Asthma, Rhinitis, Other Respiratory Diseases
Asthma deaths during sports: Report of a 7-year experience

https://doi.org/10.1016/j.jaci.2003.10.052Get rights and content

Abstract

Background

Asthma mortality and the mortality of athletes during sports have been described separately in detail in the medical literature. However, asthma has not been reported as a cause of death in competitive athletes.

Objective

The object of this study was to raise the awareness of physicians, coaches, trainers, and parents that children and adults can have fatal asthma exacerbations during and immediately after participating in sports.

Methods

The Temple Sports Asthma Research Center identified athletes from 1993 until 2000 who died during or after sporting activity by using the nationwide Burrell's Information Service. Once a possible asthma-related sports death was identified, the autopsy report was requested from the coroner or medical examiner, and an attempt was made to contact the family. Contact with the family was limited to information about the death, medical history, sports involvement, and any medication usage by the person who had died. Secondary sources, including news reports, were used to confirm whether the subject died of asthma during or immediately after a sporting activity.

Results

Two hundred sixty-three possible cases were identified. Sixty-one deaths met the criteria for study inclusion. White deaths outnumbered black deaths by 2 to 1. Deaths among male subjects predominated. Most subjects were younger than the age of 20 years, with the most prevalent age group being between 10 to 14 years old. Fifty-one percent (18 of 35) of the competitive athletes had their fatal event while participating in organized sport, 14 in a practice situation and 4 deaths during a game or meet setting. Basketball and track were the 2 most frequent activities performed at the time of the fatal event.

Conclusion

The subjects who had fatal asthma exacerbations were usually white male subjects between the ages of 10 and 20 years. Mild intermittent or persistent asthma by history was commonly identified. Sudden fatal asthma exacerbations occur in both competitive and recreational athletes and can be precipitated by sporting activity.

Section snippets

Methods

The Temple Sports Asthma Research Program initially identified subjects who died during or immediately after a sporting or athletic event between July 1993 and December 2000, regardless of cause, by using the Burrell's Clipping Service. This news release service reviews newspapers from throughout the country by using specified search criteria and forwards the articles on request. We used the search terms asthma, sports, and death related to sports or asthma. This service reviews 1871 general

Results

We identified 263 potential asthma-related athletic deaths between July 1993 and December 2000. To ensure that only subjects who died of asthma during sports events were included, 202 (77%) were excluded for 1 or more of the following reasons: (1) death was not attributed to asthma at the time of autopsy; (2) the autopsy listed the cause of death as asthma, but concurrent cardiac or other disease was noted; (3) the subject's history or autopsy had signs, symptoms, or findings that could be

Discussion

There is little information concerning asthma death in association with sport, especially in the context of the competitive athlete. This paucity of data partially stems from a societal belief that athletes rarely become afflicted with a disease. This study highlights a previously unrecognized group of subjects who die of asthma, the competitive and noncompetitive athlete. Several reviews of asthma deaths, as well as a review of death in the competitive athlete, have not considered the

Acknowledgments

This work is in memory of Theodore C. Quedenfeld, MEd, whose passion and dedication have improved the health and care of children and athletes nationwide.

References (32)

  • MJ Campbell et al.

    Age specific trends in asthma mortality in England and Wales, 1983-95: results of an observational study

    BMJ

    (1997)
  • Center for Disease Control and Prevention

    Asthma mortality and hospitalization among children and young adults: United States, 1980-1993

    MMWR Morb Mortal Wkly Rep

    (1996)
  • R Sly

    Changing asthma mortality

    Ann Allergy

    (1994)
  • BJ Maron et al.

    Sudden death in young competitive athletes: clinical, demographic and pathological profiles

    JAMA

    (1996)
  • BJ Maron

    Sudden death in young athletes: lessons from the Hank Gathers affair

    N Engl J Med

    (1993)
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    Supported by an unrestricted educational grant from GlaxoSmithKline Inc, Triangle Park, NC.

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