Asthma prevalence is roughly 8% in the US population1, and a breakdown by profession does not currently exist. Asthma, particularly exercise-induced asthma, is an underdiagnosed condition that is an occupational hazard in many athletes and artists. Singers and woodwind and brass instrumentalists may be particularly at risk of disruption of their work in the setting of asthma exacerbations that would be relative inconveniences to other individuals. In these artists, however, there is an additional significant risk of undertreatment of their asthma exacerbations due to significant differences between their breathing and that of typical patients.

Objective: Assessment of lung function in a sample of professional and university-level singers to establish baselines and guide treatment of respiratory disease exacerbations.

Methods: We will present data on baseline breathing measurements in professional and university level singers and strategies for obtaining usable lung function measurements, and management strategies to ensure singers receive appropriate treatment for these serious and sometimes life or career-threatening episodes.

Results: Trained singers, instrumentalists and athletes may have much higher baseline lung function than expected, with some estimates between 10% and 50% above typical population baselines used for spirometry and other quantitative lung measurements. Further, because of training in sustaining breath in vocal performance, breathing in singers may be difficult to accurately measure by standard spirometry, due to a very prolonged expiratory phase used to support singing. We have seen similar patterns in other singers and in endurance athletes such as runners.

Conclusions:
The danger for singers with asthma, however, is that "asthma action plans" create an approach based on percentages of a patient’s own healthy vital capacity. Treatment plans are typically calibrated to interventions at 80%, 50% and 30% of the patient's own baseline breathing levels (volume and flow of air). Since treatment is based on how far a patient is from his or her own capacity, singers whose healthy normal may be significantly higher than typical patients of their age, height and gender may be sicker than they appear.

In athletes, singers, and instrumental artists with well-trained breathing, especially for those with unknown baseline measurements, their apparently normal numbers when sick may mask just how close to danger these patients may be. Doctors who are unfamiliar with the patient may, therefore, underestimate their risk and provide less medication and less aggressive medical intervention than is necessary to protect the patient from further decompensation and return them to their healthy baseline (and back to work).