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Asthma

Asthma . Pharmacological Management In the Athletic Setting. Exercise Induced Asthma (EIA). Transient bronchospasm resulting from vigorous physical activity EIA affects 10-15% of population 70-90% of asthmatics have EIA 40-50% of people with allergies have EIA

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Asthma

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  1. Asthma Pharmacological Management In the Athletic Setting

  2. Exercise Induced Asthma (EIA) • Transient bronchospasm resulting from vigorous physical activity • EIA affects 10-15% of population • 70-90% of asthmatics have EIA • 40-50% of people with allergies have EIA • 16-18% of Olympic Athletes have EIA

  3. Clinical Symptoms • EIA occurs after strenuous exercise near 80% maximum capacity for > 6 minutes • Can also occur 4-8 hrs after exercise • Repetitive attacks can cause  severity by strengthening bronchial muscle • Common symptoms • Shortness of breath • Coughing • Chest tightness • Wheezing

  4. Pulmonary Function • 15-20% fall of forced expiratory volume (FEV1) • > 10% fall of peak expiratory flow rate (PEFR) • Bronchospasm is greatest 3-15 minutes post exercise • Severity: mild, moderate, severe

  5. Influencing Factors Type of exercise Duration of exercise Intensity of exercise Environmental conditions Pulmonary disease Dietary salt

  6. Type of Exercise • Activities that cause EIA • Running • Cycling • X-country skiing • Activities less likely to cause EIA • Swimming • Dancing • Gymnastics • Rowing

  7. Duration / Intensity of Exercise • Occurs after 5-8 minutes of vigorous exercise • Exercise for longer periods does not increase the chance of bronchospasm • Strenuous defined a >80% maximal heart rate

  8. Environmental Conditions • Increased with cold, dry air, pollution, allergens • Decreased with warm / humid air

  9. Other Factors • Pre-existing conditions such as asthma, bronchitis, emphysema • Dietary salt • High intake increases symptoms, occurrence • Lower intake decreases symptoms, occurrence

  10. Current Theories • Increased ventilation results in water loss from bronchial tree • This results in increased osmolarity of epithelial fluid that causes inflammatory mechanisms (mast cell degranulation) • Inflammatory mediators are released when exposed to allergens • Mouth breathing cools the airways and causes bronchial vascular bed dilation

  11. Diagnosis • Refer for testing in clinical situation • Must abstain from medications before testing • Beta agonists – 6 hrs. • Leukotriene inhibitors, oral meds. • Have medications to treat bronchospasm after testing

  12. Nonpharmacological Rx • Conditioning • Warm up that includes strenuous bouts • Diet (salt intake, 30 mg. lycopene) • Run through • Avoid hyperventilation • Nasal breathing • Cover mouth in cold weather • Avoid strenuous exercise when allergens are high • Choose indoor sports during winter

  13. Pharmacological Treatment Beta agonists Cromolyn sodium & nedocromil Leukotriene inhibitors Theophylline Steroids Ipratropium Bromide Ca++ channel blockers

  14. Beta 2 Agonists • Taken 15 minutes prior to exercise • Relax smooth bronchial muscle • If more than 1/month is needed – other medications needed for better control • Side effects: tachycardia, tremors, headache • Inhaled forms more popular • Prohibited by IOC without documented tests, Hx. of use

  15. Albuterol / Salbutamol / Terbutaline • Commonly prescribed • Short acting • Long duration • Salmeterol • Long acting, helps with latent phase EIA • Commonly used with anti-inflammatories • Metaproterenol • Moderate duration

  16. Cromolyn sodium / Nedocromil • Better used as preventative if know exposure to allergens • Inhibits response to cold, dry air • Works in synergy with beta 2 agonists • Safe • Side effects : bad taste or smell

  17. Leukotriene Inhibitors • Long control medications • Approved for use after 11 yrs. Old • Convenience of pill vs. inhaler • Zafirlukast (Accolate) • Zileuton (Singulair)

  18. Theophylline • Dilate bronchial smooth muscle • Increases diaphragm contractility • Anti-inflammatory effects • Long term control • May help with nocturnal symptoms

  19. Ipratropium Bromide • Anticholergenic • Causes bronchodilation • Effective for quick relief of symptoms • Not effective if underlying allergies, asthma • Atrovent

  20. Steroids • Long term medications • Taken to control persistent asthma, not EIA • Inhaled used 1st - spacer makes delivery more effective • Advair

  21. Oral medications are reserved for severe cases of asthma that don’t respond to other therapy • Long term use can suppress cortisol production

  22. Banned Substances • Check list frequently as it changes with new medications • Generally • Beta 2 agonists need documentation of testing, hx. of use for IOC, not for NCAA • Clenbuterol is banned

  23. Asthma

  24. Asthma • Etiology • Caused by viral respiratory tract infection, emotional upset, changes in barometric pressure or temperature, exercise, inhalation of noxious odor or exposure to specific allergen • Sign and Symptoms • Spasm of smooth bronchial musculature, edema, inflammation of mucus membrane • Difficulty breathing, may cause hyperventilation resulting in dizziness, coughing, wheezing, shortness of breath and fatigue

  25. Asthma - Characteristics • Disease of the respiratory system • Due to: • spasm of bronchial smooth muscles, inflammation of bronchial wall, increase mucous secretion • Stimuli - allergies, colds, viral infections, smoking, psych. stress, exercise • Is not a progressive disease

