Asthma rife among elite athletes, finds study

It’s not unknown for elite sports people to have asthma – Paula Radcliffe and Paul Scholes are among well-known British examples – but the good news for wheezy children wistfully dreaming of a sporting career is that research is increasingly uncovering just how many asthmatics there are in top-level sport.

In fact, tThe figures can seem astonishing. John Dickinson from Kent university, a world expert on asthma in sport, who has tested all 33 UK-based swimmers from the British Swimming squad found 70% have some form of asthma. A similar test on the cyclists from Team Sky revealed about a third are prone to a wheeze, against a national asthma rate of about 8% to 10%.

The picture is, inevitably, a bit more complicated. While a few have so-called classic asthma, the largely allergy-triggered constriction of the bronchial tubes that usually begins in childhood, Dickinson tests for what is known as exercise-induced asthma, or EIA.

The symptoms are similar – a contraction of the airways brings the feeling of a tight chest – but instead it is caused by rapid and heavy breathing during exertion. Atmospheric factors can exacerbate this. The chlorine environment in pools is believed to be part of the reason for the very high EIA levels for high-level swimmers, while cold air can also be a trigger, boosting numbers for road cyclists and the likes of cross-country skiers, with about half of the latter group having the condition.

Dickinson, head of the respiratory clinic at Kent’s School of Sport and Exercise Science, says he nonetheless views it as asthma: “It depends which respiratory consultant you talk to on whether you put these athletes on a spectrum of asthma, or whether you think that’s purely down to them exercising really hard in a certain environment, and if you take them out of that environment they’re fine. It’s a grey zone. But my argument is it’s a form of asthma.”

The test he uses involves athletes being asked to breathe a very dry air mixture for six minutes at high ventilation, with their lung function tested before and after. The asthma-induced fall can be dramatic, as high as 40%, Dickinson says: “Athletes with asthma can feel bad if perceiving their lung function has dropped. They get used to pushing themselves, get used to feeling out of breath and being able to control that.”

The phenomenon of EIA is not new, with some mass screening programmes beginning before the 2008 Beijing Olympics due to concerns about pollution. But tests like Dickinson’s are helping to uncover the scale of it, while revised anti-doping regulations are helping to treat the symptoms.

In the past, asthma medications had to be cleared with doping authorities, via medical certificates. Now, any athlete can use common bronchio-dilating inhalers like salbuthamol so long as they do not exceed a certain dose.From his work with cyclists, Dickinson says, surprising numbers carry inhalers in the back pockets of their jerseys: “Cognitively, the inhaler can give you the confidence to push yourself that little bit more. Sometimes a rider will know a climb is coming, so they take a couple of puffs.”

Jonathan Leeder, a physiologist with the English Institute of Sport, says many athletes see their symptoms disappear with medication: “However, when medication isn’t effective to alleviate wheezing or breathlessness during exercise, other strategies can be used, like inspiratory muscle training, breathing technique exercises and postural work.”

The corollary of athletes getting to grips with asthma is that asthmatic children are increasingly being encouraged to exercise. “We know that children with asthma are often excluded from sport, not by the school but by their parents,” said Deborah Waddell, lead clinical adviser for Asthma UK. “We advise people to take right type of exercise for them.”

Dickinson says that more generally, sport can greatly help asthmatics: “It allows you to get a lot more confident about controlling the way you breathe. The sensation of an obstruction you feel when you’re younger has dropped massively. A lot of the athletes who say they had it as a child but don’t anymore, when you do the test they still have a positive test.”

Karl Cooke, head of sports science medicine for British Swimming, says swimming is seen as particularly good: “Swimming can be really good as people have to learn a certain amount of breathing control. You need a certain rhythm that isn’t necessarily required in non-aquatic sports. So we have to be careful we also don’t scare people into thinking they’ll develop asthma because of swimming.”

Shock diagnosis

Aimee Willmott, British swimming champion in the 400m individual medley, was first tested for exercise-induced asthma after she went on a high-altitude training camp and found herself struggling for breath more than her team mates.

The test results were something of a shock: “It turned out I was well into being an asthmatic, but I’d just never been diagnosed. With the asthma I was losing 20% of my lung function. It was a shock, but also a relief – I knew what the reason was for getting so out of breath.” Willmott was placed on two different asthma inhalers, a regime now boosted to include an inhaled steroid. The treatment has notably helped her training, she after another recent bout of wheezing explains: “I’ve gone from not knowing why I was struggling for breath to finally getting the right treatment. It’s helped me a lot. I was waking up in the morning out of breath, and struggling for breath in the pool. Now, if I take my inhalers before training it helps me keep it under control.”

Her experience, she sayscan be seen as an example to younger sportspeople: “If you’re a child with asthma, but your inhaler regulates it, then it’s not too much of a hassle to do any sport.”