Asthma is a clinical 'syndrome' that has a triad of symptoms - cough, wheezing, and shortness of breath. All need not be present.
The player usually presents with shortness of breath or 'poor conditioning.' The problem is that players don't come with a sticker on their forehead saying "asthma."
Shortness of breath has a broad differential diagnosis (range of possibilities) ranging from heart or lung disease, to anemia, kidney, or thyroid disease, nerve or muscle disease, or even psychological conditions (e.g. anxiety/"battle fatigue.")
But let's focus on exercise-induced asthma/exercise-induced bronchoconstriction (EIB).
How does it happen? Traditional teaching taught that loss of heat and moisture from airways caused airway narrowing, leading to shortness of breath. Observation showed that sports like outdoor running in the cold or ice skating were often strong triggers.
How frequent is it? A broad range of prevalence is reported... between 5 and 20%.
How is it diagnosed? The most common diagnostic test is a "bronchoprovocation" test via a breathing test (spirometry) before and after exercise. Treadmill or cycle exercise at adequate intensity for 6 to 8 minutes may produce a drop in FEV1 (air expired in one second) of 13 to 15 percent. There are other tests including inhalation of dry air or a medication (methacholine) in varied concentrations looking for a temporary drop in lung function.
Pitfalls? Physicians worry about confusing EIB with alternative causes of shortness of breath - especially myocarditis (heart inflammation), cardiomyopathy (heart muscles disease), congenital heart disease, and occasionally other types of lung disease (blood clots, pulmonary hypertension). During the COVID era, concerns about COVID-related myocarditis are especially relevant.
Some patients with long-COVID syndrome have chronic shortness of breath and/or cough for months. Jayson Tatum was a good example on the Celtics last season.
How can we treat it? Several types of approaches are used depending on whether a patient has isolated exercise-induced asthma or a combination of asthma with exercise triggers. Most EIB patients get short-acting bronchodilators (inhaled medication) taken 20-30 minutes before exercise and sometimes montelukast which is taken about 24 hours earlier. For patients with chronic asthma, many are on combination inhaler a long-acting bronchodilator with an aerosol steroid.
New horizons. There is limited evidence that specialized face masks may lessen drops in airflow with exercise during cold, dry conditions.
Practical concerns. Remind players to pack whatever "medical supplies" they require, such as contact lenses, inhalers, or other medications. That's part of learning professional habits.
Lagniappe. How does individual excellence mesh with team commitment?
I don't remember petty jealousies or parental hovering growing up playing sports. Have we changed that much or is memory just flawed?
Lagniappe 2. "Player and ball circulation"
