At the August ('98) NENSA coaches' meeting, EIB was reported by Dr. Ken Rundell (Lake Placid Olympic Training Center's physiologist) to occur in 30% of nordic racers. Bronchospasm is a constriction of the airway muscles. It is occassionally accompanied by inflammation of the airways. This effect can be triggered by various irritants or by allergies. In XC skiers cold, dry air and heavy exertion frequently trigger EIB. The symptoms can include noisy breathing (stridor), wheezing, painful sensation in the upper airways(dyspnea) and shortness of breath(tachypnea). Onset of these symptoms often causes anxiety, and sometimes panic, especially in children and teens. After an episode of EIB, some will also exhibit a late reaction at night(coughing, heavy sensation in the chest and shortness of breath).
Anyone who works out hard on the first really cold day of the season is likely to exhibit some symptoms of EIB. It is a common reaction, and not necessarily a symptom of a chronic problem or underlying asthma. Athletes with continuing symptoms of EIB, however, should see a doctor. The doctor will need to know whether episodes have occurred due to other causes such as cigarette smoke, pets, dust, viral illnesses, or the like. A follow up appointment in two to four weeks is necessary in order to assess improvement. An athlete needs to explain to their doctor their degree of sports involvement so the treatment can be personalized. Treatment will probably involve prescription of medicines used for asthma. If the treatment is not working then underlying chronic asthma must be checked for through complete pulmonary tests or by doing daily peak flow measurements.
The first line of medical treatment is usually "beta-agonists" such as albuterol (Ventolin) or salmeterol (Serovent), which is longer lasting. A beta-agonist relaxes the smooth muscles around the airways and stops spasms. It is used 1/2 hour prior to exercise. Secondly, an anti-inflammatory that stops the initial response may be added. This group includes cromolyn (Intal) and nedocromil(Tilade). These are also used 1/2 hour prior to exercise if not more regularly. Thirdly, an anti-inflammatory that stops the initial and late response to a triggering agent, may be used daily. This group includes inhaled steroids (Vanceril, Beclovent, Aerobid, Flovent etc.).
All medicines should be taken as prescribed. Coaches should have instructions about the use of medicines signed by the doctor and parent. Spacers improve the delivery of inhaled medicines to the lungs instead of the mouth, and I strongly recommend their use. Environmental controls help too, such as easing into cold weather by using a face scarf . Proper warm up exercise helps. Also many athletes report a decrease in EIB as they get into better shape.
Usually, EIB is easily controlled. EIB should not stop one from enjoying the snowy trails or from skiing fast! If you have questions contact National Allergy & Asthma Network 1-800-878-4403 or you may e-mail me at xcskiing@aol.com.
Nancy Crocker has offered to perform EIB screening tests with a portable spirometer at selected Eastern Cup events this season. For information on this program please send e-mail to nensa@sover.net with "EIB" in the subject heading. Also feel free to send comments and questions that you'd like to have posted here.