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Management of Exercise Induced Asthma in XC-Skiing High Prevalence of Exercise Induced Asthma in Elite Swedish Cross Country Skiiers Surgical Face Masks for Cross Country Skiiers! Further Reading on Asthma. |
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Management of Exercise Induced Asthma in XC-Skiing
After a seven year break from racing and some serious work on managing this condition it is no longer such an obstacle, so I thought I'd share some of the strategies I use to manage my asthma and give the reasoning behind their effectiveness. One in 7 Skiers may suffer... Asthma is characterized by a wheeze, shortness of breath, a cough and chest tightness. However, not all these symptoms may be present, and in some athletes presenting with shortness of breath, the diagnosis may be missed. The prevalence of exercise-induced asthma (EIA) in the Australian population is thought to be 12%. Data from the 1996 summer Olympics stated that 14% of the USA team used anti-asthma medication. The prevalence in winter sports is likely to be much higher. Triggered by rapid drying of the upper airways... The most recognized theory on the cause of EIA is that increased ventilation rate leads to rapid drying of the upper airways and triggers bronchoconstriction. hence, the harder one breathes, and the colder and dryer the air, the risk of EIA increases. This combination of conditions is inherently part of cross country skiing. Asthmatics who exercise in 37 degrees temperature with 100 % humidity can almost completely block their EIA. Buteyko breathing method. It's all through the nose! Nose breathing can ameliorate the severity of EIA because inspired air is warmed by the blood vessels and tissues of the nose, and the air that hits the upper airways is warmer and more humidified. The Addition of a mask/balaclava further warms and moistens inhaled air. Another advantage of nose breathing is that air flow is more controlled than with mouth breathing which reduces the negative effect of rapid breathing on airway drying. Nose breathing in XC skiing is considered impossible given the amount of air that is required. However for the asthmatic, if nose breathing decreases symptoms, it far outweighs any possible advantage that mouth breathing may have. Nose breathing has been recently popularized by the Buteyko breathing technique. A respected randomized placebo controlled trial of Buteyko technique(4) has demonstrated its clinical effectiveness in reducing symptoms and inhaler use. The method teaches a series of exercises for breathing correctly, and enables a sense of breathing control to be developed. The breathing exercises are a useful tool for managing symptoms even whilst racing. Bronchoconstriction occurs 7 minutes into exercise, or at the end of exercise... In most cases, broncho-constriction does not occur during the first few minutes of exercise. With continued exercise respiratory flow rates begin to fall after 6 to 8 minutes. The greatest drop in flow rates is often seen in the first few minutes after the cessation of exercise. Asthmatics commonly show a 20 to 40% decrease in lung function . Normal range is less than a 10% decrease. Use your "Refractory period"! Most athletes with mild EIA recover spontaneously within minutes or soon after treatment with a bronchodilator (e.g. Ventolin). However more severe broncho-constriction may persist. Interestingly, in more that 50% of patients, after an episode of EIA there is a period where further exercise is followed by a smaller episode of bronchoconstriction, or no bronchoconstriction at all. This "refractory period" may persist for up to 4 hours following the initial episode. This can be applied in a warm up prior to races whereby a period of skiing intensely provokes EIA which is then treated, and allows for the refractory period to be utilized during the race. Another hypothesis which re-enforces the need for a thorough warm up (especially prior to intensity work) is that some asthmatics talk of being able to "run through their asthma", whilst others can not. The idea behind this is that with continued exercise the mediators that cause bronchoconstriction are "burnt up". Medication management is critical in EIA. Don't get discouraged! Rules related to AOC and IOC legislation on asthma medications are currently changing so check out what you are taking with the Australian Sports Drug Advisory (PH 1800020 506) and you doctor. The variable nature of EIA is well known . When in very similar weather conditions and exertion levels, asthma severity can vary. So don't get discouraged by a bad period. Re-assess medication usage, work on overall immune function (e.g. to eliminate possible underlying viral situation) and experiment with nose breathing, masks and a thorough warm up. Sensibly thinking through different approaches may go a long way to minimizing symptoms of asthma and enjoying this fantastic sport. References, Management of Exercise Induced Asthma in XC-Skiing:
Exercise Induced Asthma in Elite Swedish Cross Country SkiiersExercise induced asthma in elite Swedish Cross country Skiers is phenomenally high! 36% of Swedish elite cross country skiiers routinely used asthma medication. Similar studies from Norway indicate a much lower level of asthma: In the order of 14%(2) . The authors quoted speculate that:"Strenuous exercise at low temperatures entailing breathing large volumes of cold air is the most probable explanation of persistent asthma in skiers".Mid-Swedish winter daytime maximum temperatures may average -20 to-10 degrees centigrade. Norwegian day time temperatures may average 10 degrees warmer, and this may explain the difference in exercise induced asthma between the two groups of skiers.
Note 1: These measurements did not change between summer and winter. References, Exercise Induced Asthma in Elite Swedish Cross Country Skiers:
Surgical Face Masks!!!... When temperatures dip to well below 10 degrees centigrade, Skiers may wish to manage their exercise induced asthma by the use of surgical face masks. Further Reading on Exercise Induced Asthma relevant to Cross country Skiers...
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