- High-pitched whistling sound made while breathing

Module 2 - Respiratory Issues in Sport Flashcards by Daniel Munn

What is the Definition of Asthma?

Common Chronic Inflammatory disease of the airway

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What is Asthma characterized by?

Variable and Recurring Symptoms
Reversible Airflow Obstruction
Bronchospasm

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What is the definition of Exercise-Induced Bronchoconstriction?

Intermittent narrowing of airways

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What is Exercise-Induced Bronchoconstriction accompanied by?

Decrease in some measure of airflow
Wheezing
Chest Tightness
Coughing
Dyspnoea

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

Exercise

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How many Chronic Asthmatics experience Exercise-Induced Bronchoconstriction?

50-90%

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Can non-asthmatics have exercise-induced bronchoconstriction?

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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

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Describe Wheezing

High-pitched whistling sound made while breathing

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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

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

Wheeze
Cough
Dyspnoea
Chest Tightness

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

Heart Attack
Fatigue
Cramps

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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

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

30-90minutes the following exercise

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

1-3 hours

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

Continued exercise does not produce symptoms

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

Cold Dry Air (Nordic Skiing)
Chlorine (pool sports)
Exhaust (ice Resurfacing Machines)

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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