"I'm a basketball coach, not a doctor." Regardless, we usually have at least one player on our team with asthma. This article is not designed to be comprehensive but a primer on asthma for coaches. Medical staff have the final decision about fitness to play.
Asthma is a syndrome, a condition of unknown origin, of airway hyperresponsiveness (irritability) that produces some combination of cough, shortness of breath, and wheezing.
Genetics, development (frequent respiratory infections in childhood), allergy, sinus disease, poor air quality, acid reflux (heartburn), occupational exposures (e.g. isocyanates), exercise, and other factors can contribute the clinical findings.
Asthma is not a "one size fits all condition."
I tell patients that asthma management is a partnership between them and their health care provider. Like diabetes, you have a choice - "you take care of your asthma or your asthma will take care of you."
Some people have simple asthma, where they seldom have symptoms, less than a few times a week. Avoiding triggers and as needed (p.r.n.) inhaler use can work well and they have no limitations. These players won't present much of a problem. For the coach, neither will patients with severe asthma, as they usually won't be participating in high aerobic demand sports.
It goes without saying that smoking or vaping don't work with asthma or any underlying conditions.
Triggers include allergens (dust, pollen, animal dander, mold), fumes, respiratory infections (e.g. the common cold), exercise, and rarely psychological factors.
Although much of the pathophysiology of asthma relates to limitation of airflow expiration, this results in faster breathing (tachypnea) and respiratory muscle fatigue. With dynamic hyperinflation (lung overinflation), patients also breathe less efficiency as the breathing muscles suffer with suboptimal length. (Take a deeper breath, then only breathe in and out from there. That's the feeling a patient with overinflated lungs has.)
With exercise-induced asthma, loss of heat and moisture from the airways results in symptoms, most commonly shortness of breath and wheezing. Outdoor running in cooler climates and ice skating can be especially problematic, while swimming can be less of a problem. There is often a "warmup phenomenon" where release of preformed airway chemicals is a trigger, so that warming up reduces the symptoms.
"All that wheezes is not asthma." Most coaches obviously aren't doctors, aren't respiratory specialists, and aren't trained and published in exercise physiology. If players aren't doing well on their treatment, they need evaluation by their physicians or a respiratory specialist. It's not the coach's job to make medical diagnoses, but to recognize when players are struggling. Treating heart problems, anemia, sarcoidosis, kidney disease, and other conditions with inhalers predictably won't work.
Many patients don't use inhalers properly. Spacers and breath-activated inhalers can limit this problem. It's also NOT television; inhalers don't work in ten seconds. For exercise-induced asthma, I usually recommend the athlete use the inhaler at least twenty minutes before exercise.
All medications have side effects. Inhalers cause faster heart rate (tachycardia), tremor, and sometimes anxiety and insomnia.
What's a coach to do?
- Get the most from our players.
- Get our players in condition to play harder and longer than our opponents.
- Communicate with players to know they're ready to go.
- Remind them to "pre-pack" their gear including whatever medical supplies they require for prevention or treatment of their asthma. Practically, I've seen players use each other's inhaler when someone forgets.
- The player is responsible for knowing what allergies she has. Our program asks players for allergy lists, especially food allergies.
- If a player is struggling medically, sit her and get medical authorization before return to play.