Module 2 - Respiratory Issues in Sport Flashcards
What is the Definition of Asthma?
- Common Chronic Inflammatory disease of the airway
What is Asthma characterized by?
- Variable and Recurring Symptoms
- Reversible Airflow Obstruction
- Bronchospasm
What is the definition of Exercise-Induced Bronchoconstriction?
- Intermittent narrowing of airways
What is Exercise-Induced Bronchoconstriction accompanied by?
- Decrease in some measure of airflow
- Wheezing
- Chest Tightness
- Coughing
- Dyspnoea
What are the symptoms of Exercise-Induced Bronchoconstriction triggered by?
- Exercise
How many Chronic Asthmatics experience Exercise-Induced Bronchoconstriction?
- 50-90%
Can non-asthmatics have exercise-induced bronchoconstriction?
- YES
What is Stridor Breathing?
- High pitched, turbulent sound that can happen during inhales or exhales
- Usually indicates an obstruction or narrowing in the upper airway, outside of chest cavity
Describe Wheezing
- High-pitched whistling sound made while breathing
What is the pathophysiology of Exercise-Induced Bronchoconstriction?
- Transient airway narrowing
- High Ventilatory rates, leads to evaporative water loss
- Cooling and osmolar changes in the airway
- Inflammatory cascade
- Smooth Muscle Contraction, airway oedema
What are the common signs and symptoms of Exercise-induced bronchoconstriction?
- Wheeze
- Cough
- Dyspnoea
- Chest Tightness
What are the less common signs and symptoms of Exercise-Induced Bronchoconstriction?
- Heart Attack
- Fatigue
- Cramps
What performance-based signs are there for exercise-induced bronchoconstriction?
- Poor performance for a given level of conditioning
- Performance changes that are season/climate-related
How long can symptoms of Exercise-induced bronchoconstriction last following exercise?
30-90minutes the following exercise
How long can the refractory period last from exercise-induced bronchoconstriction?
1-3 hours
What happens during the refractory period for exercise-induced bronchoconstriction?
- Continued exercise does not produce symptoms
What are the causes of aggravation for Exercise-Induced Bronchoconstrictions?
- Cold Dry Air (Nordic Skiing)
- Chlorine (pool sports)
- Exhaust (ice Resurfacing Machines)
What is the Gold Standard test for Diagnosing EIB? Why is it not always used?
Field Test
- Can be impractical
- Lab Treadmill test can be insensitive
What is a chemical challenge test best used for? what types?
Type
- Methacholine Challenge
Used for
- Chronic Asthma, not good for EIB
What does EVH stand for?
- Eucapnic Voluntary Hyperpnoea
What is EVH testing? what is it used to diagnose?
- 6 min at 85% MVV
- Target is FEV 1.0 x 30 each minute
- Mimics exercise hyperpnoea (airway cooling)
- Used to diagnose EIB
What non-pharmacologic treatments can be used to treat EIB?
- Plan Activities for: low ventilatory rates; warm, humid environment
- Low-to-moderate warm-up: use the refractory period; intensity increased in steps
What is the Ideal Warm-up Protocol for EIB?
20-30 minutes
- 2-5min mod-high intensity bouts
- 80-90% maximal intensity
- Equivalent rest period of 4-6 repetitions
- Minimize impact of EIB during subsequent exercise
What Pharmacological Treatment is Used for EIB?
- Bronchodilators
- Corticosteroids
- Short-Acting B-agonist (salbutamol)
What does the use of bronchodilators or corticosteroids do for individuals with EIB?
- Stabilize chronic asthma
When would you use Short-ACting B-agonists (salbutamol) for individuals with EIB?
- 15 minutes prior to exercise
- Can also be used as ‘rescue’ medication
What is the Old WADA guideline on Beta-2 Agonist usage?
- All beta-2 agonists, including D- and L- isomers are prohibited
- Can be used with therapeutic use exemption
What are the exceptions for Old WADA guidelines?
- Formoterol, Salbutamol, Salmeterol, and Terbutaline
- Only when administered by inhalation
- Only if used to prevent/treat asthma and EIB
- Requires abbreviated Therapeutic Use Exemption
What is the limit for Salbutamol use under the Old WADA Guidelines?
- ## 1000ng/ml, even with Therapeutic USe Exemption
What are some other Anti-Asthmatics that are permitted for use?
- Mast-cell stabilisers
- Leukotriene Antagonists
- Theophylline
- Inhaled Corticosteroids
What could be an alternative diagnosis if treatment for Exercise-Induced Bronchoconstriction fails?
- Exercise Induced Laryngeal Obstruction
- Pulmonary Embolism
What results from Exercise-Induced Laryngeal Obstruction?
- Vocal Cord Dysfunction
- Paradoxical Vocal Cord Motion
- Laryngeal Dyskinesis
- Vocal Cord Adduction
- Munchausen’s Stridor
What is the pathophysiology of Exercise-Induced Laryngeal Obstruction?
- Paradoxical Vocal Cord Adduction
- Inspiratory Airflow Obstruction
Who is affected by Exercise-Induced Laryngeal Obstruction?
- Females are more Common (2:1)
- Younger Patients more common
- More common in high-performance athletes
What are the symptoms and signs of Exercise-Induced Laryngeal Obstruction?
- Throat Tightness
- Stridor
- Chest Tightness
- Air Hunger
- Coughing, Hoarseness
- Variable Pattern, not easily repeatable
- Often at very high intensity exercise
How do you diagnose Exercise-Induced Laryngeal Obstruction?
- Usually a clinical diagnosis
- Often initially diagnosed as EIB: does not respond to EIB therapy
- Spirometry when symptomatic
- Laryngoscopy when symptomatic (gold standard)
What is the treatment protocol for Exercise-Induced Laryngeal Obstruction?
- Education
- Treatment of aggravating factors: GERD (gastro-esophageal reflux disease; post-nasal drip)
- Vocal Cord Resynchronisation: cough, pant; abdominal breathing
- Postural Techniques: jut out jaw; shoulders back
- Stress management
What evidence supports the treatment for Exercise-induced laryngeal obstruction?
Uncontrolled Case Series
- Ipratropium prior to exercise prevented 6/7 patients from EI PVCM
Individual Case
- Resolved PVCM after 5 weeks of 5day/week inspiratory muscle training
What is a rare cause of exertional dyspnoea?
- Pulmonary Embolism
What is Paget von Schrotter Syndrome?
- Axillary Vein Thrombosis
- More common in athletes (throwers)
- Can lead to Pulmonary Embolism
What are the risk factors of Thromboembolsim in Athletes?
- Use of Illicit Substances: Diuretics, EPO, Anabolic Steroids
- Ritual Dehydration: Boxers, Lightweight Rowers
- Effort-Induced THrobosis: Trauma to the vessel wall
What are the Symptoms of Pulmonary Embolism in Athletes?
- Pain, Swelling, numbness in distal limb
- Chest pain, Dyspnoea
- Poor exercise performance
- Profound arterial desaturation during exercise
What is the standard protocol for treatment when you suspect Exercise-Induced Bronchoconstriction?
- stabilize Chronic Asthma
- warm-up, activity modification
- B-agonist 15’ prior to exercise
- Consider Exercise-induced laryngeal obstruction if stridor or EIB therapy failure
- Consider the rare but serious pulmonary embolism
