Microsoft word - 3.9 asthma policy vjuly06 final.doc

SURF LIFE SAVING AUSTRALIA
POLICY STATEMENT

INTRODUCTION
Asthma is a common condition in Australia, affecting 12.8% of the population1. It is
more common in school aged children than adults2. Currently there is no cure for
asthma but in the majority of cases it can be well controlled so that the person with
asthma has no limitations in their life. There are many examples of state,
Australian, world and Olympic champions who have competed with well controlled
asthma.
There is considerable evidence that exercise is very helpful in the overall
management of people with asthma3. A history of asthma by itself should be no
deterrent to participation in any aquatic activity including teaching, being taught,
examining, competing, or practical
lifeguarding providing the lifeguard or student concerned is following the advice of a
medical practitioner who is fully conversant with the implications of these activities
When poorly controlled asthma can severely restrict a persons ability to participate
in sport and can be life threatening. Three elements which have been shown to
improve asthma control are;
Regular medical review (twice yearly)
Self management education (clear understanding of trigger management,
medication and device use)
A written asthma action plan (detailing how to manage or avoid asthma attacks) 4
Asthma has potential to be a variable condition and SLSA recognises that a
lifeguard with asthma may be fully fit at some times but not fit for various
lifeguarding activities during asthma exacerbations. The responsibility for the
individual’s management at all times rests with the person and the medical adviser
concerned.
ASTHMA
Asthma is a chronic condition in which there is an underlying inflammation or
irritation in the air passages. This irritation can lead to the narrowing of the air
passages when exposed to certain triggers. Common triggers are infection, smoke
or other chemical irritants, exposure to allergens, or sudden airway drying. Airway
drying can be caused by rapid changes in weather, immersion in cold water, and
changes in respiratory rate (exercise, strong emotions) 5
A person with well controlled asthma will have normal lung function and no
symptoms of an asthma attack.
An asthma attack (exacerbation) may be recognised by rapid breathing, shortness
of breath, cough, an expiratory wheeze and the person complaining of a tight chest
(or stomach pains in children).
Severe or life threatening asthma attacks are normally preceded by days to weeks
of increasing symptoms.
POLICY 3.9 VERSION 3, JULY 2006
Note: Patients with severe asthma may have no audible wheeze. However, they will
have an obvious severe breathing problem. Patients will be pale, sweating, and
may have slight blueness of lips, earlobes and fingertips. In very severe cases, the
person may become unconscious.
In severe asthma, the small air tubes in the chest are grossly narrowed from: -
i. Constriction (tightening) of the muscles surrounding the small airtubes
ii. Blockage or narrowing of the small air tubes with thick sticky mucus. This mucus
is often discoloured due to the inflammation inside the air tubes.
The combined effect of these two factors prevents the easy escape of air
(expiration) from the lungs and the chest becomes over-inflated. This is also the
reason that people who have stopped breathing from severe asthma are very
difficult to resuscitate, as it is also very difficult for the rescuer to blow air into the
over-inflated lung, and for that air to escape.
* If this should occur the rescuer will perform EAR to the best of their ability, using
mouth to mask with oxygen, or a bag and mask with 100% oxygen, whilst calling for
urgent medical aid.
One of the aims of asthma management is to reduce the risk of such a severe
asthma attack occurring. It is essential that asthma be treated with preventative
treatment (inhalers or other medications).
Simply treating asthma with reliever inhalers on a regular basis does not provide
protection from an asthma attack and does not improve the general fitness and
health of an individual. Reliever inhalers should not be used without assessment
by a Doctor.
COMMON ASTHMA MEDICATIONS
“Reliever” Inhalers
These open the airways to improve breathing and are the best for emergency
treatment (see below). They can be bought over the counter which, although being
of benefit for the acute asthma attack, can lead to misuse of these blue / grey
inhalers
Note: In competition these can only be used by people with asthma. The diagnosis
must be confirmed by their Doctor, and approved by the National Medical Officer on
receipt of a signed letter by that treating Doctor.
Reliever inhalers are not performance enhancing and will not increase endurance
unless the person has asthma. They will not improve recovery rates unless the
person has asthma.
“Preventer” Inhalers
These medications are the cornerstone of treatment of chronic (long-term) asthma
and are commonly based on cortisone. They are the most important inhaler to
prevent breathing problems, particularly in the person with persistent asthma.
These inhalers are started generally when more that 3 doses a week of relievers
are needed 2. As the main effect of asthma is long-term irritation of the small air
tubes an inhaler that prevents this is the best management. Preventer inhalers
(coloured orange, yellow or brown) are available only with a script. They are of no
benefit during an asthma attack.
POLICY 3.9 VERSION 3, JULY 2006
It is important to note that it may take up to 2 weeks before the best effect is gained
from these inhalers.
Side effects are minimal from these inhalers and they are NOT anabolic steroids or
have performance enhancing properties.
“Symptom Controller” Inhalers
Symptoms controllers are medications that have very similar action to relievers
(open the airway) but have a prolonged action. While the reliever medications
normally provide relief from symptoms for up to four hours, symptom controllers
have a twelve hour action.
Symptom controllers can take up to two hours to have their best effect and should
not be used in the acute asthma attack. They should always be used in conjunction
with preventer inhalers.
The symptom controller inhalers are normally coloured green and only available
with a script.
“Combination” Inhalers
These inhalers combine both a preventer and a symptom controller in one inhaler.
These inhalers are coloured purple or white with red markings. Like preventer
medications they are used twice daily (morning and night) to give good control of
asthma. They are of no benefit during an asthma attack.
Other Medications
Include cortisone taken orally (prednisone) and other less common medications.
These can only be prescribed for competitors under strict medical guidelines, which
include their treatment plan from a certified Respiratory Physician, and permission
MUST be requested each time this medication is used (i.e. there is no “blanket”
permission for a season). Other tablets are available (such as Singular or Nuelin)
which also require notification and permission.
CONTENTS OF AN ASTHMA FIRST KIT
1. A spacer device (large or small)
2. Reliever inhaler that fits the spacer
3. Asthma First Aid Procedure sheet.2
4. Written advice on good asthma control to give to patient 6.
ASTHMA MEDICATIONS AND COMPETITION
SLSA condemns the use of performance enhancing substances in sport as both
dangerous to the health of the participant, and contrary to the ethics of the sport.7
The SLSA Anti Doping Policy8 applies to all competitors and testing may be carried
out at any SLSA sanctioned event.
In relation to the Doping Policy mentioned above, medications used to treat asthma
may contain drugs that are either prohibited or subject to certain restrictions. It is
not the intent of SLSA’s Doping Policy to penalise lifesavers who have asthma.
However, it is wholly on the lifesaver and his medical attendants to provide
indisputable evidence of this fact.
Most asthmatic conditions can be treated by medications that are permitted or
approved; however notification to the SLSA Medical Officer is still required.
WARNING: Do not alter your asthma treatment without first consulting your doctor
or the National Medical Officer.
POLICY 3.9 VERSION 3, JULY 2006

