Insights into teaching sports from the point of view of an asthma-sufferer
This article today was written by Colin Farrell, a member of the Academy of Historical Arts, to help address what he perceives as a serious gap in provision in the current teaching of historical fencing. He hopes that this article will be beneficial for many teachers in the hobby.
Starting from the age of 4 or 5 I have taken part in a variety of sports, as a new learner, as an experienced learner and as an instructor. What has struck me over the years is a noticeable lack of knowledge about asthma, which I have thought peculiar given that nearly 5.5 million people in the UK suffer from it to some degree and the number is steadily increasing, especially amongst children. That’s just under 1 in every 10 people in the UK. That means that any sports class you’ve been in will almost certainly have had an asthmatic or two present. And yet most instructors have at best minimal knowledge of how to deal with asthmatics, and at worst have complete misperceptions of how to deal with them. I hope to be able to provide a basic level of accurate knowledge to you all here, to let you deal better with the situation should it arise.
To give some background, I am 21 and was diagnosed with asthma at the age of 5. I have been living with moderate to severe asthma since then, and I have it on good authority from my parents I suffered from it well before I was diagnosed with it. Every asthmatic has different triggers for their illness. This means that the same things will not bring out symptoms in everyone. However, there are certain very common triggers and one of these is exercise. I am one of those unfortunate enough to have exercise as a very strong trigger for my asthma, so I have had to learn how to deal with a lot over the years.
For those who do not know what asthma actually is, which is quite a lot of people including a lot of asthmatics, it is a combination of factors all of which act to reduce your ability to breathe. These factors include mucus building up in your airways, your throat muscles tensing uncontrollably and your diaphragm tensing uncontrollably. What is commonly known as an asthma attack is where these all occur to an extreme degree. Before discussing exactly what an asthma attack is, its important to know the basic symptoms of asthma. A shortness of breath is often the first thing one will notice, progressively getting worse if left untreated. Wheezing accompanies shortness of breath once it becomes more serious. This will potentially be your first sign as an instructor or fellow learner that the person is in trouble. An audible wheeze in someone’s breathing means their lung capacity as been reduced by at least 50%, which is not a good state to be in believe me.
Around the time audible wheezing begins, coughing may also begin. All of these factors will get worse and normally the last symptom to set in is a tightness in the chest. By the time someone is suffering from this last symptom they are likely to be somewhat panicked, due to a severe inability to breath. In this panic, they may believe they are having a heart attack. However, if someone is only able to indicate to you that they are suffering chest pains and not give you any details due to severe shortness of breath, you should of course treat it as you normally would anyone suffering chest pains during a class. These are the 4 main symptoms of asthma, they vary from person to person but the end result in always pretty much the same. They can’t breath properly.
In the most severe state, this is known as an asthma attack. These are highly dangerous, and can occur if asthmatic symptoms are not properly and quickly treated. The official advice is that if you are suffering severe asthmatic symptoms, and your medication does not provide relief within about 30 minutes, an ambulance should be called straight away. However, the official advice is also that if proper treatment of symptoms had been carried out nearly 75% of asthma related hospitalisations could be avoided.
Now, in my experience most sports clubs will generally say that if you are asthmatic, you should ensure you have your inhaler with you to each session. I would suggest you should go further than this. If you are instructing a class, find out specifically who is asthmatic. If you can, have a short discussion, individually with each of them. Find out how severe their asthma is, what their initial symptoms usually are (as these vary from individual to individual), and also make sure that they themselves are confident in their ability to manage a severe onset or an attack. During this discussion, you should also try to make clear that you understand that its asthma that might hold them back at times, and that you will do your best to work with them on it. This will allow them to be more confident in bowing out of activities if their symptoms are onsetting. Beyond this, try to ensure that if a persons asthma is exercise induced they take a dose of their inhaler before beginning any exercise, even a warm up. This can help prevent any symptoms, or minimise their onset from the start.
Beyond these preventative measures, there are a number of things that you can do as an instructor or fellow learner to help ensure asthma sufferers are ok. Keep an ear out for their breathing, even if they aren’t wheezing you can still notice if their breathing has noticeably changed after some exercise. This change can either be particularly heavy breathing, as you might expect from anyone after a significant level of exercise, or it might be short gasping and panting. Either of these is a sign that their asthma has kicked in. If you notice this, and they are acting like they haven’t, verbally check that they are ok to continue. If they do not verbally respond or their verbal response is audibly strained, make them stand out of the practice and take their medication until they are recovered. A physical indication of being able to continue, such as a nod or other gesture, should not be accepted. This is a common and simply diversion tactic I have employed more than once in the past when I didn’t want to be thought of as unfit or weak. This is something many asthmatics suffer from beyond their illness, particularly teenagers, or those who have been more recently diagnosed. They do not want to admit they need to stop when others do not.
