Case Report: New Onset Anxiety in An Elite Athlete with Uncontrolled Asthma

Abstract

Anxiety in elite athletes has been well-documented and can significantly affect both mental health and athletic performance. Generalized and social anxiety in particular, have been shown to be higher in athletes compared to the general population. However, new onset anxiety due to poorly controlled asthma in elite athletes can be missed when multi-disciplinary care is absent. We present the case of a 17-year-old male ice hockey player with a history of moderate persistent asthma exacerbated by viral triggers and cold air. His symptoms were well-controlled during the spring and summer months with as needed bronchodilator-inhalers. During his fallwinter ice hockey season, he experienced severe exacerbations requiring multiple medical interventions including daily combined long-acting bronchodilator and steroid inhaler, as needed bronchodilator treatment during practices and games, and frequent treatment with oral steroids and antibiotics. Before his season, he was a well-adjusted high school student and reported no symptoms of depression or anxiety. Between October and March, he began to experience poor sleep, low mood, and fatigue. At follow up appointments, he also expressed increased intense worry about his athletic performance, missed practices or games due to exacerbations and need for so many medications. We referred him to a  psychotherapist who made a diagnosis of intermittent anxiety due to situational triggers. Psychotherapy was initiated with good response. The relationship between asthma and anxiety in athletes is multifaceted and clinically significant. Routine screening and targeted interventions by any physician treating an elite athlete with asthma is warranted.