Chapter Eight Common medical conditions affecting athletes

Learning outcomes

Describe and manage a range of medical conditions affecting athletes.

1. Describe management techniques of athletes with known medical conditions.

2. Identify signs and symptoms of a range of viral medical conditions.

3. Identify signs and symptoms of a range of chronic medical conditions.

Assessment of outcomes

Underpinning knowledge

You may be asked a number of written or oral questions related to the management of medical conditions that may be exhibited by an athlete. You may also be asked to complete an online task or workbook with related activities.

Practical demonstration

You will be asked to demonstrate effective management strategies of a variety of medical conditions in a sporting context.

Scenario

You may be asked to identify a number of medical conditions and how you would manage them in a crisis situation. This may include prioritising conditions as they present.

Introduction

Some medical conditions are common in the general population and, therefore, can also be present in sports participants. Medical conditions can affect an athlete’s performance. Similarly, performance can affect a medical condition. The sports trainer requires a basic understanding of common illnesses and medical conditions and how they can affect or be influenced by athletic performance.

Common medical conditions

The sports trainer is expected to have a sound knowledge of the following common medical conditions and their effects on sports participation:

asthma

diabetes

epilepsy

cardiovascular conditions

viral infections

chronic illness and injury.

These conditions, when medically controlled and supervised, may not preclude an athlete from participating in physical activity, but modification of their exercise program may be necessary. After diagnosis by a medical practitioner, each athlete should have an individual management plan that covers prevention and treatment of their condition. The sports trainer has an important role in ensuring the athlete follows their plan and assisting them to do so.

Medical management plans should take into consideration:

the nature and severity of the illness

potential risks to the athlete and to other participants

the athlete’s goals.

For the protection of the athlete and to assist the sports trainer, every athlete should:

undertake a pre-competition medical assessment (PCMA) with their doctor. The pre-exercise screening system developed by SMA in conjunction with Exercise Sports Science Australia and Fitness Australia could also be used

for athletes with medical conditions, obtain clearance from a medical practitioner before beginning a new season

complete an athlete medical profile form that outlines their medical history

notify the sports trainer of any changes to their condition or medications, including recent illnesses not of a chronic nature such as a virus or other infection.

Figure 8.1 Athlete medical profile form (see Appendix C for a full-sized version)

Asthma

Asthma is the narrowing of the airways due to spasm and/or swelling of the airway walls, which restricts airflow and makes breathing difficult. There may also be an accumulation of mucus and fluid in the airways that contributes to the narrowing of the airways.

Figure 8.2 Normal airway versus asthma-affected airway

Some general triggers for asthma include:

allergies, commonly including dust, pollens, grasses, lawn cuttings, animal hair

cigarette smoke

cold air

certain medications, such as aspirin

viral illnesses, including colds and flu

altered emotional state, including stress.

Exercise-induced asthma (EIA) refers to asthma that is triggered during or shortly after exercise. EIA can vary from a mild cough to wheezing or to severe breathing difficulties. EIA may occur during exercise but is more likely to occur after exercise, usually up to 30 minutes after exercise.

During exercise, heat and water are lost from the airways and it is this cooling and dehydrating effect on the airways that is thought to trigger EIA. The more intense and the longer the duration of the exercise the more likely it is that EIA will occur.

Continuous activities such as distance running are more likely to induce EIA than stop/start activities such as soccer or netball. Cold and/or dry air can also affect people with asthma and the combination of this with exercise presents an added risk in sport.

It is important for all people with asthma to be prepared before exercising. This always involves an effective warm-up but may also include taking prescribed medication. Being physically and aerobically fit benefits all people, including people with asthma.

Signs of an asthma attack

There is often, but not always, a history of asthma. During an attack, the athlete may appear to have one or more of the following signs:

difficulty breathing

difficulty speaking

shortness of breath

noisy breathing, such as coughing or wheezing

increased respiratory rate

increased heart rate

pale and sweaty skin

quiet and slow responses

in children, skin being sucked in around the base of the neck and between the ribs.

A severe attack can lead to:

a blue tinge to the lips (cyanosis)

unconsciousness.

Symptoms of an asthma attack

Distress

Anxiety

Difficulty speaking

Tiredness and exhaustion

In severe asthma attacks, the audible wheezing may subside as the condition worsens with very little air moving in and out of the lungs. This is an emergency. Never assume that a decrease in audible wheezing is a sign of improvement unless breathing also improves. If there are any signs of a severe attack, call an ambulance immediately and commence first aid following the usual DRSABCD principles.

Management of a severe asthma attack

Sit the athlete comfortably upright. Be calm and reassuring.

Help administer four puffs of a reliever or combination inhaler (Ventolin, Airomir, Epaq, Symbicort or Asmol).

Relievers are best given through a spacer, if available. Use one puff at a time and ask the person to take four breaths from the spacer after each puff. Use the person’s own inhaler if possible. If not, use the inhaler from the first aid kit or borrow one from someone else.

Wait 4 minutes. If there is no improvement, give another four puffs, ensuring the person takes four breaths in and out through the spacer after each puff of medication.

If there is little or no improvement, call an ambulance immediately and state that the athlete is having an asthma attack. Keep giving four puffs every 4 minutes until the ambulance arrives.

Note: The protocol is the same for adults and children.

If the athlete loses consciousness at any stage, place them on their side, make sure the airway is clear and monitor breathing and circulation. Start CPR if necessary.

Reliever medication with a spacer

Shake the inhaler and insert the mouthpiece into the spacer.

Place the spacer mouthpiece in the person’s mouth and fire one puff.

