Exercise-Induced Bronchoconstriction in College Athletes: Are We Doing Enough?

More Americans than ever before have asthma, and although the disease can be managed with proper trigger prevention and treatment, there are still a significant number of deaths. The Centers for Disease Control and Prevention report that 1 in 14 people have asthma, with 3,651 deaths reported in 2014 at an annual cost of $56 billion.1,2 Adults are nearly 7 times more likely to die from asthma than children.3 A comprehensive review of 195 asthma deaths in the United Kingdom during 2012–2013 found that almost half died without emergency medical response or any medical assistance, and the majority were not being cared for by a medical specialist during the year before their deaths. Only one quarter had asthma action plans or acknowledged concern for their disease, and there was evidence of excessive use of short-acting beta agonists, under-prescribing of preventive medication, and possibly inappropriate prescribing of long-acting -agonist bronchodilator inhalers as monotherapy. The authors concluded that improved access to appropriate asthma medication should be a goal to reduce asthma mortality worldwide.4 D’Alonzo and colleagues recognize that a deadly episode of asthma can occur that is unrelated to the severity or stability of the disease. These researchers tracked asthma deaths in athletes and found 100 deaths related to asthma in a 2-y period. This group believes that proper treatment and prophylaxis improves health and performance and may reduce the risk of fatal asthma exacerbations.5,6 There are, unfortunately, several high-profile examples of mortality in athletes secondary to asthma. For example, a 21-y-old potential major league baseball player from Sarasota, Florida, arrived in Mesa, Arizona for intensive coaching. He was aware that he had exercise-induced bronchoconstriction (EIB) and used an inhaler. He died shortly after a training session from possible complications of asthma. In 2001, a Northwestern University football player, age 22, collapsed during football practice and died an hour later. His teammates witnessed him having asthma exacerbations many times and thought this time was no different.7