Asthma, sport, and exercise

Most children with asthma cough or develop a tight chest after certain kinds of exercise. Cold or dry air, may act as physical triggers causing the air pipes in the lungs to narrow. If they narrow slightly, the child simply coughs after the exercise. If they narrow even more, the chest becomes tight. This occurs after about six to ten minutes of exercise, and may interfere with continuation of sport. If not recognised, the child will perform the exercise with a partially tight chest. The tight chest may open on its own after an hour or two, or it may become necessary to consult a doctor. This coughing or tightness of the chest after exercise is part of asthma and expected in this condition. It is easily prevented with safe medications. Some children's symptoms after exercise are the only sign of asthma as they do not cough or wheeze at other times.

Some common questions and answers about ASTHMA, SPORT and EXERCISE

If my child has asthma .....

Should my child be allowed to play sport?

Definitely yes. This is one of the goals of successful asthma management. Correct uses of simple medications should prevent symptoms that occur with exercise in asthmatic children (cough, chest tightness).

What kinds of exercise are better?

• Swimming is a good sport for asthmatic children
• Short burst types of exercise are better e.g. sprinting
• Longer distance running, where an asthmatic child runs at about three quarters pace for 6-10 minutes, is more likely to cause coughing and tightness of the chest e.g. cross country running or marathon running.

What if your child likes running long distances and cannot swim well?

Encourage them to continue running. Use the simple methods outlined below to prevent symptoms during exercise.

What can I do to improve my child's exercise tolerance?

Use the recommended asthma pumps to prevent exercise related chest tightness. Encourage fitness and normal activity as exercise is good for everyone. This usually allows children to cope better with asthma.

How do you prevent your child from developing exercise induced wheezing or coughing?

Exercise related coughing or wheezing can be prevented by using simple safe medications (asthma pumps) before exercise.
Examples of effective medications include (see leaflet "Asthma medicines and how they work")

• Reliever (bronchodilator) inhaler pumps e.g. fenoterol (Berotec) 1 puff, salbutamol (Ventolin or Venteze) 1-2 puffs or terbutaline (Bricanyl) 1 puff, 10-15 minutes before exercise.
• Reliever bronchodilator dry powders e.g. Berotec inhalers, Bricanyl turbuhalers or Ventolin rotacaps, Ventodisks or Ventolin Accuhaler.
• Preventer mast cell stabilisers e.g. sodium cromoglycate (Lomudal) - 1 puff.
• Reliever nebulised bronchodilators - effective but cumbersome.

How do I treat my child once the exercise related coughing or wheezing has already happened?

Use a reliever bronchodilator. Sodium cromoglycate, theophyllines and inhaled steroids will not relieve symptoms once they have started.

If my child gets an asthma attack during a sporting event, when should the exercise be stopped?

Prevention is always better than cure. If the attack occurs despite use of a reliever medication before the exercise, repeat this medication during the exercise when the chest gets tight. If the symptoms continue the exercise should probably be stopped.

Is it important to recognise exercise induced asthma?

Yes. This is an important clue for diagnosing asthma. It can easily and effectively be treated. It may mean that an asthmatic with child exercise induced difficulty needs more medication, and that the asthma is not properly controlled.

Are any asthmatics famous for sporting achievements?

Many Olympic medals have been won by people with asthma. Also, many children with asthma achieve provincial and national colours for their sports.

What about Sporting Drug Control Units and the legality of inhaled corticosteroids used for asthma?

Inhaled corticosteroids are not the same as anabolic steroids used by some athletes to improve their performance.

Inhaled corticosteroids for asthma are allowed by sporting regulating agencies. However, the sporting authorities need to be informed about the use of inhaled steroids and permission obtained for their use before the event(s).

How do I decide if my child has exercise related asthma or not?

All children get breathless after exercise. If exercise is followed by coughing, wheezing or chest tightness, exercise induced asthma is very likely. Your child can blow into a peak flow meter for measuring breathing before and after exercise. If the read (peak flow) on the meter drops by 15% or more, it confirms that your child is getting exercise induced asthma (see leaflet "A guide to peak flow in childhood asthma").

How soon can my child resume exercise after an attack?

Usually children whose peak flow reading has returned to within 80% of the value expected for their height, are able to exercise normally and safely. Your doctor can assist you in making this decision.

Should my asthmatic child be encouraged to lead a completely normal life, with regular competitive exercise?

Yes.

Are there any ways of preventing exercise induced asthma without using medications?

As the medications are safe, using them is the best way to control exercise induced asthma. However, if you warm up first with some stretching and slow running, the exercise that follows will be managed better.

What if my child gets asthma all the time, and cannot do strenuous exercise?

This probably means that your child's asthma is under treated. Consult your doctor to choose the preventer treatment best suited to your child's needs.

Are there any sports that asthmatic children should avoid?

Children whose asthma is correctly managed and well controlled can easily play the sport of their choice. The only sport that asthmatic children should participate in with caution is scuba diving.

Written by: Dr Fred Nagel