubles are simply part of the disease -- something they have to live with. In fact, medications are available to treat these symptoms.

Adolescents are even less likely to stick to maintenance therapy, Light noted, because of their natural tendency to rebel against authority. "We haven't found a good way to get them to comply," he said.

Becker said the best way to increase compliance is to spread the word to the adult community about the importance of treating asthma before problems occur. Working with an advocacy group called Coalition of Health for Asthmatics in Sports & Exercise (CHASE), he lectures several times a month to school groups, teachers and other physicians about the importance of treating asthma properly so that children can participate in sports.

There's certainly no need to think kids with asthma can't take to the field, gym or pool, he said.

"The news is that you can play sports at a high level and still have asthma if you work with physicians, coaches and parents to make sure you're well-controlled," Becker said.

Some simple precautions can help asthmatic kids have all the (safe) fun they want this summer:

  • Make sure the child's rescue inhaler is nearby at all times.
  • Keep asthma under control. If a child is up all night coughing and wheezing, sending him or her off to the playing field the next morning isn't a good idea.
  • If a child uses rescue medication once just before a game and then again once during the game, fine. If they require it a third time, that's a sign they need to be withdrawn from play.

Winning against asthma is the real championship play, Becker said. "I tell people that you need to be on top of your asthma if you want to play the best you can."

More information

For information on making sports safe for kids with asthma, head to the Coalition of Health for Asthmatics in Sports & Exercise.

SOURCES: Jack M. Becker, M.D., chief, allergy and asthma, St. Christopher's Hospital for Children, Philadelphia, Pa.; Michael Light, M.D., director of clinical service, pediatric pulmonary and professor, clinical pediatrics, University of Miami Medical School, Fla.; February 2004 Journal of Allergy and Clinical Immunology.
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