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KIN 424 - Medical Aspects of Sport > Module 2 - Respiratory Issues in Sport > Flashcards

Module 2 - Respiratory Issues in Sport Flashcards

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1
Q

What is the Definition of Asthma?

A
  • Common Chronic Inflammatory disease of the airway
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2
Q

What is Asthma characterized by?

A
  • Variable and Recurring Symptoms
  • Reversible Airflow Obstruction
  • Bronchospasm
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3
Q

What is the definition of Exercise-Induced Bronchoconstriction?

A
  • Intermittent narrowing of airways
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4
Q

What is Exercise-Induced Bronchoconstriction accompanied by?

A
  • Decrease in some measure of airflow
  • Wheezing
  • Chest Tightness
  • Coughing
  • Dyspnoea
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5
Q

What are the symptoms of Exercise-Induced Bronchoconstriction triggered by?

A
  • Exercise
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6
Q

How many Chronic Asthmatics experience Exercise-Induced Bronchoconstriction?

A
  • 50-90%
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7
Q

Can non-asthmatics have exercise-induced bronchoconstriction?

A
  • YES
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8
Q

What is Stridor Breathing?

A
  • 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
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9
Q

Describe Wheezing

A
  • High-pitched whistling sound made while breathing
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10
Q

What is the pathophysiology of Exercise-Induced Bronchoconstriction?

A
  • 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
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11
Q

What are the common signs and symptoms of Exercise-induced bronchoconstriction?

A
  • Wheeze
  • Cough
  • Dyspnoea
  • Chest Tightness
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12
Q

What are the less common signs and symptoms of Exercise-Induced Bronchoconstriction?

A
  • Heart Attack
  • Fatigue
  • Cramps
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13
Q

What performance-based signs are there for exercise-induced bronchoconstriction?

A
  • Poor performance for a given level of conditioning
  • Performance changes that are season/climate-related
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14
Q

How long can symptoms of Exercise-induced bronchoconstriction last following exercise?

A

30-90minutes the following exercise

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15
Q

How long can the refractory period last from exercise-induced bronchoconstriction?

A

1-3 hours

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16
Q

What happens during the refractory period for exercise-induced bronchoconstriction?

A
  • Continued exercise does not produce symptoms
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17
Q

What are the causes of aggravation for Exercise-Induced Bronchoconstrictions?

A
  • Cold Dry Air (Nordic Skiing)
  • Chlorine (pool sports)
  • Exhaust (ice Resurfacing Machines)
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18
Q

What is the Gold Standard test for Diagnosing EIB? Why is it not always used?

A

Field Test
- Can be impractical
- Lab Treadmill test can be insensitive

19
Q

What is a chemical challenge test best used for? what types?

A

Type
- Methacholine Challenge
Used for
- Chronic Asthma, not good for EIB

20
Q

What does EVH stand for?

A
  • Eucapnic Voluntary Hyperpnoea
21
Q

What is EVH testing? what is it used to diagnose?

A
  • 6 min at 85% MVV
  • Target is FEV 1.0 x 30 each minute
  • Mimics exercise hyperpnoea (airway cooling)
  • Used to diagnose EIB
22
Q

What non-pharmacologic treatments can be used to treat EIB?

A
  • Plan Activities for: low ventilatory rates; warm, humid environment
  • Low-to-moderate warm-up: use the refractory period; intensity increased in steps
23
Q

What is the Ideal Warm-up Protocol for EIB?

A

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

24
Q

What Pharmacological Treatment is Used for EIB?

A
  • Bronchodilators
  • Corticosteroids
  • Short-Acting B-agonist (salbutamol)
25
Q

What does the use of bronchodilators or corticosteroids do for individuals with EIB?

A
  • Stabilize chronic asthma
26
Q

When would you use Short-ACting B-agonists (salbutamol) for individuals with EIB?

A
  • 15 minutes prior to exercise
  • Can also be used as ‘rescue’ medication
27
Q

What is the Old WADA guideline on Beta-2 Agonist usage?

A
  • All beta-2 agonists, including D- and L- isomers are prohibited
  • Can be used with therapeutic use exemption
28
Q

What are the exceptions for Old WADA guidelines?

A
  • Formoterol, Salbutamol, Salmeterol, and Terbutaline
  • Only when administered by inhalation
  • Only if used to prevent/treat asthma and EIB
  • Requires abbreviated Therapeutic Use Exemption
29
Q

What is the limit for Salbutamol use under the Old WADA Guidelines?

A
  • ## 1000ng/ml, even with Therapeutic USe Exemption
30
Q

What are some other Anti-Asthmatics that are permitted for use?

A
  • Mast-cell stabilisers
  • Leukotriene Antagonists
  • Theophylline
  • Inhaled Corticosteroids
31
Q

What could be an alternative diagnosis if treatment for Exercise-Induced Bronchoconstriction fails?

A
  • Exercise Induced Laryngeal Obstruction
  • Pulmonary Embolism
32
Q

What results from Exercise-Induced Laryngeal Obstruction?

A
  • Vocal Cord Dysfunction
  • Paradoxical Vocal Cord Motion
  • Laryngeal Dyskinesis
  • Vocal Cord Adduction
  • Munchausen’s Stridor
33
Q

What is the pathophysiology of Exercise-Induced Laryngeal Obstruction?

A
  • Paradoxical Vocal Cord Adduction
  • Inspiratory Airflow Obstruction
34
Q

Who is affected by Exercise-Induced Laryngeal Obstruction?

A
  • Females are more Common (2:1)
  • Younger Patients more common
  • More common in high-performance athletes
35
Q

What are the symptoms and signs of Exercise-Induced Laryngeal Obstruction?

A
  • Throat Tightness
  • Stridor
  • Chest Tightness
  • Air Hunger
  • Coughing, Hoarseness
  • Variable Pattern, not easily repeatable
  • Often at very high intensity exercise
36
Q

How do you diagnose Exercise-Induced Laryngeal Obstruction?

A
  • Usually a clinical diagnosis
  • Often initially diagnosed as EIB: does not respond to EIB therapy
  • Spirometry when symptomatic
  • Laryngoscopy when symptomatic (gold standard)
37
Q

What is the treatment protocol for Exercise-Induced Laryngeal Obstruction?

A
  • 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
38
Q

What evidence supports the treatment for Exercise-induced laryngeal obstruction?

A

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

39
Q

What is a rare cause of exertional dyspnoea?

A
  • Pulmonary Embolism
40
Q

What is Paget von Schrotter Syndrome?

A
  • Axillary Vein Thrombosis
  • More common in athletes (throwers)
  • Can lead to Pulmonary Embolism
41
Q

What are the risk factors of Thromboembolsim in Athletes?

A
  • Use of Illicit Substances: Diuretics, EPO, Anabolic Steroids
  • Ritual Dehydration: Boxers, Lightweight Rowers
  • Effort-Induced THrobosis: Trauma to the vessel wall
42
Q

What are the Symptoms of Pulmonary Embolism in Athletes?

A
  • Pain, Swelling, numbness in distal limb
  • Chest pain, Dyspnoea
  • Poor exercise performance
  • Profound arterial desaturation during exercise
43
Q

What is the standard protocol for treatment when you suspect Exercise-Induced Bronchoconstriction?

A
  • 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

KIN 424 - Medical Aspects of Sport (11 decks)

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