What’s the best treatment plan for an athlete with exercise-induced asthma? When competing, she uses a short-acting beta-agonist before exercising, which she does four to five times a day. She is asymptomatic, with normal pulmonary function testing at rest.
—Susan Dirks, MD, Cockeysville, Md.

The best treatment plan is the one that provides for adequate control of the patient’s asthma symptoms. Your patient sounds well-controlled on her current regimen. Elite collegiate athletes must also be aware of inadvertently taking prescribed or OTC medications that are banned performance-enhancing compounds. These agents are often sport- and competition-specific. As a general rule, inhaled beta-agonists are acceptable for National Collegiate Athletic Association competitions. Olympic competition, however, requires objective evidence (by spirometry or bronchial provocation challenge) of airway reactivity. Consultation with a clinician or athletic trainer well-versed in the acceptable medications for an athlete’s sport and competition level should be sought in these cases.
— R. Steven Tharratt, MD, MPVM