Exercise induced Asthma (EIA) Posted on Thursday, September 11, 2003 - 00:00 Also known as Exercise Induced Bronchospasm, it effects 6-10% of the general population. Commonly occurs in active children, adolescents and young adults. Asthma sufferers are especially likely to develop E.I.A. How does E.I.A Present? Symptoms: -  coughing, especially at night and after exercise. “tight chest” approximately 5 minutes after exercise tiredness and shortness of breath A typical presentation would be in an active, asthmatic individual (athlete) who is running for about 5-6 minutes continuously, enough to increase the pulse rate to about 140 beats per minute.(180 beats per minute in children). Approximately 5 minutes after stopping the athlete would start having a dry irritating cough, his chest would start wheezing and he will progressively become short of breath. If no action is taken done, in the form of medication, the symptoms would usually disappear spontaneously after about 30 minutes. Who are most likely to develop E.I.A? Some forms of exercise are more likely than others to precipitate E.I.A High risk - Running especially events lasting more than 2 minutes eg long distance running. Cycling especially uphill and against the wind. Intermediate Risk: -  Rugby Hockey Netball Basketball Low Risk: -  Soccer Tennis Squash Sprints Very Low Risk: - Swimming What additional factors may precipitate an attack of E.I.A? Inhalation of cold, dry air Inhalation of antigens such as pollent. Acute viral infections How is the Diagnosis made? The diagnosis is suspected in individuals who may have a family history of asthma, and who cough and become short of breath after exercise. The diagnosis is confirmed in the consulting rooms as follows: 6 minutes of exercise (usually on a treadmill) with pulse rate increasing to 140/min in adults and 180/min in children. Measure peak flow immediately prior to exercise, then at 5 minutes and 15 minutes after completion of the exercise. a reduction of more than 10% of the pre-exercise peak flow is diagnostic of E.I.A How is E.I.A treated? The aim of treatment is to prevent attacks of E.I.A. Make absolutely sure of the diagnosis. Heart disease such as heart valve disease can also present with similar symptoms. Warm-up prior to strenuous exercise. However, the duration of protection seldom exceeds 40 minutes in this instance. Use of Bronchodilators (2 inhalations of an asthma inhaler) 15 - 30 minutes before exertion. Terbutaline / Salbutamol (short acting) 2-3 hours “protection” Salmeterol / Formoterol (longer acting) 10 - 12 hours “protection” Cromoglycate 1½ - 2 hours “protection”   No other asthma medications are quite as successful as the inhalers in preventing attacks of E.I.A. The use of corticosteroid inhalers has not been found to be effective in E.I.A. Are the inhalers used in E.I.A banned by the WADA /IOC? The use of inhalers by sportsmen must be authorised by their attending physicians and their relevant sporting bodies notified of their use. Notification includes the diagnosis of Asthma, dosage, and the name of the bronchodilator. The WADA/IOC permits the use of the inhalers mentioned above for the management of E.I.A but only upon authorisation by a physician. Sportsmen should be warned however, that they could be committing a Doping Offence if their relevant Sporting organisations have not been informed of the use of the inhalers. Advice to Sportsmen The belief that asthmatics cannot take part in exercise and sport is a myth. Asthmatics are not doomed to be spectators when they have the skills and potential to become top class sportsmen. They should be encouraged to actively participate in sporting activities. The use of the precautionary measures mentioned would ensure that E.I.A sufferers perform optimally in whatever sport they choose. ISMAIL JAKOET General Manager : Medical SA Rugby (Pty) Ltd. SA Rugby requires all players to have the form below completed by their doctor, should they be using asthma inhalers. These completed forms should be returned to the SARFU offices on fax number 021-6863330 prior to the commencement of the season each year. Declaration of Medication For use of PROHIBITED substances (SUBJECT TO CERTAIN CIRCUMSTANCES) SCHedule 3 PLAYER NOTIFICATION FORM   In accordance with IRB Regulation 21.7.1, all Players participating in any rugby sporting activity conducted by or under the auspices of the IRB are required to have prior written approval by a prescribing physician, respiratory physician or endocrinologist as appropriate for the therapeutic use of specified Prohibited Substances in certain circumstances. The only prohibited substances permitted with notification are set out below. Declarations for those prohibited substances in IRB Regulation 21.7.1 (a) & (c) are valid for ONE (1) YEAR ONLY from the date of certification by the Players prescribing physician, respiratory physician or endocrinologist as appropriate. Declarations for those substances in IRB Regulation 21.7.1 (b) & (d) are valid for THAT PARTICULAR USAGE ONLY on certification by the Players prescribing physician. This information will be kept strictly confidential by the IRB. This form may be used for both chronic and acute conditions.   Substances Prohibited Authorised with Notification 21.7.1 (a) Selected Beta 2 Agonists Formoterol, Salbutamol, Salmeterol and Terbutaline. Oral Systemic Injections Inhalator only to prevent and/or treat asthma and exercised induced asthma* 21.7.1 (b) Glucocorticosteroids Systematic use is prohibited when administered orally, rectally or by intravenous or intramuscular injection. Local Injections Intra-articular Injections or For the purpose of life saving treatment 21.7.1 (c) Insulin   Only to treat certified insulin-dependant diabetes** 21.7.1 (d) Local Anaesthetics On match day unless for suturing of bleeding wounds or dental treatment. When administered with Glucorticosteroids intra articular for therapeutic purposes more than 48 hours prior to the commencement of a match. * A Respiratory physician or the Player’s prescribing physician must complete part B & C below. ** An Endocrinologist or the Player’s prescribing physician must complete part B & C below.   PART A - Notification by Player First Name: Surname: National Union: Team/Club: PART B - Certification by Players Prescribing Physician Name: Qualifications: Contact Address: Telephone: Name(s) of Prohibited Substance(s): Dosage(s): Method(s) of Administration: Reason(s) why the administration of this prohibited substance is necessary for the health of the athlete: Reason(s) why a non-listed drug cannot be used: PART C - Declaration and Consent to Disclosure We hereby declare that the information contained in this form is correct and true. We hereby agree that the information contained in this declaration is disclosed to the IRB and/or the Players Union for the purposes of IRB Regulation 21.7.1. We also agree that any such disclosure shall not constitute a breach of medical confidentiality. Players Signature: ___________________________________________ Date ______________ Prescribing Physicians Signature: _______________________________ Date: ______________ PART D - Acceptance & Notification to IRB by Union Representative (only applicable for Players that meet IRB Criteria below) Name: Position: Signature: Date Notified to IRB: Official Holder of Declaration of Medication Records and Criteria IRB - Players competing in any International Match. National Unions - any other Player outside of the above criteria.