Summer is over and many adults and children are planning fall
and winter sports or other exercise-related activities. We don't
often stop and think about asthma and exercise. And yet, asthma
in general, whether exercise induced or chronic, is one the most
common chronic diseases worldwide which patients, parents and
health care providers need to think about and understand.
Consider the statistics: In the United States alone, there are
10 million asthmatics, with up to 30% being children; Asthma
attacks will cause significant absences from school and work,
generating at least 6.5 million outpatient visits and 450,000
hospital admissions, at a staggering cost of 4 billion dollars;
Despite growing awareness, better understanding of the
physiology and excellent medication, the prevalence and death
rate from asthma in the 1990s is increasing.
How does exercise cause asthma?
Remember that asthma is a genetic disease which at times may be
well controlled, while at other times, may be associated with
chest tightness, shortness of breath or wheezing. A child may,
for example, be perfectly healthy and then start coughing and
wheezing during and after exercising or playing sports. In this
case, the rapid breathing of cold, dry air causes airways to
narrow and become obstructed, triggering coughing and wheezing.
Without question, our awareness
of asthma has increased, and is due to better patient and parent
education. A special NIH panel has determined that asthma should
be classified as being mild, moderate or severe, and the
inflammation associated with asthma should be treated with
inhaled steroids, or the newer leukotrienes antagonists (see
Asthma articles #1,2,3), depending on the kind and frequency of
daytime symptoms, nighttime sleeping problems and peak flow
values. The mild category is interesting and further divided
into two types: mild intermittent and mild persistent. Mild
persistent asthma should be treated with inhalers regularly.
Patients who wheeze or get short of breath occasionally, as may
occur with exercise, are considered to have mild intermittent
asthma and are treated as needed. More recently, however, a lot
of debate and research has suggested that regular treatment may
help prevent intermittent asthma from worsening and becoming
persistent. The decision to treat regularly will depend on each
individual patient, whether child or adult.
For exercise induced mild
asthma, warm up in an indoor setting before starting the outdoor
activities. Use a short acting bronchodilator 5-60 minutes
before exercise is usually sufficient to relax the airways and
prevent any symptoms from occurring. The most commonly
prescribed short acting bronchodilator is Proventil HFA.
Proventil HFA and similar bronchodilators are commonly
recommended for any acute exacerbation of asthma. In certain
cases, however, a reaction may occur several hours after the
exercise, with the airways becoming inflammed and causing
wheezing, breathlessness, chest tightness, and cough. For these
patients, steroids may very well be needed.
What if a patient plays several
sports and needs a bronchodilator more than once a day for
prevention? One can use longer acting (i.e., up to 12 hour)
bronchodilators such as inhaled Serevent or oral Volmax, to
prevent and treat symtoms all day long. Even the new leukotriene
antagonists, Singulair and Accolate, may have benefit in
preventing exercise induced asthma.
Heighten your awareness
,therefore, and consider having an evaluation for asthma if you
or your child has had: an attack or recurrent attacks of
wheezing; coughing or chest tightness after viral infections,
exposure to airborne allergens, pollutants (i.e., smoke, ozone),
cold air, sports or exercise. Viral infections that "go to
the chest" and take more than 10 days to clear, and in
which over-the-counter medication have failed should be
evaluated immediately.