This is why its important to be aware of an asthmatics breathing, as many, including myself, often try to push past the point where we really should stop. However, once you have noticed a persons breathing and got them to stand out of the practice, or they have voluntarily stepped out, you should ensure they take their medication. If the symptoms are mild, then its fine to leave them be and let them take a couple of minutes to recover. If the symptoms are more severe, either because they pushed themselves too far before stepping out, or because the symptoms simply onset more severely to begin with, you should ensure they are not standing off to the side alone and are with a responsible adult (whether the sufferer is adult or child). There are several reasons for this.
Firstly, they can ensure that the asthmatic takes the time they need to to recover. They should not re-enter the practice until their breathing has normalised. If left alone off to the side, my own experience tells me that asthmatics rush re-entering, and will begin to participate with reduced lung capacity and breathing ability, which is obviously the way to induce much more severe symptoms.
Secondly, the responsible adult can monitor the asthmatics symptoms and use of medication. Whilst the asthmatic should be able to do both themselves, one of the most panic inducing experiences you can have is to be unable to breathe properly. Even slight panic can result in the asthmatic trying to puff like mad on their inhaler. Whilst they aren’t going to harm themselves unless they take a really quite extreme level of inhaler medication, taking a lot at once does them no more good than a standard dose and can cause problems for medical professionals later if hospitalisation is necessary.
Third, and somewhat related, is that the mature adult can help the sufferer deal with their panic. Panic is one of the worst enemies of an asthmatic, as it reduces your ability to breathe on its own, and combined with asthmatic symptoms can lead to a very unpleasant circle. Often all that’s needed is simple conversation. So long as their symptoms are not severe to point of excluding all other thoughts, try to talk to them about other things. Be it the practice you are at, or what you each had for dinner, the act of conversation will help can someone. Be prepared for the conversation to be quite one-sided at first though, until they have managed to recover some ability to breathe properly. The point of the conversation is simply to calm them. If the symptoms are more severe, you can help the person work through their panic by directly instructing them on how to breathe, and calmly reassuring them of their ability to do so. All you need to do is calmly and slowly instruct them to breathe in as much as they can, and not force it, and breathe out. Get them into a regular pattern of breathing in, but only as much as they can. Trying to force a deeper breath will not do them any favours, and can trigger anything from a protracted coughing fit to quite potent pains all through their chest cavity as their lungs try to do things they quite literally cannot. Imagine the sort of pain you feel on taking a complete breath, then trying to force more air into your lungs, and multiply it significantly. Not pleasant at all. Getting the sufferer to breathe in and out only as much as they can, whilst properly taking their medication, can normalise quite severe symptoms relatively quickly.
Fourth, to ensure that the sufferer does not make it more difficult for themselves to recover. This primarily consists of ensuring they stand upright, back straight so as to give their lungs to most room possible to function. One of the most instinctual movements when suffering shortness of breathe is to hunch over, or to sit or crouch bent over at the waist. Whilst this provides a measure of physical comfort, as it eases muscles which are being strained to help them breathe, it greatly restricts the lungs and thus prevents recovery. Standing straight, often its easiest to get a sufferer to do this so against a wall, is uncomfortable, but can dramatically decrease recovery time. This duty for the responsible adult can be difficult to carry out along with the third purpose I listed. It takes a reasonably charismatic or a well trusted individual to get a sufferer into an uncomfortable position whilst getting them calm. If you are in a position where this is not possible, work to calm the person first and get them into as good a position as possible. If they can’t stand straight, try to get them sat upright with their back up straight, as this is nearly as good as the standing position.
And finally, I’ll just take a moment to repeat the official advice. If after taking a dose of their medication ever 2 minutes of suffering severe symptoms, the sufferer has not begun to recover after taking roughly 20 doses of normal asthmatic medication, then an ambulance should be called. Beyond that, if someone suffers severe symptom onset and then recovers they should encouraged to make an appointment with their doctor within the next few days to ensure their medication is as effective as it can be.
There are a number of websites which contain helpful information for asthmatics, or those who are around asthmatics. Please note though, that I have primarily written this article from personal experience with only minimal reference to other bodies of literature. Potentially useful websites include: