The 2008 Summer Olympics in Beijing began on Friday. I love the Olympics, always have, and you can bet I'll be watching and cheering on our American team. But, as a respiratory therapist, I'll be watching and listening especially to see how the athletes with asthma do with the unique challenges presented at this Olympics.
Athletes with asthma (I prefer to not use the term "asthmatic" athletes - just don't like the label) competing this month in Beijing face not only the challenge of competing against the best in the world, but the threat of significant air pollution, as well as making sure that their asthma medications are approved in light of anti-doping regulations.
There's a lot to consider here so I thought I'd break this article into four aspects of asthma and the Beijing Games.
What is EIB? Exercise Induced Bronchospasm (EIB) otherwise known as Exercise Induced Asthma
The prevalence of asthma in elite athletes, and what sports are more likely to be affected by asthma
Can they take their meds? Doping regulations and asthma medications
Is it really as bad as they say? Air quality in Beijing for the 2008 Olympics
Exercise Induced Asthma / or Exercise Induced Bronchospasm
Exercise induced bronchospasm (EIB) affects as many as one in every six Olympic athletes, according to the American Academy of Allergy, Asthma & Immunology (AAAAI).
EIB is caused by airways that are overly sensitive to sudden changes in temperature, cold, humidity, allergens and irritants. During strenuous activity, people tend to breathe a larger volume of air and take it in through their mouths, allowing more air to reach the lungs without passing through the filtering, humidifying, and warming effects of the nose.
People with EIB experience difficulty breathing within 5-20 minutes after exercising.
Prolonged or unexpected shortness of breath
Sports that require short bursts of energy, such as baseball, football, wrestling, golfing, gymnastics, and short-term track and field events are less likely to trigger EIB, as opposed to endurance sports such as distance running, cycling, and basketball.
Swimming has many benefits for those with EIB. The warm, humid atmosphere, toning of upper body muscles, and horizontal body position can help mobilize mucus. However, chemicals used in and around pools can be an irritant for the athlete with asthma.
Why are there so many elite athletes with asthma?
The prevalence of asthma in elite athletes is well documented, but perhaps not as remarkable as in that of a study done with the 1998 United States Winter Olympic team. In this study, researchers tested every athlete in seven sports - biathlon, cross-country skiing, figure skating, ice hockey, Nordic combined, long-track speed skating and short-track speed skating. It was found that nearly a quarter of the athletes (25 per cent), including half of the cross-country skiers (50 per cent), had asthma. In comparison, about 5 percent of the general population has asthma.
Asthma is prevalent in the summer sports as well, especially in swimmers (among them, Dara Torres ), distance runners, and cyclists who can be affected by air pollution, especially fine and ultra fine particles, and by the drying effect of breathing rapidly for long periods of time. Pollen can make symptoms even worse for those who are allergic to it, which includes the majority of athletes with asthma.
Competitors must prove before the games that they have asthma in order to be allowed to take medications banned by international sports federations. There is a lot of paperwork involved in doing so, and they must have everything in place before arriving in Beijing.
According to the New York Times article, Asthma Medications: Not a Clear Advantage, "Elite-level athletes with documented proof that they have asthma are allowed to take certain inhaled corticosteroids, which prevent inflammation of airway and can hold asthma symptoms at bay. And they are allowed to take other inhaled drugs, beta-2 agonists, which relax the smooth muscle cells of airways, relieving symptoms."
In order to be banned, a drug has to meet two of three criteria. Taking it must:
Enhance or potentially enhance performance
Place an athlete's health at risk
Violate the spirit of sport
In a person who does not have asthma, the drugs have no benefits, only the risk of side effects that can place an athlete's health at risk. An athlete taking substances in an attempt to gain a competitive advantage would then be violating the spirit of sport.
Beijing is one of the most polluted cities in the world, and in spite of a 120 billion yuan ($17.3 billion) clean-up over the last decade, air quality remains a big concern. Officials have pledged to cut the number of cars on the road during the August 8-24 Games. The Chinese government has said the air pollution will be reduced, but it also warned that the Olympics will be held during pollen season.
In a recent interview with Reuters, Greek Olympian Athanasia Tsoumeleka expressed concerns that the combination of pollution, humidity and heat will hamper performances at the Beijing games. Tsoumeleka, who won gold in Athens in the women's 20 km walk, said just competing in Beijing will be a daunting task and that performances across the board will be affected.
"I wish the event would be held somewhere else, to be honest," the 26-year-old Tsoumeleka told Reuters.
"As an athlete suffering from asthma I can feel the difference in air quality between Beijing and other less-polluted places. It eats up the athlete."
Two-time Olympic champion, Haile Gebrselassie, who has asthma, has already withdrawn from the men's marathon.
Asthma study to be conducted in Beijing
Many questions remain. Fortunately, a study will be conducted at these games that will hopefully provide answers and less concern and confusion in the future. Athletes from 10 European countries will take part in the research, announced on World Asthma Day by the Global Allergy and Asthma European Network. The study is likely to involve hundreds of athletes and will allow scientists to specify the prevalence of asthma, exercise-induced asthma and other allergic diseases among European athletes.
Participating countries are Britain, Denmark, Finland, Germany, Greece, Italy, Norway, Poland, Portugal and Spain. British asthma expert Peter Burney said the study would look at the effects of peak exertion as well as the polluted atmosphere in the Chinese capital, and look at the relationship between activity at the Olympics and previous health, and the outcome.
Just a few weeks from today we'll, no doubt, be on our way to getting answers to many of these concerns. For now, let's watch, cheer our teams on, and hope for not only victory, but good health and breath for every athlete.