Asthma medications: basic pharmacology and use in the athlete.

OBJECTIVE Asthma is a chronic disease that affects athletes at all levels of sport. Several categories of drugs, including relatively new agents, are available to treat the asthmatic patient. By understanding the appropriate uses and effects of these drugs, the athletic trainer can assist the asthmatic athlete in improving therapeutic outcomes from the asthma therapy. The appropriate use of these medications includes not only the use of the appropriate drug(s), but also appropriate technique for administration, compliance with the prescribed dosing intervals, and sufficient care to avoid side effects. DATA SOURCES I searched MEDLINE and CINAHL from 1982 to 1999 and International Pharmaceutical Abstracts from 1990 to 1999. Terms searched were "asthma," "athlete,""athletic," "exercise-induced," "exercise," "performance," "therapy," and "treatment." DATA SYNTHESIS Bronchodilators include beta2 agonists, anticholinergics, and methylxanthines. Of these, the beta2 agonists used by inhalation are the drugs of choice to treat an acute asthma attack or to prevent an anticipated attack (such as before exercise). Anti-inflammatory agents include corticosteroids mast cell-stabilizing agents, and antileukotrienes. Corticosteroids by inhalation are the drugs of choice for long-term treatment to curb the inflammatory process in the lung. Each of these drug categories has a unique mechanism of action. The athletic trainer who understands the appropriate use of these medications can help the athlete to obtain optimal results from drug therapy. Encouraging the athlete to comply with appropriate therapy, monitoring the effectiveness of the therapy, and recognizing the stimuli that initiate asthmatic attacks can improve the patient's therapeutic outcomes. CONCLUSIONS/RECOMMENDATIONS The athletic trainer has an opportunity to play a key role in ensuring that the asthmatic athlete achieves the desired outcomes from treatment. The athletic trainer can help to minimize the effect of asthma on athletic performance by ensuring that the athlete uses inhaler devices properly, is compliant with the prescribed drug therapy, monitors pulmonary function appropriately, uses medications properly before exercise, and is aware of the factors that initiate asthma symptoms.