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Asthma and Wheezing Recognition and Treatment Policy
RationaleAsthma and Exercise Induced Asthma/Bronchospasm (EIB), together, affect as many as 30% of all athletes. Asthma is a condition of chronic, inflammation of the airways that ranges in severity from mild-intermediate to severe-persistent that may be manifested by a number of signs and symptoms. Likewise, EIB is a bronchospastic event that is caused by a loss of heat, water, or both from the lung during exercise because of hyperventilation of air that is cooler and/or dryer than that of the respiratory tree. These conditions are most often associated with symptoms such as wheezing and cough and in some may progress to severe bronchospasm and air starvation. Although asthma and EIB can be serious, precautions and measures can be taken to ensure the health and safety of all those affected while promoting optimal athletic performance. These measures have long been established within the medical literature and national asthma treatment guidelines. The literature emphasizes the importance of recognition of symptoms and proper management as key components to ensuring the highest level of athletic performance and preventing serious incidents, hospitalization, and death. Pre-participation Identification and Evaluation Recognition of Signs and Symptoms of Asthma or Exercise Induced Bronchospasm (EIB) The common signs and symptoms associated with asthma and EIB are wheezing, cough, shortness of breath, and chest tightness/chest pain. EIB usually occurs during or minutes after vigorous activity, reaches its peak 5 to 10 minutes after stopping the activity, and usually resolves in another 20 to 30 minutes. Asthma is a much more serious condition and early recognition of symptoms and intervention is imperative. Treatment If an athlete experiences any sign or symptom of asthma or EIB, he or she should be removed from play immediately. The athlete should be moved to a cool, shaded location and not allowed to continue any strenuous activity for a minimum of 30 minutes. The athlete shall be taken to the training room or field house for further evaluation if the athlete does not respond to conservative field measures within 15 minutes. Any medication prescribed by a physician for the treatment of these conditions should be administered at this time. The athlete should continue to drink fluids as required to prevent dehydration and maintain adequate hydration. If an athlete does not resolve symptoms within a short period of time, refer for immediate medical attention. Emergency situations Any of the following symptoms indicate a life-threatening, emergency situation: blue tinted skin and /or lips, stops breathing, air hunger, difficulty speaking in sentences, use of accessory muscles, respiratory rate > 30 breaths per minute, severe agitation, or sitting straight and upright. Figure 3-9 from the Guidelines on the Diagnosis and Treatment of Asthma gives a classification of severity of an asthma attack. If any of the above occurs, Emergency Medical Services should be activated by calling 911. Clearance to Play An athlete may be considered cleared to resume play if he or she is asymptomatic (without ANY symptoms) within 30 minutes after treatment, has returned to a normal respiratory rate, no audible wheezing with normal breath sounds is present, and no wheezing using stethoscope can be heard. If there is any questions the athlete should not return to play. Removal from Play An athlete should be ineligible to return to play if he or she fails to meet ALL above clearance requirements within 30 minutes. The athlete shall be removed from play for the remainder of the play period if a recurrence of symptoms after treatment during the same game or practice period occurs. Likewise, an athlete may be deemed ineligible for play if he or she experiences any symptoms deemed serious by coach, trainer, or team physician. Prevention of Symptoms One goal of management is to enable
patients to participate in any activity they choose without experiencing
asthma symptoms. EIB should not limit either participation or success in
vigorous activities. Beta 2 -agonists (Albuterol, Proventil, Ventolin,
Serevent) will prevent EIB in more than 80 percent of those affected.
These agents should be used shortly before exercise (or as close to
exercise as possible) and may be helpful for 2 to 3 hours. Serevent has
been shown to prevent EIB for 10 to 12 hours. A lengthy warm-up period
before exercise may benefit patients
who can tolerate continuous exercise with minimal symptoms. The warm-up
may preclude a need for repeated medication.
Notification to Parents, Coaches, and Director Any question regarding treatment of any athlete for EIB or asthma attack shall be directed to the athletic trainer or the team physician. Any athlete treated for EIB or asthma or referred to the emergency department shall be reported promptly to the head coach and the athletic director. Proper notification of the parents or guardians of the athlete shall also be attempted. DEVELOPED by: |
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