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Help! My son can't breath during his wrestling matches
My son was diagnosed with exercise-induced asthma about a year ago. The only time he experiences problems is when he wrestles. He is 10 years old and has been wrestling since he was 5. This has been devastating to him, as he has always been a very successful wrestler, and practices 3-4 times a week. He is able to wrestle for most of the 1 1/2 min first period, but by the end of that time he is gasping for air and putting his hands over his head to try to get a breath. The coach constantly has to stop the match for medical time so he can try to breath. He is now unable to compete against other top wrestlers in his weight class ( competitors that he has successfully beat in the past), because he can't breath during his match. I can't begin to tell you how frustrated he feels and how crushed he is when he can't use the skills he has worked so hard to learn simply because he can't breath. We are currently using an albuterol inhaler 15 min before his matches, also a Flovent inhaler twice a day, and have recently started taking singulair. Thus far these have not worked. Please help with any suggestions you may have...we are desperate to help our son succeed in the sport he loves.
ok some people here are a bit confused about astham medications.
the drug you are referring to (albuterol) is a beta 2 agonist (short acting). it is NOT a last resort by any stretch of the imagination. indeed, it is first line in any asthmatic symptoms. its action is to relax the smooth muscle walls of the airways allowing air entry and this is manifeted as a reduction in wheeze. the medication can be taken back to back quite safely, but when this point is reached we need to move up the ladder.
the ladder i speak of is an evidence based guide to the escalation of asthma treatments.
in general everyday use, step 1 is short acting beta 2 agonist such as you are taking now. once this is not able to control the asthma, we add in a regular long acting beta 2 agonist such as salmeterol and you continue to use the short acting as and when needed. is this fails, the next step is to add in regular steroid such as beclomethasone. once this fails , we replace the inhaled steroid for oral regular steroids. there are also leukotrience receptor antagonists and mast cell stabilisers.
in an acute setting, the approach is different. we use nebulisers of salbutamol, bedesonide (a steroid) and ipratropium (anti cholinergic). we can also administer inhaled adrenaline should the need arise. in these emergency sitations we can administer IV drugs such as antihistamines, steroids, aminophylline and magnesium. if all that fails, we move onto intubation and ventilation.
in exercise induced asthma, although the aetiology is slightly different is responds to the same medications. many patients will take short acting beta 2 agonists half an hour or so before attacks, and may also take a dose of steroid.
because EIA exhibits a particular characteristic called refractory period, it is possible to be active before the main physical event, have the asthma symptoms, then when they settle there will typically be one hour where the patient will not experience the symptoms. similarly, one can use increasing intensities of a warm up to harbour this refractory period. if you wish to look into this further a simple internet search should yeild answers.
i hope this helps
billy
junior doc
the drug you are referring to (albuterol) is a beta 2 agonist (short acting). it is NOT a last resort by any stretch of the imagination. indeed, it is first line in any asthmatic symptoms. its action is to relax the smooth muscle walls of the airways allowing air entry and this is manifeted as a reduction in wheeze. the medication can be taken back to back quite safely, but when this point is reached we need to move up the ladder.
the ladder i speak of is an evidence based guide to the escalation of asthma treatments.
in general everyday use, step 1 is short acting beta 2 agonist such as you are taking now. once this is not able to control the asthma, we add in a regular long acting beta 2 agonist such as salmeterol and you continue to use the short acting as and when needed. is this fails, the next step is to add in regular steroid such as beclomethasone. once this fails , we replace the inhaled steroid for oral regular steroids. there are also leukotrience receptor antagonists and mast cell stabilisers.
in an acute setting, the approach is different. we use nebulisers of salbutamol, bedesonide (a steroid) and ipratropium (anti cholinergic). we can also administer inhaled adrenaline should the need arise. in these emergency sitations we can administer IV drugs such as antihistamines, steroids, aminophylline and magnesium. if all that fails, we move onto intubation and ventilation.
in exercise induced asthma, although the aetiology is slightly different is responds to the same medications. many patients will take short acting beta 2 agonists half an hour or so before attacks, and may also take a dose of steroid.
because EIA exhibits a particular characteristic called refractory period, it is possible to be active before the main physical event, have the asthma symptoms, then when they settle there will typically be one hour where the patient will not experience the symptoms. similarly, one can use increasing intensities of a warm up to harbour this refractory period. if you wish to look into this further a simple internet search should yeild answers.
i hope this helps
billy
junior doc
There's a difference between "exercise induced asthma" (EIA) and asthma. I know, I'm a college wrestler and I have both. And yes, I was prescribed albuterol as a prevention medicine before every practice and every match.
If you read the prescribing info for albuterol, you'll see very clearly that it is both a rescue medicine AND a preventative treatment for EIA. If I'm having a regular asthma attack and my albuterol doesn't stop it, I know to immediately seek help. If I take albuterol and still struggle through a workout, I know that it's only being caused by the exercise, so I don't panic. I just take it easy and breathe deeply. EIA is different. Check with your doctor. And look it up.
I think he can still wrestle if he's on the right meds. Asthma can be controlled. Some of the best wrestlers have bad asthma, including former Olympians. We just need to know our limits, when to push and when to take it easy.
I take exception to the idea that you should hold back. Albuterol isn't doesn't go into a "reserve." It's not "last ditch" for EIA -- it is a primary preventer, which it isn't for other types of asthma. Again, check with your doctor instead of well-intentioned people on the internet.
If you read the prescribing info for albuterol, you'll see very clearly that it is both a rescue medicine AND a preventative treatment for EIA. If I'm having a regular asthma attack and my albuterol doesn't stop it, I know to immediately seek help. If I take albuterol and still struggle through a workout, I know that it's only being caused by the exercise, so I don't panic. I just take it easy and breathe deeply. EIA is different. Check with your doctor. And look it up.
I think he can still wrestle if he's on the right meds. Asthma can be controlled. Some of the best wrestlers have bad asthma, including former Olympians. We just need to know our limits, when to push and when to take it easy.
I take exception to the idea that you should hold back. Albuterol isn't doesn't go into a "reserve." It's not "last ditch" for EIA -- it is a primary preventer, which it isn't for other types of asthma. Again, check with your doctor instead of well-intentioned people on the internet.
I gave a lot of thought before posting again, because I am sure you are the greastest mom and would never want to endanger your children. This post IS NOT a criticism, or an attempt to make you feel badly. Albuterol is a "last ditch" emergency medication. When you reach for the albuterol you are "reaching for lung reserve". Once that albuterol is ingested, the lung has no more reserve. Thus, when an asthmatic attack is precipatated after the albuterol, you are in a 911 situation and the time between an attack and death from respiratory arrest and death can sometimes be measured in minutes. "More albuterol" won't work. Your son will need intravenous medications and likly endotracheal intubation. There are alternative medications that still alow for the albuterol to be "held in reserve". But the safest course of action is to eliminate wrestling from the curriculum for a while. If a physician recommended albuterol as a "pre-wrestling" precaution, this is a serious improper and unjustifiable recommendation.
My opinion is that the wrestling career has to come to an end and it is irresponsible to use an albuterol enhaler before the matches. The coach who knows about this should be suspended from coaching. Asthma is life-threatening. If a doctor recommended this protocol his actions are irresponsible. Your son could have an attack that could end up in his death and I am certain there is not an ALS crew at the match with someone certfied in endotracheal intubation. That being said, take heart. Children often outgrow asthma for reasons that are unclear.
Go to www.asthmastory.com and read about infectious asthma and the antibiotic treatment and trials that are going on across the country right now.
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