Olympic Athletes With Asthma

When elite athletes compete in the Olympic Games, more than a few will reach for their asthma inhaler. Asthma is the most common chronic condition among Olympic athletes. Asthma involves coughing, wheezing, difficulty breathing and chest tightness. Athletes with asthma may experience these symptoms during and after competition.

A study of the five Summer and Winter Olympic Games between 2002 and 2010 found about 8% of Olympians had asthma. More recently, a 2022 study of European athletes in the Summer Olympics found 16.5% had asthma.

Why do some elite athletes develop asthma or exercise-induced asthma symptoms, also called EIA? (It is also called exercise-induced bronchospasm or exercise-induced bronchoconstriction.) No one knows for sure. It could be due to the intense training of endurance sports. These sports generate very high airflow rates.

Studies show many athletes with asthma compete in endurance sports such as:

• Long-distance running
• Cycling
• Swimming

Many young athletes with asthma list exercise as their top symptom trigger. Elite-level training can worsen asthma symptoms, notes Tod Olin, MD, of National Jewish Health in Denver. Dr. Olin is Director of the hospital’s Pediatric Exercise Tolerance Center.

Asthma and EIA are often caused by the airway drying. “The two main things that dry an airway are dry air and high airflow rates,” Dr. Olin says. “Sport itself predisposes the athlete to bronchospasm. It’s most likely due to the breathing requirements.”

Olympic athletes with asthma also compete in winter sports. They do so even though dry and cold air is a trigger for respiratory symptoms. These sports include:

• Alpine skiing
• Figure skating
• Snow boarding
• Curling

And of course there are professional athletes with asthma competing in sports worldwide. This includes football, soccer, basketball, baseball and hockey.

Why is asthma common among Olympic swimmers?

Olympic swimmers have the highest prevalence of asthma compared to other sports. This could be due to the level of endurance that swimming requires. It could also be due to the presence of chlorine in pools.

Olympic swimming champion Tom Dolan was diagnosed with asthma at age 12. Dolan won gold medals in the 400-meter individual medley in Atlanta in 1996 and again in Sydney in 2000.

Dolan runs a swim school in Sterling, Virginia. He says one of his biggest asthma triggers is chlorine, especially with indoor pools.

“The first 5 to 7 inches off the surface of the water is where the chloramines sit,” Dolan says. “That’s what you breathe in. For asthmatics, that’s a real challenge.”

Despite the chlorine risk, swimming is a good exercise option for asthma. Pools are often in warm, moist environments that won’t dry out airways.

If your asthma is affected by chlorine in pools, make an appointment with an allergist. Work together with your allergist to get good control of your asthma. This way chlorine is less likely to cause asthma symptoms.

Can asthma give athletes an advantage in competition?

In the 2008 Beijing Games, 17% of cyclists and 19% of swimmers had asthma. These Olympic athletes captured 29% and 33% of the medals in those sports, respectively.

When athletes with asthma perform better than athletes without asthma, this is sometimes called the “asthma advantage.”

How is this possible? A rigorous warm-up generates a “refractory period,” Dr. Olin says. The airways are primed to stave off an asthma attack during exercise. Athletes with asthma may essentially become protected from asthma symptoms.

These athletes may also train more intensely due to their asthma. Their breathing allows them to exercise longer. As a result, athletes with asthma are able to compete at their highest level.

How do elite athletes manage asthma?

Asthma treatment is the same for elite athletes as it is for those who play sports for recreation or to stay in shape. Treatment involves a daily controller inhaler and quick-relief medication for asthma attacks. It also involves lifestyle changes.

Are you having breathing problems during exercise or physical activity? Make an appointment with your doctor for an asthma diagnosis or to develop a management plan. It’s important to have good asthma control to perform any physical activity.

Studies show regular exercise can help people with asthma. Exercise can:

• improve breathing;
• improve lung function;
• reduce stress and anxiety.

Here are some tips so that you can enjoy the benefits of physical activity and not be limited due to asthma:

• See an asthma specialist for a complete diagnosis. Work together to develop an Asthma Action Plan. This details what prevention steps to take before, during and after exercise. It can also explain what to do if symptoms worsen.
• If you have an asthma diagnosis and exercise is a trigger, your allergist may prescribe an inhaled corticosteroid to take daily. This will help calm inflamed airways. It can also help prevent asthma symptoms. People diagnosed with EIA may not need a daily controller medication.
• Use a prescribed quick-relief albuterol inhaler 15-30 minutes before exercise.
• Warm up 15-20 minutes before exercise. This can reduce the chances of tight airways during exercise.
• Use the quick-relief albuterol inhaler again if symptoms arise during or after exercise.
• Stay hydrated.
• Cool down after exercise. Walk or stretch for several minutes.
• If you exercise outdoors, check local air quality reports online. Air pollution may be an asthma trigger for runners, cyclists and other athletes.

Some recreational sports and activities are better than others for people with asthma. Sports that require short bursts of activity are less likely to trigger an asthma attack. These sports include:

• volleyball
• gymnastics
• baseball
• golf
• swimming
• walking or light jogging

Are asthma medications prohibited at the Olympics?

Before competing, Olympic athletes with asthma must make sure their medications are approved for use. If the medications are prohibited, the athlete must get a therapeutic-use exemption (TUE).

Tom Dolan was limited in what asthma medications he could take during the 1996 and 2000 Games. This was due to the doping regulations at the time. When new and better asthma drugs came on the market, he could not use them. Olympic governing bodies had to test them before they could be approved for athletes.

Dolan noted the process today is more efficient. “There is a much greater understanding now than when I swam as to what exactly inhalers do,” he says.

Here’s a look at certain asthma medications and whether they are approved for use in the Olympics.

Inhaled beta-2 agonists

Inhaled beta-2 agonists relax tight muscles in the airways. They provide relief of asthma symptoms.

The World Anti-Doping Agency (WADA) prohibits all inhaled beta-2 agonists except for four. These four inhaled beta-2 agonists are allowed by WADA under a specific dose amount:

• Inhaled albuterol or salbutamol: 1,600 micrograms over 24 hours in divided doses, not to exceed 600 micrograms over 8 hours.
• Inhaled formoterol: 54 micrograms over 24 hours.
• Inhaled salmeterol: 200 micrograms over 24 hours.
• Inhaled vilanterol: 25 micrograms over 24 hours.

Each of these medications treat asthma.

Studies have shown these drugs do not enhance performance in non-asthma athletes. “They just cause some jitters,” says board-certified allergist William Storms, MD. Dr. Storms has served as a consultant with the U.S. Olympic Committee (USOC).

Inhaled corticosteroids

Inhaled corticosteroids are used to control airway inflammation. These medications are allowed by WADA.

Glucocorticoids

Glucocorticoids are a class of corticosteroids. They are used to treat severe asthma flares.

Glucocorticoids are prohibited by WADA when given as a pill (orally) or by IV or injection. They are prohibited because they are deemed to enhance performance.

The asthma medication prednisone is an oral glucocorticoid. Taking it during the Olympics would require a TUE.

Inhaled glucocorticoids are permitted by WADA. But they must be used for their prescribed purpose. And they must be taken using the manufacturer’s dosage.