^[1]By Laurie Ross

“By the time an athlete has spent a decade preparing daily for the Olympics, there is a certain grace in competing. During my races, I typically felt a oneness with my body, the water, and my soul.  Swimming felt masterful, effortless, light, blessed… like swimming was a part of me … until the last 10 or 15 yards. Then it’s pure guts, keeping the stroke together, arms, legs, lungs burning, chest tightening, driving for the wall.”

Nancy Hogshead-Makar knows what it feels like to win – she earned three gold medals and a silver medal in swimming at the 1984 Los Angeles Olympics. Like all great athletes, she also knows what it feels like to lose. But what she didn’t know was that the end-of-the-race tightening was asthma.

“I’m from humid Florida,” she explains, “and I didn’t swim as well in California outdoor pools, with its dry air. I didn’t know why at the time, I just thought maybe it was the time change or maybe I was ‘choking’ psychologically. I tended to do well at the beginning of the competition, and then taper off. I swam four events, prelims and finals, before my last race, the 200 butterfly. Standing on the racing block, I was retracting, having a hard time getting a full breath, to get to the top of the breath, and it took a lot of effort to do so. Those last few meters of the race were very painful as every cell in my body cried out for oxygen. I missed a medal by .07 of a second. That’s an eyelash! A blink is .25 of a second!

“I had been having regular, predictable symptoms for about 10 years,” she says, “despite having a father who is a physician, a brother with asthma, and eight years of world-class competitions with physicians on deck, watching me cough. When I was finally diagnosed after the Olympics, all the pieces came together. It made sense. No wonder I coughed in practice. No wonder I needed to warm up more than my teammates. No wonder I got ‘bronchitis’ frequently. No wonder I didn’t swim as well in dry climates. I thought I had small lungs – in fact, they’re enormous: 8 liters, which is about double for a woman my height.”

Lung Power

At the last Olympics Games in Beijing, almost one in four Olympic swimmers had asthma. According to James Miller, MD, chair of the Sports Medicine Task Force for USA Swimming and a member of the FINA Sports Medicine Committee, there are several reasons for this:

“First there is a baseline incidence of asthma in the athletic population. Secondly, many athletes with asthma are encouraged to take up swimming due to the beneficial effects of hydration, humidity, and the physiological benefit of oxygen exchange in the supine [horizontal] position. So, there is a selection of asthmatics who are being directed to aquatic sports. Finally, there is the problem with the exposure to chemicals in poorly balanced air/water environments.  When out of balance, chemical byproducts hover over the water exactly where the athletes are breathing. A simple rule is that if you can find the pool by following your nose, the pool is not in balance. These same chemicals tend to be irritants to airways.”

Dr. Miller says there have been problems in the past with asthma actually being over-diagnosed. “The use of inhalers in swimming reached an alarming level 8-10 years ago when it seemed that you could not walk across a pool deck without stepping on someone’s inhaler,” he recalls. “How many had asthma? No one really knew, since typically a parent or athlete would tell their medical practitioner that they had coughing or felt tightness during their workout and the common response was to try a bronchodilator inhaler to see if it helped. Since everyone else had one, rarely did the athlete want to discontinue it – ‘just in case it helped’.”

Now, World Anti-Doping Agency (WADA) rules can require a strict documentation of the diagnosis of asthma in order to be able to use certain bronchodilator medications particularly at the higher concentrations – a diagnosis that Miller says is critical to the athlete’s long-term health.

“You do not want to use a medication that is not indicated,” Dr. Miller says. “Every medication has side effects. However, if an athlete has undetected asthma with low levels of chronic inflammation brought to the surface by exercise, that athlete must have the baseline asthma addressed. Treating the allergies, addressing the inhaled toxins and/or treating the lung inflammation make a tremendous difference in athletic performance and long-term health. Untreated chronic lung inflammation can cause irreversible damage to the lung that resembles chronic obstructive pulmonary disease.”

From 1984 – 2012

One of today’s outstanding Olympic swimmers with asthma is Dara Torres. Four years ago she stunned the Olympics audience by winning five medals in Beijing and becoming, at age 41, the first U.S. swimmer in history to compete in five Olympics – teaming up with Nancy Hogshead in 1984 then coming back to compete in 1988, 1992 and 2000.

After the birth of her daughter in 2006, she began training for a comeback in 2008 and discovered she had asthma. At press time, Dara was well on her way to making the 2012 U.S. team as well. Follow her progress on www.daratorres.com ^[2].

Swimming With Ease

Whether you aspire to be a recreational or professional athlete, there’s no reason asthma should keep you out of the pool or off the court. However, what these elite athletes have found is that “no pain, no gain” doesn’t apply to asthma symptoms.

Breathing is fundamental to all activity – and once you get your symptoms under control and understand what makes asthma worse, then you can move on. Here are Nancy Hogshead-Makar’s 10 steps:

1. Work with a physician to develop a personal, detailed medication regimen that works for you, and then stick with it.
2. Use a peak flow meter. Many people with asthma don’t act on their early symptoms because they don’t recognize them as asthma. Prior to using a peak flow meter, I could only tell I was having asthma after I had lost 40% of my lung function. I couldn’t act because I couldn’t self-assess.
3. Pre-medicate. Don’t wait until symptoms appear.
4. Check the air quality. Look for allergens, pollution and weather and know how they interact with your particular case of asthma.
5. Wear a mask, like a bandana, over your nose and mouth to warm and humidify the air when it’s dry or cold.
6. Take a long warm-up. Take advantage of the “break through effect” of a sustained gradual build-up of exercise intensity.
7. Stay hydrated. Drink small amounts throughout the exercise.
8. Use breathing exercises. Asthma is not caused by improper breathing, so any breathing technique will not cure asthma. However, it will help you get a more efficient, more relaxed breath.
9. Cool down. Stopping exercise quickly can sometimes bring on asthma.
10. Re-medicate if necessary. I only need to re-medicate if I’m just getting over a cold, if it’s very dry outside or if I’m competing and really hitting it hard. But a personal asthma management plan will evaluate the need for this possibility.

Reviewed by Michael Mellon, MD