Athletes With Asthma: There’s No Stopping Them At the Olympics

By P.K. Daniel

When athletes compete in the Olympic Games, more than a few will reach for their inhaler to deal with asthma symptoms.

Asthma is the most common chronic condition among Olympic athletes. A study of the five Summer and Winter Olympic Games between 2002 and 2010 found approximately 8% of Olympians had asthma.

No one knows for sure why some elite athletes develop asthma and exercise-induced asthma (EIA – also called EIB, or exercise-induced bronchospasm). Some medical experts say it could be related to intense training in endurance sports and the very high airflow rates they generate.

Studies show a high percentage of athletes with asthma who compete in sports like long-distance running, cycling and swimming.

Many athletes with asthma list exercise as their top symptom trigger. Elite-level training can worsen an underlying condition like asthma, says Tod Olin, MD, director of the Pediatric Exercise Tolerance Center at National Jewish Health in Denver.

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

Swimmers had the highest prevalence of asthma compared to other water sports, according to a study in The Journal of Allergy and Clinical Immunology. The study cited the level of endurance swimming required and the presence of chlorine as factors.

Two-time Olympic swimming champion and former world-record holder Tom Dolan was diagnosed with allergic and exercise-induced asthma when he was 12 years old. Dolan won golds in the 400-meter individual medley in Atlanta in 1996 and again in Sydney in 2000.

Dolan, who runs a swim school in Sterling, Virginia, says one of the biggest asthma triggers for him, especially with indoor pools, is chlorine. “The first 5 to 7 inches off the surface of the water is where chloramines sit and that’s what you breathe in. For asthmatics, that’s a challenge,” he says.

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, Dr. Olin says.

• See a board-certified allergist or pulmonologist for a complete diagnosis. Work together to develop an Asthma Action Plan that can detail steps to take before, during and after exercise and what to do if symptoms worsen.
• If you are diagnosed with asthma and exercise is a trigger, your allergist may prescribe an inhaled corticosteroid to take daily. This will help calm inflamed airways and prevent asthma symptoms. Those diagnosed with EIA may not need a daily controller medication.
• Use a prescribed quick-relief albuterol inhaler 15-30 minutes before exercise and if symptoms arise during or after exercise.
• Warm up 15-20 minutes before competition or exercise. This can reduce the chances of airway constriction during exercise.
• Stay hydrated.
• Cool down after exercise by slowly walking and stretching 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.

Studies show regular exercise can actually help people with asthma improve breathing. It can also reduce stress and anxiety that can trigger flares.

Some sports are better than others for people with asthma. Sports that require short bursts of activity are less likely to trigger asthma. These sports include volleyball, gymnastics, baseball, golf and track and field.

Swimming is also a good exercise option for athletes with asthma. Swimming is in a warm, moist environment that won’t dry airways. Those affected by chlorine while swimming in pools should see an allergist for a treatment plan.

Can asthma give athletes an advantage in competition?

In the 2008 Beijing Games, 17 percent of cyclists and 19 percent of swimmers had asthma. They captured 29 and 33 percent of the medals in those sports, respectively.

When elite athletes with asthma appear to perform better than athletes without asthma, it is sometimes referred to as the “asthma advantage.”

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

As a result, these athletes – who typically train intensely for long periods of time – are able to compete at their highest level.

What is not known is how these athletes perform at a higher level than their non-asthmatic counterparts.

Are asthma medications prohibited at the Olympics?

In order for Olympic athletes with asthma to manage their condition during and out of competition, they first have to make sure their medications are approved. If the medications are prohibited, they are required to get what is known as a “TUE” – a therapeutic-use exemption.

Former U.S. Olympic swimmer Tom Dolan was limited in what asthma medications he could take due to the doping regulations during the 1996 and 2000 Games. When new and better asthma drugs came on the market, he wasn’t able to take advantage of them because the 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 Olympic competition:

Inhaled beta2 agonists

In 2002, all inhaled beta2 agonists – including albuterol – were prohibited by the World Anti-Doping Agency (WADA). There were concerns athletes were misusing them, says Kenneth Fitch, MD, a sports medicine expert at The University of Western Australia and a member of the International Olympic Committee (IOC) Medical Commission from 1985 to 2012. Albuterol is a short-acting bronchodilator used for quick-relief treatment of asthma symptoms.

In 2010, WADA reversed course and took albuterol off the prohibited list. Two years later, long-acting bronchodilators formoterol and salmeterol, which are used to prevent asthma symptoms, were taken off the prohibited list. All three are now allowed up to certain maximum doses.

“A number of studies have shown these drugs do not cause enhanced performance in non-asthmatic athletes,” says Denver allergist William Storms, MD, a member of the United States Olympic Committee (USOC) Sports Medicine Advisory Committee. “They just cause some jitters.”

Oral glucocorticoids

Oral glucocorticoids, a class of corticosteroids used to treat severe asthma flares, are prohibited because they are deemed to enhance performance. The asthma medication prednisone, for example, is an oral glucocorticoid and would require a TUE for Olympic competition.

Inhaled corticosteroids used to control inflammation, such as fluticasone, are not prohibited.