Sideline management of asthma

Sideline Management of Nonmusculoskeletal Injuries by the Orthopaedic Team Physician

Although recognized as the most well-trained providers to address musculoskeletal injuries, many orthopaedic surgeons do not routinely treat patients with nonmusculoskeletal issues in their clinical practice. Nonetheless, when serving as a team physician, an orthopaedic surgeon may need to initiate management of or manage many nonmusculoskeletal issues. Knowing how to accurately diagnose and initiate management of sports-related medical and surgical conditions is an important facet of being an orthopaedic team physician. Common systems that may be involved include the cerebral/neurologic, ocular, dental, respiratory/pulmonary, cardiac, abdominal, and genitourinary systems. Each of these systems has specific pathologic processes and risks related to athletic or sporting participation. Orthopaedic team physicians must have a baseline familiarity with the most common nonmusculoskeletal issues to provide comprehensive quality care to athletes and patients.

Current concepts in the diagnosis and management of exercise-induced bronchospasm

Exercise-induced bronchospasm (EIB) is a common occurrence in individuals with asthma, though it can also affect individuals without asthma. It occurs frequently in athletes. Common symptoms include coughing, dyspnea, chest tightness, and wheezing; however, there can be a variety of more subtle symptoms. The differential diagnosis of EIB is broad and includes several pulmonary and cardiac disorders. During the initial evaluation, a complete history, physical examination, and spirometry should be performed. In most patients with EIB, the baseline spirometry is normal; therefore, bronchoprovocation testing is strongly recommended. Both pharmacologic and nonpharmacologic approaches are important in the treatment of EIB. Management of EIB on the sideline of athletic events requires preparation and immediate access to rescue inhalers.

Management of exercise-induced bronchospasm in NCAA athletic programs

PURPOSE

The prevalence of exercise-induced bronchospasm (EIB) is significantly higher in athletes than that in the general population and can result in significant morbidity in young, competitive athletes. Guidelines emphasize that education and written treatment protocols improve clinical outcomes for asthmatics. Evidence also supports objective testing when EIB is suspected, when there is immediate availability of rescue inhalers, and when there is involvement of asthma specialists in the care of asthmatic athletes. We sought to determine how EIB is managed at the National Collegiate Athletic Association (NCAA) sports medicine programs.

METHODS

A survey consisting of multiple-choice questions related to EIB in athletes was sent electronically to 3200 athletic trainers affiliated with NCAA sports medicine programs.

RESULTS

Five hundred and forty-one athletic trainers responded. A minority of athletic trainers surveyed (21%) indicated that an asthma management protocol exists at their institution. Twenty-two percent indicated that pulmonologists are on staff or consultants to the sports medicine department. Many indicated that a short-acting beta-agonist is not required to be available at all practices (39%) and games (41%), and few athletic trainers indicated that their programs use objective testing to diagnose EIB (17%). Regression modeling demonstrated education about EIB, and involvement of pulmonologists significantly improved adherence to current consensus guidelines.

CONCLUSIONS

On the basis of our data, many NCAA sports medicine programs do not manage athletes with EIB according to current consensus guidelines. This may result in inaccurate diagnoses and may be detrimental to clinical outcomes and overall health of student athletes. Providing education about EIB and involvement of pulmonologists significantly increase adherence to guidelines that likely improves clinical care of athletes and potentially athletic performance.