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Use of the Refractory Period in the Treatment of Exercise- Induced Bronchoconstictions in a Collegiate Football Player:

Asthma. Exercise triggers asthma in 50 -90% of known Asthmatics (Parsons et al., Freed et al.)10 % of non ? asthmatics report symptoms of asthma during exercise (Parsons et al.)WheezingCoughing Tightness in chestInability to catch one's breathIncreased mucus production. Pathogenesis of EIB.

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Use of the Refractory Period in the Treatment of Exercise- Induced Bronchoconstictions in a Collegiate Football Player:

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    1. Use of the Refractory Period in the Treatment of Exercise- Induced Bronchoconstictions in a Collegiate Football Player: A Case Study Brian G Pietrosimone, M.Ed, ATC John MacKnight, MD Ethan Saliba, PhD, PT,ATC,SCS Jay Hertel, PhD, ATC

    2. Asthma Exercise triggers asthma in 50 -90% of known Asthmatics (Parsons et al., Freed et al.) 10 % of non – asthmatics report symptoms of asthma during exercise (Parsons et al.) Wheezing Coughing Tightness in chest Inability to catch one’s breath Increased mucus production

    3. Pathogenesis of EIB The pathogenesis behind exercise induced bronchospasm is not fully understood (Tan et al. & Chang- Yeung) Different Theories Dehydration of mucosal lining Bronchial mucosal hyperemia

    4. Dehydration of Mucosal Lining Cold, dry air causes dehydration of the mucus membrane Water loss causes an increase in osmotic pressure Mast Cell degranulation leads to inflammatory mediator release (Parsons & Mastronarde, Tan, Maler)

    5. Hyperemia Re- warming in the lungs causes distal airways to increase blood flow Increased hydrostatic pressure in bronchial vasculature Increased airway edema (Parsons & Mastronarde, Tan, Maler)

    6. History Setting ACC, NCAA Division 1 Football Program Climate Zone 3 Athlete Demographics 18 year old Male Single Caucasian Height: 6’ 2’’ Weight: 258 pounds Position: Defensive Line Hometown in Climate Zone 3

    7. Past Asthma History Health history form – Indicated past history of asthma Exercise was a stimulus No other health problems, or family problems Prescribed prior to enrolling at the University Albuterol MDI prn- short-acting bronchodilator Salmeterol (Serevent) MDI - long-acting bronchodilator Fluticasone propionate (Flovent) MDI- inhaled corticosteroid

    9. Differential Diagnosis Exercise Induced Bronchospasm Extrinsic Asthma Chronic Bronchitis Cardiomyopathy

    10. FEV1 Spirometry measurements reported a decrease of 19% in FEV1 - confirming the diagnosis of EIB (Tan and Spector) FEV1 = (Pretest FEV1 - Post test FEV1) x100 Pretest FEV1 No significant findings on Echocardiogram

    11. Pattern Team Physician noticed pattern

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