A new study has observed that the majority of National Collegiate Athletic Association (NCAA) sports medicine programs do not have a pulmonologist on staff despite the fact that asthma is highly prevalent athletes. The study presented at CHEST 2007, the 73rd annual international scientific assembly of the American College of Chest Physicians (ACCP), found that less than 25% of NCAA-affiliated athletic trainers report having a pulmonologist on their sports medicine program staff. However, the presence of a pulmonologist on staff increased the likelihood of a program's adherence to national asthma management guidelines, which may, ultimately, improve the clinical care of athletes with asthma.
"Studies estimate that exercise-induced asthma among athletes is double the rate seen in the general population; however, diagnosing asthma and other respiratory disorders in athletes can be challenging," said the study's lead author, Jonathan Parsons, MD, Associate Director, The Ohio State University Asthma Center, Columbus, OH. "There are many mimics that can be confused with asthma. Pulmonologists offer expertise that may provide assistance in managing asthma that often will help improve health and performance of many athletes."
Dr. Parsons and researchers from The Ohio State University surveyed 541 athletic trainers affiliated with the NCAA about their asthma management programs. Researchers found that only 22% of responders reported having a pulmonologist on their sports medicine program staff. Furthermore, sports medicine programs with a pulmonologist on staff were significantly more likely to follow national asthma management guidelines published by the National Education and Prevention Program - part of the National Health, Lung, and Blood Institute - and a position statement concerning asthma management in athletes published by the National Athletic Trainers Association (NATA). The guidelines and position statement recommend having an emergency action plan for the management of acute asthma attacks, yet, only 20% of respondents in the survey reported their program having a specific, written protocol for managing acute asthma exacerbations during games or practice.
"At this point in time, we can't predict which athlete may have an asthma attack or how severe that episode may be. Hence, having a plan for how to respond to such an event and having necessary equipment and medication immediately available is paramount," said Dr. Parsons. "For sports medicine programs, having both an asthma management plan and a pulmonologist on staff is optimal; however, having an asthma management plan is essential."
The NATA position statement also states that all patients with asthma should have a rescue inhaler available during games and practices, and that athletic trainers should have an extra rescue inhaler for each athlete for administration during emergencies. Current survey results showed that 61% of respondents' programs mandate that a rescue inhaler be available for practices, and 59% indicated that a rescue inhaler is required to be available at all games. However, researchers note that some states prohibit athletic trainers from carrying inhalers unless prescribed for a specific athlete. The position statement further recommends that athletes with a history of asthma or of taking a medication used to treat asthma and those suspected of having asthma should consult a physician for proper medical evaluation, including having a pulmonary function test. However, only 17% of survey respondents reported objective lung function testing being performed in their program when exercise-induced asthma is suspected by history.
"Following asthma management guidelines can help improve clinical care for athletes with asthma and may help decrease asthma-related morbidity in this population," said Alvin V. Thomas, Jr., MD, FCCP, President of the American College of Chest Physicians. "Collegiate sports medicine programs should be encouraged to follow a comprehensive approach, which includes having a plan for managing asthma and other chronic diseases among athletes."