Ask the person to breathe in and out normally for about four breaths.

Repeat in quick succession until four puffs have been given.

Figure 8.3 Reliever medication with a spacer

Reliever medication without a spacer

Shake the inhaler.

Place the puffer in the person’s mouth. Fire one puff as the person inhales slowly and steadily.

Ask the person to take four normal breaths.

Repeat until four puffs have been given.

Figure 8.4 Reliever medication without a spacer is less effective

First asthma attack

If someone collapses and appears to have difficulty breathing, call an ambulance immediately, whether or not the person is known to have asthma.

Give four puffs of a reliever and repeat if there is no improvement.

Keep giving four puffs every 4 minutes until the ambulance arrives.

No harm is likely to result from giving a reliever to someone who does not have asthma.

If a reliever is used for an athlete who is not known to have asthma, the athlete must be referred to a doctor for further assessment; this may confirm a diagnosis of asthma and thus require ongoing medical management.

Asthma medications

There are three types of medications prescribed for asthma:

1. reliever medications

2. preventive medications

3. combination medications.

Reliever medications

Reliever medications are taken 5–10 minutes prior to exercise and during exercise when necessary. They are available over the counter at most pharmacies. All sports trainers should carry at least one reliever inhaler and spacer in their sports medicine equipment. Reliever medications are blue/grey inhalers with the following product names: Ventolin, Airomir, Epaq and Asmol. Bricanyl, which is a dry powder reliever, is not recommended for first aid and can only be used by elite athletes if a Therapeutic Use Exemption (TUE) request has been submitted.

Figure 8.5 An asthma medication plan from a doctor is essential

Preventive medications

These are taken regularly and are prescription drugs that will not help when an athlete is having an asthma attack. They are:

white with a blue cap (e.g. Intal)

white with a red cap (e.g. Intal Forte)

a brown turbuhaler (e.g. Pulmicort)

burgundy (e.g. Qvar)

orange (e.g. Flixotide)

dark orange (e.g. Alvesco).

Combination medications

These medications combine a preventer and a long-acting reliever in the same puffer. Combination medications are:

red (e.g. Symbicort)

purple (e.g. Seretide).

Asthma and the athlete

Well-controlled asthma should not prevent exercise and participation in most sports (however, people with asthma should not scuba dive). People with diagnosed asthma should have an asthma management plan or an asthma action plan that is established in conjunction with their doctor. The athlete, teammates, coach and the sports trainer should know this plan. The sports trainer should also encourage the person with asthma to:

know the severity of their asthma

exercise safely and regularly to improve fitness and lung function

avoid trigger factors where possible

perform at their best by using the right medication in the correct manner

have their asthma checked regularly by their doctor – every 6 months

have a ready supply of medication for use before, during and after exercise.

The sports trainer should identify the athletes in their team that have asthma and know their asthma management plan.

Pre-exercise advice

During pre-exercise, the athlete should avoid:

allergy triggers, where possible (e.g. dust, pollens, grasses etc)

exercising in cold air (e.g. early morning or late evening)

vigorous exercise when the athlete has a viral infection

any exercise if the athlete is wheezing or has a chest infection.

The athlete should always:

warm up adequately to allow the body to adapt to changes in the weather; an indication of an adequate warm-up is a light sweat

if advised by the doctor, take medication 5–10 minutes before exercise

stretch after warming up.

Two different types of warm-up have been shown to be effective in reducing EIA:

5–7 sets of 30-second sprints with 30–60 seconds rest

a brisk walk/slow jog for 20–30 minutes.

During exercise advice

If asthma develops during exercise, stop the athlete and have them take their reliever medication.

Do not allow the athlete to resume activity until all the signs and symptoms have subsided.

If the symptoms recur:

use the reliever medication again

do not allow the athlete to return to activity

refer the athlete to their doctor

do not encourage an athlete to ‘run through’ an asthma attack.

Post-exercise advice

Ensure an adequate cool-down takes place; i.e., 5–10 minutes of light activity followed by stretching.

If EIA continues, refer the athlete to their doctor, who may recommend:

a change in medication

regular preventive medication in the overall asthma management plan.

Further information

For more information on asthma, visit the National Asthma Council website at www.nationalasthma.org.au.

Diabetes

Diabetes is a disorder in which the body does not produce enough effective insulin to regulate blood sugar levels correctly. Insulin is a hormone that is needed to regulate the blood sugar levels in the body. In most instances, diabetes does not prevent a person from being able to participate in regular activity.

A regular exercise program will help to maintain blood sugar levels. A long-term regular exercise program may have considerable benefits to the diabetic, including decreased insulin dosages as well as increased wellbeing, flexibility, endurance and strength. The correct balance between diet, medication (oral or injection) and exercise can help control diabetes. The athlete should also be assessed regularly by their doctor.

If diabetic athletes overexert themselves or suddenly change their routine, their blood sugar levels may drop, which can lead to lead to serious consequences including shock or a diabetic coma.

Types of diabetes

There are two main types of diabetes:

1. Type 1 diabetes – it is believed that this is an autoimmune condition where the insulin cells in the pancreas fail. This condition typically presents before the age of 30 years and usually early in childhood. Type 1 diabetics require insulin replacement via injection, pen or pump to survive.

2. Type 2 diabetes – this is the most rapidly increasing medical condition in the world. It more often affects people over the age of 40 years and accounts for around 85% of all cases of diabetes. Lifestyle factors (lack of exercise and obesity) are the biggest contributing factors in developing type 2 diabetes. This condition may be controlled with diet, exercise and oral medication, but may require insulin-replacement therapy.

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