By Dr. Chris Fanta, Brigham & Women’s Hospital

While the challenges that Rich Wilson and the skippers of Vendée Globe face are enormous—managing a large sailing vessel by yourself, day after day, without break, and without a “time out” for bad weather—Rich Wilson has another obstacle to overcome that may not be shared by other skippers. Rich has asthma.

Asthma is a very common disease. In the United States approximately seven million children under age 18 have asthma, and an additional 16 million adults have the disease. In asthma, the breathing tubes in the lungs can become narrowed in two ways: (1) the bands of muscle that encircle the tubes squeeze down on the tubes, and (2) the tube walls can swell and fill with mucus. The result can be difficulty breathing (like breathing through a narrow straw), tightness in the chest, and wheezing.

So how can Rich Wilson, who needs to be capable of peak performance at any moment, avoid an asthma attack while circumnavigating the globe? The key is prevention. Rich takes several asthma medicines every day to prevent asthmatic reactions in his airways. Periodically, Rich will take additional medicine (a bronchodilator inhaler) before strenuous exertion. This medicine keeps the muscles from contracting in response to exertion.

Lastly, since Rich is far out to sea, it is unlikely that he will experience asthma attacks caused by pets, cigarette smoke or air pollution.