  26. Signs & Symptoms of Asthma Attack • tight chest • wheezing • coughing • rapid, shallow breathing • anxiety • tachycardia • pale color • lack of endurance

  27. Exercise Induced Asthma • Onset of S/S w/in 30 min. post exercise • Prevention of symptoms • know environmental conditions • warm-up gradually & cool down • use a bronchodilator

  28. Exercise Induced Asthma • 15% decrease in peak expiratory rate is diagnostic • 10-20% of general population, 90% with asthma • Episode usually occurs after 5-10 minutes • May be caused by water and heat loss from airways from mouth breathing and increased respiration rate • Also consider: • Type of exercise • Environmental factors • Preexisting inflammation • Intensity of exercise

  29. Treatment for Asthma Attack • Calm the patient • Controlled breathing • Drink water • Medications • Bronchodilators • Corticosteroids • Leukotriene Receptor Antagonists

  30. Refractory Period • Occurs after an asthmatic episode • Time during which additional exercise doesn’t cause bronchospasm • Lasts 1-4 hours • In some individuals a refractory period can be induced with light exercise and no episode • (ex) run 10 submaximal 100 yard sprints 30 minutes before competition

  31. Preventive Measures • Avoid cold, dry polluted air • Increase nose breathing • Change sports • Decrease intensity • Regular exercise, appropriate warm-up and cool down, w/ intensity graduated • Exercise in warm, humid environment • Exercise during refractory period

  32. Monitoring Asthma • Peak expiratory flow rate can be measured with a hand-held peak flow meter to allow self monitoring • Take before and after bronchiodilator therapy to check effectiveness of Rx • ATC may consider keeping one in kit with disposable mouth pieces

  33. Medications • 5-10% of asthma symptoms are worsened by NSAIDS • Controller medications • To prevent Sx • (ex) Long acting beta agonist – Salmeterol • Reliever medications • 2-4 puffs just before exposure or as Sx present • (ex) Short acting agonist – Albuterol • Cause dilation of smooth muscles around lung and inhibits release of chemicals that cause inflammation • Usually inhaled, but also oral • (ex) Mast cell stabilizers • Prevent release of contents of mast cells –therefore prevent inflammation and brochoconstriction

  34. Medications - Bronchodilators • Stimulate Beta2 receptors - causes dilation of bronchials • Decrease smooth muscle spasm • For an acute asthma attack **Long term / excessive use causes hyper- responsiveness

  35. Bronchodilators - Examples • Administration - Inhalation • (Albuterol) Proventil • (Piributerol) MaxAir • (Salmeterol) Serevent • (Epinephrine) Primatene Mist • (Theophylline) TheoDur, SlowBid • decrease release of prostaglandins • Side effects - nausea, mental confusion, irritability, restlessness

  36. Medications - Corticosteroids • Use prophylactically before asthma attack to decrease release of prostaglandins, decrease responsiveness of smooth muscles in airways • Has no effect on an acute attack

  37. Corticosteroids - Examples • Administration - Inhalation, Ingestion • (Dexamethasone) Decadron • (Cromolyn) Intal, NasalCrom • Azmacort • Tilade • Vanceril • Flonase – allergy corticosteroid

  38. Medications - Leukotriene Receptor Antagonists • Prevents spasm and swelling within the bronchial smooth muscles • Leukotrienes cause constriction of airways & promote mucous secretions • Examples • Singulair • Accolate

  39. Role of the ATC • Recognize decreased performance caused by EIA • Measure peak flows and refer if indicated • Monitor efficacy of Rx by tracking Sx and tracking peak flows • Educate on proper inhaler use

  40. Proper use of an inhaler

  41. Diabetes

  42. What is diabetes? • A disease which involves the production or function of insulin • Normal blood sugar level = 80-90mg/100 ml blood

  43. Diabetes - Types • Type II, Non-Insulin Dependent, Adult Onset • 90% of all cases • Predisposing factor – obesity, heredity • Pancreas still produces insulin • Symptoms usually controlled by diet & exercise • Oral Antidiabetic Drugs - stimulates pancreas to produce insulin • Amaryl Glimepiride • Glucophage • Avandia

  44. Diabetes - Types • Type I, Insulin Dependent, Juvenile Onset • Onset before age 30 • Pancreas does not produce insulin • Must take insulin - type & dosage determined by severity & Dr. • Administration • Injection • Implant pumps

  45. Effects of exercise on diabetes • Decreases need for insulin

  46. Associated Conditions • Diabetic Coma • blood sugar elevated • develops over days • S/S - thirst, difficulty breathing, nausea, vomiting, mental confusion, loss of consciousness Ketoacidosis • Rx. - call 911, insulin

  47. Associated Conditions • Insulin Shock (Hypoglycemia) • blood sugar level too low • develops rapidly • S/S - physical weakness, moist pale skin, headache, tachycardia, fatigue, hunger, anxiety • Rx. - eat sugar, candy, fruit juice, crackers, • Prevention - eat before practice

  48. Diabetes Mellitus • 1997 report by The Expert Committee on Diagnostic and Classification of Diabetes Mellitus • Defined diabetes, “a group of metabolic disorders characterized by hyperglycemia resulting from insulin secretion, insulin action or both and is associated with damage and failure of various organs, especially the eyes, kidney, nerves, heart, and blood vessels.”

  49. Glucagon vs Insulin

  50. Criteria for Diabetes • 2 fasting blood glucose levels > 126mg/dL or • 2 random draws > 200mg/dL • Normal blood glucose level varies between 80-120mg/dL

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