Don’t Forget Asthma When Doing Your Pre-Sports Participation Physicals Free

Prior to the start of each school year, pediatricians are inundated with forms to complete for the annual pre-sports participation physicals. Although intended to screen for any medical condition that could impact the athletes’ ability to participate in sports, much of the attention is focused on the heart. The attention is warranted, as sudden cardiac death has been shown to have an incidence for high schoolers of 1.5 per 100,000 athlete-years in the US, making it the number one medical cause of death in these athletes.¹ However, we cannot forget another potentially dangerous condition that these athletes can harbor: asthma.

Asthma has a prevalence of 20% in athletes, making it the most common medical condition in this population.² Although we have limited data on the subject of sudden asthma deaths, one longitudinal study using the US National Center for Catastrophic Sport Injury Research (NCCSIR) database looked at sports-related deaths from the years 1982–2018 and found that asthma was sixth in the causes of sudden death while participating in sports, after cardiac, heat stroke, and various forms of trauma.² The current sports clearance forms in my surrounding school districts do ask about asthma diagnosis and shortness of breath with exercise, but this is a subset of patients that may get missed. I frequently see patients who have undiagnosed asthma or have exercise-induced symptoms that present as a cough. Coughing with exercise is not one of the asthma screening questions. Plus, exercise-induced bronchospasm (EIB) can happen in athletes without having underlying asthma,³ so it is important to be inclusive of all symptoms that can point to EIB.

I am not recommending that asthma be a contraindication to participating in sports. On the contrary, studies have shown exercise to benefit asthma control and quality of life overall.⁴ Recent news of a Houston student-athlete dying from an asthma attack while at school made me wonder about what other opportunities we have as medical professionals to screen for and address asthma. I agree with what Drs. Khandai and Coleman wrote in their May Pediatrics in Review article that sports physical visits are an excellent opportunity to catch up on preventive services, but it is also a good time to further investigate asthma, another potentially dangerous condition.

References

1. Finocchiaro G, Westaby J, Sheppard MN, Papadakis M, Sharma S. Sudden cardiac death in young athletes: JACC state-of-the-art review. J Am Coll Cardiol. 2024;83(2):350–370. doi:10.1016/j.jacc.2023.10.032
2. Price OJ, Kucera KL, Price HM, Drezner JA, Menzies-Gow A, Hull JH. Asthma-related sudden death in athletes: a retrospective analysis of the US NCCSIR database (1982–2018). Eur Respir J. 2021;58(1):2100088. doi:10.1183/13993003.00088-2021
3. Koya T, Ueno H, Hasegawa T, Arakawa M, Kikuchi T. Management of exercise-induced bronchoconstriction in athletes. J Allergy Clin Immunol Pract. 2020;8(7):2183–2192. doi:10.1016/j.jaip.2020.03.011
4. Nyenhuis SM, Kahwash B, Cooke A, Gregory KL, Greiwe J, Nanda A. Recommendations for physical activity in asthma: a work group report of the AAAAI Sports, Exercise, and Fitness Committee. J Allergy Clin Immunol Pract. 2022;10(2):433–443. doi:10.1016/j.jaip.2021.10.056