ASTHMA CHECKLIST
To ensure you are taking a permitted medication and have notified the relevant
authority, follow the checklist below.
MAKE SURE THAT
1. A doctor has diagnosed your asthma
2. The asthma medications9 you are taking has been prescribed by your doctor
3. The medications, which have been prescribed by your doctor, are permitted (see
below)
4. You have sent notification, in writing and from your doctor, to include the name,
strength and dose of medications used.
5. You have notified:
The National Medical Officer,
Surf Life Saving Australia
Level 1, 1 Notts Avenue,
Bondi Beach
NSW 2026
Phone (02) 9130 7370 Fax (02) 9130 8312
APPROVED AEROSOL SPRAYS (inhalers) - 1ST SEPTEMBER 200(4) to check
These MUST be approved PRIOR to competition
Medical name
Asmol, Airomir, Respolin*, Respax, Respolin, Ventolin SYMPTOM CONTROLLERS Eformoterol fumarate Dihydrate Fluticasone proprionate Flixotide Sodium cromoglycate COMBINATION INHALERS Salmeterol and Fluticasone proprionate Eformoterol fumarate
Dihydrate and Budesonide Symbicort
CURRENTLY BANNED AEROSOL SPRAYS (inhalers)
Medical Name
If you have any questions about the use of asthma medications, Contact ASDA Drugs in Sport Hotline 1800 020506 (Mon to Fri 0900 to 2100) or Surf Life Saving Australia (02) 9130 7370 Medications may change each year You MUST renew your approval EVERY YEAR POLICY 3.9 VERSION 3, JULY 2006

REFERENCES / FURTHER READING
1. Australian Centre for Asthma Monitoring, 2003
2. National Asthma Council, 2002 Asthma Management Handbook
3. Oxford Textbook of Medicine 3rd edition. Oxford. 1990.
4. Self Management Education Evidence Based Review. P Gibson, 2000
5. Asthma Educators Association (NSW) 2002
6. Central Coast Health guidelines 2004
7. Drugs in Sport Handbook. Australian Sports Drug Agency - PO Box 345, Curtin
ACT 2605
8 Anti-Doping Policy. Surf Life Saving Australia, Sydney 2004.
9 MIMS Annual (all medications available) – www.mims.com.au
Reviewed as a draft by Ken Langbridge, Adult Asthma Educator, Central Coast
Health on behalf of the Copacabana SLSC as part of the Copacabana SLSC
asthma community activity. December 2004
POLICY 3.9 VERSION 3, JULY 2006

Source: http://sls.com.au/sites/sls.com.au/files/downloads/SLSA%20Governance/Policies/3.09%20%20Asthma%20Policy%20july06.pdf