Nowadays, however, medicine has advanced to the point where asthma is manageable and controllable, and asthmatics can and do compete in athletic sports up to the highest levels.

There are still the occasional tragedies however, as when like a Northwestern University football player collapsed and died of an asthma attack after running sprints during a practice session in the US. Naturally this was a frightening episode, particularly for the other 10 asthmatics on the same team.

Such tragedies are, however, preventable, according Christopher Randolph, MD, chair of the American Academy of Allergy, Asthma and Immunology Sports Medicine Committee. The key is proper diagnosis and management. For asthmatic athletes to remain healthy and competitive all they have to do is follow doctor’s orders.

An estimated seven percent of the population suffer from asthma. Strenuous physical exercise brings on asthma symptoms in these people, but it can also induce asthma in non-asthmatic patients, generally those who have allergies or a family history of allergies.

According to Randolph people with exercise induced asthma (EIA) have airways that are overly sensitive to sudden changes in temperature or humidity. During strenuous activity people tend to breathe through their mouths, allowing the cold or dry air to reach the lower airways without passing through the warming, humidifying effect of the nose. This brings on asthma symptoms. On top of this mouth-breathing the symptoms can be worsened by air pollutants, high pollen counts and viral respiratory tract infections.

Symptoms of exercise-induced asthma include:

• breathing difficulty within five to twenty minutes after exertion begins;
• prolonged shortness of breath, often beginning five to ten minutes after brief exercise;
• wheezing;
• chest tightness;
• coughing;
• and chest pain.

Randolph advises that all coaches and referees, at all levels of competition, should be on constant watch for the appearance of these symptoms among players and athletes, and of course, the officials involved should be fully informed by the player/athlete of any asthma problems and treatment being received.

Asthmatics, athletes or not, usually take two medications. One is a daily, long-acting medication that controls the broncial inflammation at the root of asthma. The other is an inhaled, short-acting medication that relieves acute asthma symptoms when they occur.

"It is important for asthmatics to take their medications as prescribed, especially if one of those medications is a long-acting medication," Randolph said. "Asthmatics also must be able to recognise their acute symptoms and take the appropriate reliever medication at the onset of symptoms. Taking a break from practice to take your reliever medication may not be a 'macho' thing to do, but it may save your life."

Inhaled medications taken prior to exercise are helpful in controlling and preventing exercise-induced bronchospasm, according to Randolph. The medication of choice in preventing EIA symptoms is a short-acting beta 2 agonist bronchodilator spray used 15 minutes before exercise. These medications are effective in 80 to 90 percent of patients, have a rapid onset of action, and last for up to four to six hours.

In addition to medications, a warm-up period of activity before exercise may lessen the chest tightness that occurs after exertion. A warm-down period, including stretching and jogging after strenuous activity, may prevent air in the lungs from changing rapidly from cold to warm, and may prevent EIA symptoms that occur after exercise.

Athletes should restrict exercising when they have viral infections, when temperatures are extremely low, or — if they are allergic — when pollen and air pollution levels are high, according to Randolph.