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Asthma is the most common chronic respiratory disease among children and young adults. There are numerous triggers of asthma. In the physical education field (EIA) exercise induced asthma is a very important disease to understand and help maintain stability. Asthma is a chronic lung disease that makes breathing difficult. During an attack, the linings of the bronchial tubes become inflamed and irritated causing mucus production and the constriction of surrounding muscles. These three factors cause a narrowing of the tubes blocking the amount of air into and out of the lungs.
This disease cannot be cured but control and treatment will lessen the severity and frequency of attacks. The exact cause of asthma is unknown, but has been found to run in families. Persons with asthma may be supersensitive to many substances and environmental conditions that are normally harmless. Common triggers are allergens (pollen, molds, animal dander, dust, and dust mites), as well as irritants (smoke, fumes, and strong odors), exercise, stress, and changes in weather and temperature.
Also a cold or flu, certain drugs, and food additives can be triggers. There are five classifications of asthma based on severity, 5. Severe persistent, which is when the symptoms are bad enough to limit daily activities, frequent nighttime symptoms also occur. This classification requires the most intensive treatment. 4. Moderate persistent is when symptoms occur every day and or cause night symptoms several times a week. 3.
Mild persistent, is when symptoms occur several times a week and or occasionally at night. 2. Mild intermittent, which is when the symptoms occur about twice a week or less. Otherwise breathing is normal. The last and least severe is exercise-induced asthma (EIA), which means that the symptoms are generally limited to periods of sustained physical activity. When exercising vigorously for a few minutes or longer chest tightness, coughing and wheezing will occur. The symptoms can be relieved by a period of rest, but can persist for a few minutes or a few hours after the activity has stopped.
When not active, breathing is normal. EIA is optimally treated by the use of a short acting inhaled bronchodilator 15 to 30 minutes before the start of the exercise. If the exercise is longer or pre- activity medications were forgotten, additional use of the inhaler may be needed. At least 80 % of people with asthma have symptoms triggered by vigorous exercise. The symptoms will typically arise 5 to 10 minutes into the exercise. Sustained aerobic exercises like running, bicycling, soccer, and handball are a few of many sports which can trigger an attack.
However, because bronchial passageways naturally relax and open during exercise, symptoms may not be noticed until a few minutes after the exercise has stopped. EIA is triggered by the inhalation of large volumes of dry cold air during exercise, which leads to the loss of heat and water from the bronchial mucosa in airway cooling and drying. Mechanisms include drying and increased os molarity stimulating mast cell de granulation. Rapid airway warming after exercise causes vascular congestion, increased permeability and edema leading to obstruction of the bronchial tubes. Symptoms may spontaneously resolve in about 60 min. The refractory period can last up to 3 hours after recovery, during which if exercise is repeated the severity of the symptoms are lessened.
There are two very important factors in producing the symptoms, the amount of ventilation and the temperature of the inspired air. The greater the ventilation, and the colder the air, the higher the severity of the attack. The use of warm, humidified air lessens the degree of constriction, and lowering the intensity of the exercise will lower the amount of air being ventilated, which will also lessen the severity of the attack. This leads to: any exercise or activity done long and hard enough will increase the chances of having an asthma attack. Diagnosing EIA can be simple. If a person is known to have asthma and experiences symptoms after exercise there is no need for further diagnostic procedures.
In those without a history of asthma or non specific respiratory symptoms, diagnostic tests may be necessary. Spirometry testing will show a decrease in peak respiratory flow rate (PEFR) and forced expiatory volume in one second (FEV 1). If the results of the test are reversed after the use of a inhaled beta-agonist, then the diagnosis is positive. Any further tests would involve an exercise challenge test. This test involves a treadmill or cycle ergo meter. Exercising for four minutes trying to reach about 80 % of maximum heart rate, or 50 to 60 % of the predicted maximum oxygen consumption (VO 2 max. ).
A fall of more than 10 to 15 % after exercise is a positive of having exercise induced asthma. Non-Pharmacological management of asthma is very easy. It is recommended to improve aerobic fitness and regular conditioning to reduce severity of the attacks. Having an awareness of allergens and other triggers will also help. Try exercising in a room that is warmer or when running or exercising outdoors cover the mouth and nose to warm the air about to be inhaled by the previous exhalation. Breathing through the nose can also help because the air has more time to warm through before reaching the lungs.
Also change the warm up time to at least 15 to 20 minutes and then gradually increase intensity instead of rapid changes in intensity. The cool down is just as important, an abrupt stop can make the symptoms worse so remember to cool down slowly and completely. Pharmacological management is recommended in conjunction with non pharmacological. The medications that are prescribed usually lessen the severity of the symptoms and or prevent the symptoms completely. Inhaled beat- agonists are the medication of choice for EIA, taken 15 minutes to 1 hour prior to exercise. Short acting inhalants are more common for EIA.
Long lasting inhalants are not recommended because they have a slower onset, they must be taken 4 hours prior to exercise but they last for up to 12 hours at a time. Education is the key to living with asthma. Asthma should not mandate what kind of life you have. Keep in mind some sports are better for persons with asthma. Swimming is good because of the lower ventilation volume and the warm humidified water eases breathing. Also the horizontal position allows some of the air to stay in the bottom of the lungs.
Activities that are short bursts of movement like tennis and softball are also better for asthmatics. Remember to avoid cold air and long sustained activities as in running and cycling. Ice-skating and hockey are known to have major effects on asthmatics because of the cold dry air in the rink. With this information, parents, athletes, and coaches can be better informed of the asthma epidemic that is rising in this country, and will be able to help respond to a person who is having an attack with more knowledge and confidence.
Bibliography: Tan, R. A. , Spector, S. L. (1998). Exercise induced asthma. Physician Sports Medicine, Jan, 25 (1) 1 - 6. Spector, Sheldon L (1993).
Update on exercise-induced asthma. Ann Allergy (71) 571 - 577. Nastasi K. J, Henry T. L, Bliss M. S. (1995) Exercise-induced asthma and the athlete.
J Asthma. (32) 249 - 257 Brown, Ronald. (1998) Exercise-Induced asthma. Allergy and Asthma Magazine American Lung association. (1998) Asthma and Exercise.
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