Health Issues: Asthma
Exercise Induced Asthma
Posted January 21, 2009
By Lyle Micheli, MD-Children's Hospital Boston
Asthma is a disabling lung disorder characterized by wheezing and shortness of breath that affects an estimated eight million Americans.
Most doctors and nurses are familiar with the diagnosis and treatment of asthma, but much less is known about exercise-induced asthma. As the name suggests, this condition is brought on only by exercise. If your child shows signs of being out of breath even after mild exertion, he should be checked out for exercise-induced asthma.
Exercise-Induced asthma tends to begin in childhood. When a child has Exercise-Induced Asthma, he soon learns that physical exertion causes discomfort, though he may not recognize the symptoms. He may start to avoid exercise and become withdrawn, solitary, and sedentary. Since these children can’t exercise without suffering an asthma attack, they often think they are “unathletic.” This problem can be compounded if the primary care physician doesn’t recognize the condition as exercise-induced asthma and parents attribute the child’s unwillingness to participate in sports and fitness to a lack of “drive” or competitive spirit. As a result, many children with undiagnosed exercise-induced asthma drop out of sports altogether. This leaves them at higher risk of becoming obese and of not developing good heart-lung and bone-muscle fitness.
As adults, Exercise-Induced Asthma sufferers may be more vulnerable to a host of diseases due to inactivity, including heart disease, lower-back pain and osteoporosis. Most children with exercise-induced asthma don’t know they have asthma, and therefore don’t seek treatment to improve their condition. But with proper diagnosis and treatment, their world can expand dramatically. Asthma is one condition for which drug treatment can be truly liberating.
The most common drug recommendation for exercise-induced asthma is pre-treatment with Albuterol, an inhaled medication typically used for quick-relief during an asthma attack. In the case of exercise-induced asthma, it is used before the child engages in a physical activity and before asthma symptoms occur. Two puffs taken 15 to 20 minutes before starting a physical activity or sport is usually recommended. How can kids with asthma and exercise-induced asthma safely and successfully participate in strenuous sports? Asthma itself is not reason to avoid exercise. The vast majority of people with asthma show no deterioration of lung function even after repeated asthma attacks. If medication is taken to prevent attacks during exercise, the capacity to exercise should be as great as in people without asthma.
Advice to young athletes with exercise-induced asthma
Perform a warm-up (15 minutes light intensity, followed by 15 minutes moderate-to-high intensity) before training or competitions
Avoid training in cool or dry weather conditions
Avoid training in areas such as forests or grass fields where there may be pollen
Avoid training in polluted air
Wear a face mask when training in cold weather conditions
While drugs are an essential treatment for exercise-induced asthma, so is physical training, which can dramatically improve resistance to attacks. Because running for more than six minutes may trigger an asthma attack, short-duration “interval training” regimens are the most effective for improving lung function. Most exercise programs for people with asthma stress a combination of running and rest, or running and walking. The intervals should be short: two minutes of running and four minutes of rest, building up to five minutes of running and 10 minutes of walking or rest.
Exercise Recommendations for Improved Lung Function
Warm up with a combination of running and rest, or running and walking
Start with: Two minutes of running and four minutes of rest
Build up to: Five minutes of running and 10 minutes of walking/rest
Eventually, through a properly conducted exercise program, children with asthma will be able to increase their heart-lung endurance considerably. Several coaches have reported that children in their programs with asthma show fewer symptoms as the season progresses, but when the season is over and they get out of condition, there is a much higher incidence of asthma attacks. This fact reinforces the need for cardiovascular conditioning for children with asthma. One of the most important decisions for children with asthma and their parents is choosing the right sport. Outdoor endurance sports, such as soccer and cross-country skiing, are most likely to trigger an asthma attack. Particularly in a cold, dry environment, sports that mix short bursts of activity with rest periods, such as baseball, tennis, and sprints, are more suitable. Indoor swimming with its warmth and high humidity is perhaps the ideal sport for a child with asthma. A combination of conditioning, drugs, breathing exercises and the right sport will enable the vast majority of children with lung disorders like asthma to participate safely and successfully, and to receive all the physical benefits and pure enjoyment that sports offer.
Source: Adapted from The Sports Medicine Bible for Young Athletes by Lyle J. Micheli, M.D., Sports Medicine Director, Children’s Hospital Boston, with Mark Jenkins (Sourcebooks, Inc., 2001).