Read the case below and answer the questions as completely and specifically as you can. Remember to go through the steps of POEM (Problem Oriented Exercise Management).
Case
A 21-year-old female elite cross-country runner (height: 5’9”; weight: 120 lbs.; RHR 62 bpm; BP: 116/68 mmHg) complained of wheeze during exercise and presented with post-exercise cough and chest tightness. She has symptomatic episodes with her asthma during training runs and races 5K and longer. She had previously seen her family doctor, who had prescribed pre-exercise albuterol as needed. However, she was using albuterol daily and was still somewhat symptomatic. During the doctor’s visit she had a positive skin test to dust mite, cat dander, ragweed, and mold spores. No indication of childhood asthma was presented with her history. By rules governing international competition, in order for her to obtain therapeutic exemption to use a short-acting bronchodilating agent (SABA), she must test positive to a bronchial challenge test.
Pertinent Exam Information:
Atopic, normal-appearing elite runner
Medications
Albuterol as needed
Lab Tests
Skin testing positive to dust mite, cat dander, ragweed, and mold spores
Exercise Test Results
VO2max: 73 mL/kg/min
Peak HR: 198 beats/min
RPE: 10/10
Termination reason: plateau in oxygen uptake and heart rate despite increasing treadmill elevation at 9 mph (14.5 km/h)
Clinical symptoms: no symptoms of bronchial hyperresponsiveness
Pulmonary Lab Tests
Resting FEV1: 120% of predicted, with no increase in FEV1 after administration of SABA
Eucapnic voluntary hyperventilation (EVH) bronchial challenge test, in which the patient ventilates compressed medical-grade air with 5% CO 2 for 6 min at 30 × FEV 1 (~85% maximal voluntary ventilation):
The patient did not have clinically significant posttest bronchoconstriction. A more detailed history was obtained, which revealed that symptoms occurred only toward the end of long-duration events or training.
Additional lab tests were performed:
– Methacholine test: positive
– Treadmill test to mimic race conditions revealed a significant post-exercise decrease in FEV 1
Start with the following questions (You may not have a definitive answer for each question)
Does person participate in regular exercise?
Is there any known disease?
Does person report or show signs or symptoms of disease?
What is the person’s desired intensity?
Is medical clearance necessary?
Steps of POEM
Collect subjective data – What, if any, subjective information is included in the case? Is there any information not available that you would like to know?
Collect objective data – What, if any, objective information is included in the case? Is there any information not available that you would like to know?
Assessment – With the available subjective and objective information what are the most important issues that need to be considered when designing an exercise plan and why?
Formulate an exercise plan – What major elements with you include and/or exclude in an exercise plan for this individual?
Follow-up – We can’t really complete this part, but if you were you would re-assess and talk to the individual during and after their workouts to best tailor the program to meet there individual’s needs.
Other questions
- What are the unique features of this case? How will the exercise treatment for this case have to be different from the other cases that were discussed in the course? Why?
- Being that this is an elite level athlete; could there be any issues with performance enhancing drug use with her prescribed drugs? How who you handle this situation?
