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The Informed Parent

Off the Sidelines And Into The Game: A Look At Exercise-Induced Asthma

by Louis P. Theriot, M.D., F.A.A.P.
Published on May. 01, 1997

"Every time that Tommy plays soccer, he coughs like crazy!" exclaimed one frustrated mother. "If Jennifer has asthma, I'm going to pull her out of swimming," declared another. "How can my son have asthma if he has never wheezed a day in his life?" asked a worried mom.

These three concerned mothers illustrate the dilemma faced by parents throughout the country each and every day regarding their child's exercise induced asthma. Should they keep them out of sports? Should they "take it easy," or should they plan on just watching from the sidelines?

Exercise induced asthma (EIA) has been well described in the medical literature, and has been studied quite extensively. EIA is a type of asthma that is directly brought about by strenuous activity. In this regard, it is different from the typical "asthma" that we usually think of. EIA affects about 8-12% of the population in the United States, and is more prevalent in people who tend to be "allergic" (those with eczema, food allergies, and hay fever, etc.).

Asthma refers to a medical condition (bronchospasm) that affects the bronchioles of the respiratory tract. These are the smaller sized tubes that carry the air to the lungs. The size of the bronchiole is controlled by a muscle that makes up part of it's wall. In asthma, the muscle "spasms," or constricts, which causes a narrowing of the bronchiole. This causes air to get trapped in the lungs, and the affected individual must work harder to exhale, or breathe out. It is during this forced exhale that one often hears a wheeze.

In milder cases of asthma, the bronchospasm may not be severe enough to cause an actual wheeze. In these cases, however, there may be irritation of the bronchioles which cause a persistent, nagging cough. This would explain the scenario of the boy who "never wheezed a day in his life."

The bronchospasm that occurs in EIA is directly a result of strenuous activity. The symptoms usually occur within 3-10 minutes of exercising, and tend to be transient. These include: coughing, shortness of breath, chest pain, wheezing or tightness in the chest area. The symptoms typically resolve within 15-30 minutes after the activity is stopped.

Needless to say, this can be most distressing to a child, and very frightening to a parent. After a few bouts of EIA, it is easy for a child to shy away from activities that trigger the EIA. Parents are fearful (understandably) to let their children participate in these events, especially if every time they play, they end up coughing, wheezing or complaining of chest pain. But this need not be the case.

EIA is not only treatable, but in most cases, preventable. A diagnosis of EIA should not mean that a child is sentenced to a life of watching from the sidelines. Quite the contrary.

The 1988 U.S. Olympic team which competed in Seoul, Korea, had 667 athletes on the team--52 of which had EIA. The athletes who did have EIA won medals in the same proportion as those without EIA.

Most cases of EIA are responsive to bronchodilators (medications that relieve the spasm of the bronchiolar muscle), and most are taken in the form of an inhaler. One to two puffs are usually taken just a few minutes before the sporting activity or exercise. This will usually prevent the symptoms of EIA from even starting. It is not at all uncommon to see a world class athlete take their inhaler right before competing in their event.

If the diagnosis of EIA is uncertain or unclear, there is a "provocative" test that can be done to cinch the diagnosis. This entails having the patient exercise on a treadmill or stationary bike, and then perform pulmonary function tests to quantitate the degree of bronchospasm. This test is very sophisticated, expensive, and rarely necessary to make a diagnosis.

There are certain conditions that seem to play a role in triggering the EIA, and these include: exercising in cold and dry air, sudden strenuous activity, insufficient warm-up period, and bursts of strenuous activity (running wind sprints). Some environmental factors may also be contributory, and these are air pollutants (smog, smoke), and low humidity.

A person who is known to have EIA should be cautious when exercising in these conditions. This is where the inhaler can be of tremendous benefit. The person can take two puffs of the bronchodilator while they are putting on their gym clothes, soccer shoes, or swim suits, etc. This should allow them to perform without any consequence from the EIA.

EIA is a relatively common condition that affects all ages. It tends to be more "ominous" in children because its onset is sudden. It can be frightening to both child and parent. It is, however, easily treatable...and in most cases preventable. It should in no way alter the activities or affect the life style of those with EIA. Children with EIA should be encouraged to pursue all the endeavors they wish. It would be a shame to keep these children on the bench, out of the game.

Think how many world records would not have been set, or how many gold medals not won, if these athletes were told as children, "try something else...something less physically demanding. After all, you do have asthma!"

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