The chances are that every rowing club in the country has several members who have been diagnosed with asthma. Joanne Harris talks to Professor Luke Howard, consultant pulmonologist and lead clinician for the pulmonary hypertension service at Hammersmith Hospital, part of the Imperial College Healthcare NHS Trust, about how rowers with respiratory issues can manage their condition
Separately, Howard rowed for Oxford University Lightweight RC as a student before taking up the sport again in 2018. He now rows and sculls regularly out of Thames Tradesmen’s RC. On a clinical level, Howard has been involved with British Rowing since the London 2012 Olympic Games, advising on respiratory issues.
“Asthma’s the commonest respiratory disease, particularly in young people, so you’re definitely going to come across it,” says Professor Howard, who specialises in pulmonary hypertension, and has a particular interest in exercise, sports physiology and sports performance. He adds that studies suggest that approximately a quarter of endurance athletes may have the condition.
Not all wheeze is asthma
Nevertheless, he’s keen to stress that while asthma is an extremely common diagnosis among athletes, “not all wheeze is asthma”.
Exercise-induced laryngeal obstruction, for example, is also a common condition and can be misdiagnosed as asthma.
“This predominantly affects the younger athlete and much more commonly women or girls rather than men or boys,” Howard explains.
Athletes affected by exercise-induced laryngeal obstruction develop loud wheezy breathing known as ‘stridor’. This happens on breathing in and occurs at peak exercise. The stridor disappears quickly after the exercise ends. Drugs prescribed for asthma, such as salbutamol, will not work.
Another common asthma-like condition is breathing pattern disorder. This is when people develop chaotic breathing and symptoms of air hunger associated with stress and anxiety. This can layer on top of asthma, but is a separate condition. It might manifest during a situation such as an erg test.
“If you’ve got an asthma diagnosis and you’ve been given inhalers and they’re not working, seek an alternative diagnosis,” Howard advises.
A respiratory laboratory can carry out tests to confirm or refute a diagnosis of asthma, but generally asthma symptoms manifesting through intense exercise – coughing and wheezing – will go away after 15 to 20 minutes, and drugs will help prevent them or make them go away.
“Asthma can be present in various levels of severity,” Howard says. “The classic asthma that we see is people who have symptoms at rest during the daytime and particularly during the night-time. It can be cyclical, it’s highly variable by nature and there can be triggers that make it worse.”
These triggers include cold air, allergens, exercise and respiratory infections. If you are experiencing symptoms on a regular basis and outside the environment of exercise, it generally means that your asthma is not well-controlled.
“People who don’t have poorly controlled asthma may develop coughing and wheezing purely when they exercise. This tends to happen towards peak exercise and in particular, lingers on for many minutes after exercise stops. That’s a typical feature of asthma,” Howard says.
“In those cases, things like pre-treatment with a salbutamol inhaler prior to exercise, and possibly also some inhaled steroids, should help to get athletes through training and racing.”
Some individuals may have exercise-induced broncho constriction. This is a precursor to asthma and is worse in dry and cold conditions, meaning it is likely to be worse in winter.
“If you’re only ever getting symptoms post-exercise then you can manage it just by taking a salbutamol inhaler just before exercise,” Howard suggests. “But if this is quite a frequent occurrence and you’re having to use the inhaler on a daily basis, you might be better off with a low dose of inhaled steroid.”
Salbutamol – the ‘blue inhalers’ that many carry – should kick in within a few minutes. Their effect will last in an athletes’ system for some time. Wearing a face covering of some kind can also help warm the air entering the lungs.
“The critical thing is that if people are having to use too much of their blue inhaler they must escalate onto some form of inhaled steroid,” Howard warns.
Good practice for rowing clubs and coaches
Rowing clubs should make sure they know which of their athletes have asthma. They should also consider having spare inhalers in launch safety bags or in a coach’s pocket on the bank. Other crew members should also be aware so they can help teammates suffering with an asthma attack.
Asthma medication and anti-doping
Those worried about whether their steroid meets anti-doping requirements should not be concerned.
“The important thing is to make sure that you’re not just borrowing a mate’s blue inhaler because it makes you feel a bit better. If you’ve got a medically approved diagnosis of asthma and you’re receiving prescribed medication from your GP then you don’t have anything to worry about,” Howard says.
Ultimately, Professor Howard says, asthma should not prevent any rower from reaching their potential.
“With sensible measures in place you would like to think that athletes with asthma should be able to compete at and train at the same level as everyone else. You shouldn’t need to treat them with extra-special measures,” he concludes.
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