The frightening truth is children can die from asthma during sports, even if their condition isn't severe, says Dr. Jack M. Becker, chief of allergy and asthma at St. Christopher's Hospital for Children in Philadelphia.

"You can be mildly asthmatic and have a severe exacerbation," he explains.

It's not that kids with asthma are any less competitive on the athletic field than their peers. Nor should they give up sports. They just have to be smart about how they play, taking special precautions to avoid an asthma flare-up.

Becker is lead author of a study published earlier this year that documents asthma death during sports, a little-recognized problem. Many sports medicine texts don't even address asthma as a problem for athletes, he said.

Researchers hope to educate physicians, coaches, trainers and parents about the risk of sudden fatal asthma attacks during sports.

"We're not trying to tell kids not to play," Becker insists, adding that organizers of sporting activities need to anticipate an asthma event, the same way colleges keep defibrillators on hand just in case a player goes into cardiac arrest.

"They should be prepared for an asthma attack," he says, "because asthma is a heck of a lot more common."

Almost 5 million children have asthma, a chronic breathing problem caused by swelling and closing of the airways, according to the American Academy of Allergy, Asthma & Immunology. Common symptoms include coughing, wheezing, shortness of breath and chest pains or tightness.

Certain "triggers" - from pollen and mold to dust and cigarette smoke - can make symptoms worse. Exposure to cold air or exercise also may cause symptoms to flare. Without immediate treatment to keep a child's airways from constricting, asthma can sometimes be fatal.

States recently have begun addressing the issue, according to Nancy Sander, president and founder of the Allergy & Asthma Network Mothers of Asthmatics. In August, California became the 31st state to pass legislation allowing children to carry their asthma inhalers with them, and most states acted within the last year, she said.

Sander's group endorses a federal bill that would encourage schools to allow children with asthma to self-medicate.

"You should never, ever restrict a child's use of inhaler," she says.

Asthma isn't generally considered a cause of death among athletes.

But Becker and his colleagues showed otherwise by combing news reports for possible sport-related asthma deaths. In each instance, they requested autopsy records to confirm the cause of death and contacted parents for additional information.

Their report appeared in the February issue of the Journal of Allergy and Clinical Immunology.

A total of 61 confirmed asthma deaths occurred during the seven-and-a-half year study period.

Those most at risk of dying were white males between the ages of 10 and 20. Deaths of whites outnumbered those of blacks by almost two-to-one. There were twice as many male deaths as female deaths.

While basketball and track accounted for more asthma deaths than any other sport, fatalities occurred across several athletic activities, including football, swimming and cheerleading.

"Any aerobic sport can do it," Becker says.

Despite the risks, compelling reasons exist for children with asthma to get in the game: It helps them to forge friendships, learn teamwork and cooperation, and get needed exercise. With proper precautions, asthmatic children needn't sit on the sidelines.

Here are some tips that parents can follow to help keep their kids safe:

• Make sure the child's rescue inhaler is close by.

• Make sure the child's asthma is stable. If your son is up during the night coughing and wheezing, it's probably not a good idea for him to go out and play four hours of football the next day, Becker said.

• If a child needs rescue medication before a game and once during the game, fine. He or she may use it a third time if necessary, but don't allow the child to continue to play, Becker said.