Athletes with asthma tend to do better at the Winter Olympics

From cross-country skiing to speed skating, the Winter Olympics is full of breathless feats of endurance. And for a large number of Olympic athletes, the breathlessness isn’t just over who will win the next medal—it’s from asthma. But if you think the condition could hold Olympians back, think again: Athletes with asthma are more likely to win medals than their competitors.

Up to one in four winter Olympians have asthma, a condition that constricts the airways and makes it difficult to breathe normally. That’s no surprise to John Dickinson, a professor at the University of Kent’s School of Sport and Exercise Sciences. He’s studied asthma in elite competitors for years and says that the number of athletes with the condition can skew even higher in endurance sports: up to 70 percent in swimmers and 50 percent in cross-country skiers.

Endurance sports might attract athletes who have asthma, he says, but they can also cause breathing problems in and of themselves. Normally, people breathe through their nose, which warms and humidifies the air, filtering out gnarly particles and noxious chemicals along the way. But during endurance events, says Dickinson, most athletes temporarily turn into mouthbreathers.

“You get unconditioned air going into the airway,” he says. This, in turn, wreaks havoc on the lungs, drying out their air sacs and fueling inflammation. Asthma can result—and as his research with athletes shows, it often does.

These athletes manage to make it to the Olympics despite all that wheezing and coughing, and even outperform challengers without asthma. That’s especially true during the Winter Games.

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Americans who have medaled at the 2018 Winter Olympics
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Americans who have medaled at the 2018 Winter Olympics
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 13: Gold medalist Chloe Kim of the United States poses during the medal ceremony for the Snowboard Ladies' Halfpipe Final on day four of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 13, 2018 in Pyeongchang-gun, South Korea. (Photo by Sean M. Haffey/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 13: Bronze medalist Arielle Gold of the United States poses during the medal ceremony for the Snowboard Ladies' Halfpipe Final on day four of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 13, 2018 in Pyeongchang-gun, South Korea. (Photo by Sean M. Haffey/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 11: U.S. Olympian Red Gerard poses with his Gold Medal at the USA House at the PyeongChang 2018 Winter Olympic Games on February 11, 2018 in Pyeongchang-gun, South Korea. (Photo by Joe Scarnici/Getty Images for USOC)
USA's gold medallist Jamie Anderson poses on the podium during the medal ceremony for the women's snowboard slopestyle at the Pyeongchang Medals Plaza during the Pyeongchang 2018 Winter Olympic Games in Pyeongchang on February 12, 2018. / AFP PHOTO / Fabrice COFFRINI (Photo credit should read FABRICE COFFRINI/AFP/Getty Images)
USA's silver medallist Chris Mazdzer poses on the podium during the medal ceremony for the men's luge singles at the Pyeongchang Medals Plaza during the Pyeongchang 2018 Winter Olympic Games in Pyeongchang on February 12, 2018. / AFP PHOTO / Fabrice COFFRINI (Photo credit should read FABRICE COFFRINI/AFP/Getty Images)
The USA team who won bronze pose on the podium during the medal ceremony for the figure skating team event at the Pyeongchang Medals Plaza during the Pyeongchang 2018 Winter Olympic Games in Pyeongchang on February 12, 2018. / AFP PHOTO / Fabrice COFFRINI (Photo credit should read FABRICE COFFRINI/AFP/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 12: Bronze medalists Maia Shibutani and Alex Shibutani of the United States pose with their teammates during the victory ceremony after the Figure Skating Team Event at Medal Plaza on February 12, 2018 in Pyeongchang-gun, South Korea. (Photo by Adam Pretty/Getty Images)
USA's Shaun White with his gold medal after victory in the Men's Halfpipe Snowboard during the medal ceremony at the Medal Plaza during day five of the PyeongChang 2018 Winter Olympic Games in South Korea. (Photo by Mike Egerton/PA Images via Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 15: Gold medalist Mikaela Shiffrin of the United States celebrates during the medal ceremony for Alpine Skiing - Ladies' Giant Slalom on day six of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 15, 2018 in Pyeongchang-gun, South Korea. (Photo by Alexander Hassenstein/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 18: Silver medalist Nick Goepper of the United States celebrates during the medal ceremony for the Freestyle Skiing Men's Ski Slopestyle on day nine of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 18, 2018 in Pyeongchang-gun, South Korea. (Photo by Chris Graythen/Getty Images)
TOPSHOT - USA's silver medallist John-Henry Krueger kisses his medal on the podium during the medal ceremony for the short track men's 1000m at the Pyeongchang Medals Plaza during the Pyeongchang 2018 Winter Olympic Games in Pyeongchang on February 18, 2018. / AFP PHOTO / JAVIER SORIANO (Photo credit should read JAVIER SORIANO/AFP/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 20: Bronze medalists Maia Shibutani and Alex Shibutani of the United States celebrate during the medal ceremony for Figure Skating - Ice Dance Free Dance on day 11 of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 20, 2018 in Pyeongchang-gun, South Korea. (Photo by Ezra Shaw/Getty Images)
USA's bronze medallist Brita Sigourney poses on the podium during the medal ceremony for the freestyle skiing women's halfpipe at the Pyeongchang Medals Plaza during the Pyeongchang 2018 Winter Olympic Games in Pyeongchang on February 20, 2018. / AFP PHOTO / Fabrice COFFRINI (Photo credit should read FABRICE COFFRINI/AFP/Getty Images)
Pyeongchang, Gangwon - FEBRUARY 21: Bronze medallist Lindsey Vonn of the United States celebrates during the medal ceremony for the Ladies' Downhill on day twelve of the PyeongChang 2018 Winter Olympic Games at Medal PlazaFebruary 21, 2018 (Photo by Hyoung Chang/The Denver Post via Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 21: Heather Bergsma, Brittany Bowe, Mia Manganello and Carlijn Schoutens of the United States celebrate after winning the bronze medal in the Speed Skating Ladies' Team Pursuit Final B against Canada on day 12 of the PyeongChang 2018 Winter Olympic Games at Gangneung Oval on February 21, 2018 in Gangneung, South Korea. (Photo by Amin Mohammad Jamali/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 21: Jessica Diggins of the United States (L) and Kikkan Randall of the United States celebrate as they win gold during the Cross Country Ladies' Team Sprint Free Final on day 12 of the PyeongChang 2018 Winter Olympic Games at Alpensia Cross-Country Centre on February 21, 2018 in Pyeongchang-gun, South Korea. (Photo by Matthias Hangst/Getty Images)
PYEONGCHANG, Feb. 22, 2018 -- David Wise of the United States celebrates with his family after men's ski halfpipe of freestyle skiing at the 2018 PyeongChang Winter Olympic Games at Phoenix Snow Park, PyeongChang, South Korea, Feb. 22, 2018. David Wise won the gold medal with 97.20 points. (Xinhua/Wu Zhuang via Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 22: Jamie Anderson of United States is seen with her silver medal from the Ladies Snowboard Big Air Final at Medal Plaza on February 22, 2018 in Pyeongchang-gun, South Korea. (Photo by Ian MacNicol/Getty Images)
PYEONGCHANG, SOUTH KOREA -FEBRUARY 22: Silver medalist Mikaela Shiffrin #19 of the United States at the presentations after the Alpine Skiing - Ladies' Alpine Combined Slalom at Jeongseon Alpine Centre on February 22, 2018 in PyeongChang, South Korea. (Photo by Tim Clayton/Corbis via Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 22: (L-R) Carlijn Schoutens and Mia Manganello of the United States celebrate during the medal ceremony for Speed Skating - Ladies' Team Pursuit on day 13 of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 22, 2018 in Pyeongchang-gun, South Korea. (Photo by David Ramos/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 22: Silver medalist Alex Ferreira of the United States celebrates during the medal ceremony for Freestyle Skiing - Men's Ski Halfpipe on day 13 of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 22, 2018 in Pyeongchang-gun, South Korea. (Photo by David Ramos/Getty Images)
PYEONGCHANG-GUN, SOUTH KOREA - FEBRUARY 22: Silver medalists Lauren Gibbs and Elana Meyers Taylor of the United States celebrate during the medal ceremony for Bobsleigh - Women on day 13 of the PyeongChang 2018 Winter Olympic Games at Medal Plaza on February 22, 2018 in Pyeongchang-gun, South Korea. (Photo by David Ramos/Getty Images)
GANGNEUNG, Pyeongchang- FEBRUARY 22 - Team USA with their medals as Canada loses in a shootout to the United States in the Olympic women's hockey gold medal game at the Gangneung Hockey Centre in Gangneung in Pyeongchang in South Korea. February 22, 2018. (Steve Russell/Toronto Star via Getty Images)
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In a 2012 literature review, asthma expert Kenneth D. Fitch crunched the numbers. He found that during the Salt Lake City Winter Games in 2002, 5.2 percent of athletes had asthma, but that group won 15.6 percent of the medals. He observed the same effect in Torino in 2006 (7.7 percent of athletes with asthma won 14.4 percent of the medals) and Vancouver in 2010 (7.1 percent of athletes with asthma won 11.8 percent of the medals).

Could athletes’ asthma inhalers explain their dominance? Dickinson has spent years trying to find out.

Consider a salbutamol inhaler, one of the most common types. (You may know it as albuterol or Ventolin.) It’s a beta-2 agonist inhaler that relaxes the bronchial passages, making it easier for people with asthma to breathe. In 1972, the International Olympic Committee banned it as a stimulant. The IOC went back and forth for years on whether to allow the inhaler, but eventually okayed it. Over 90 percent of Olympic athletes who applied for asthma exemptions between 2004 and 2008 used such devices.

“As long as you’re using the right inhalers, your lungs are as if you haven’t got asthma. You’re on a level playing field,” says Dickinson. But what if you take a huge dose? Could that skew the field in your favor?

It depends on whether you actually have asthma or not. Years of studies show little evidence that beta-2 agonists give an advantage to people without asthma. And in ordinary doses, they don’t provide an advantage to people with asthma, either. Asthmatic athletes that try megadoses of beta-2 agonist inhalers might get some kind of boost, but they would likely experience side effects—including a pounding chest and dizziness—that would make it hard to compete.

But what if you popped corticosteroids, which reduce inflammation in the chest, instead? “It’s quite an aggressive form of treatment,” Dickinson says, “but the gray area is that that level of steroid has been shown to reduce muscle inflammation. An athlete is going to feel better when they’re doing the sport and will recover faster.” But, says, Dickinson, “If your asthma is that bad, you probably shouldn’t be competing anyway.”

Since athletes must currently apply for a dispensation to take those drugs—including assessments by an independent panel—it’s unlikely they can slip through to the field undetected. Dickinson thinks athletes who need oral corticosteroids should be required to step off the field temporarily to recover and eliminate any chance of an on-field advantage due to their medication. With the help of researchers like Dickinson, the World Anti-Doping Agency is continually revising its standards not only to prevent inhaler doping, but also to protect the health of athletes with asthma.

There’s another reason people with asthma might do better in the Olympics: because they have to pay more attention to their breath. Even though exercise can induce asthma, it can also protect against bad attacks when sportspeople warm up properly. Techniques like nose breathing and the use of face masks can also help before competition.

“When we improve breathing quality, symptoms can go away,” says Dickinson. “If your asthma is well controlled, you can do anything a non asthmatic can do.” And maybe you can do anything better than they can, too.

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