In the United States, it is estimated that as many as 10% of school-age children experience asthma symptoms brought on or worsened by exercise. This is known as exercise induced asthma (EIA).
An asthma management plan for someone with EIA would likely include some or all of the following treatments:
- Pre-treat with medication. A bronchodilator and/or cromolyn-based medication, when taken alone or together before exercise, can prevent asthma symptoms from occurring and maximize one’s exercise capacity. Bronchodilator may only protect against symptoms during one and a half hours of exercise. Healthcare providers typically advise their patients that they can take another dose after this period, if needed. They may also prescribe a long-acting bronchodilator, which would prevent symptoms for a longer period of time. (It also needs to be taken further in advance of exercise.) Pre-treatment is usually recommended even if no symptoms are present. (Note: Studies have shown that montelukast sodium, one of the new anti-leukotriene medications, may reduce the severity of symptoms of EIA and decrease the recovery time for the lungs to achieve their pre-exercise capacity.)
- Take peak flow measurements before and after exercise. If peak flow measurements before exercise indicate that the asthma is not well controlled, they should either not participate in the activity or participate in a less strenuous way (perhaps playing goalie where less running is involved). Decreased activity should only be a temporary solution, however. If the person is regularly having trouble exercising, it is a sign that his or her asthma is not controlled. The person should visit the healthcare provider so changes can be made to the treatment plan. With proper asthma management, people should be able to exercise comfortably.
- Do warm-up and cool-down exercises before and after exertion. This has been shown to help prevent asthma symptoms. If symptoms develop during the warm-up, a quick-relief medication (bronchodilator) should be taken. Once the symptoms have resolved, the warm-up can be started again.
- Quick-relief medications (bronchodilator) must be available at all times. This means during school (for children) as well as after-school activities. If medications are kept in the nurse’s office, be sure that the office is unlocked and that these are readily available during after-school sports and activities. Medications should also be available to students during field trips or sporting events that are away from the school facility. Students should be taught how and when to use their inhalers and, if school rules permit, they should carry these inhalers with them.
- Avoid cold, dry air that provokes EIA. If this is not possible, the person should wear a scarf over his or her face during the activities outside in cold weather to warm and humidify the air before it reaches the lungs.
With proper asthma management, most people can play any sport. A small percentage may still have some trouble. These people may want to choose sports that are less likely to provoke asthma symptoms. Sports that require a lot of running with little time for breaks, such as soccer or basketball, are more likely to cause symptoms than a sport, such as baseball, that provides periods of rest. Swimming and other water sports, which take place in warm, humid air, are often the best type of exercise for people with EIA.
- Work with your healthcare provider to develop an asthma management plan that prevents symptoms and allows maximum exercise capacity.
- Provide copies of the asthma management plan to school staff (including nurses, gym teachers, and coaches).
- Take medication before exercise, even if no symptoms are present.
- Encourage warm-up and cool-down exercise, even if no symptoms are present.
- Teach your child to measure peak flow before and after exercise.
- Be encouraged to exercise. Good asthma management should allow you to exercise successfully.
- Exercise if asthma is not well-controlled.
- Continue to exercise if symptoms are increasing despite pre-treatment.
- Allow a coach or gym teacher to force your child to continue exercising with asthma symptoms.
NOTE: Avoiding exercise due to uncontrolled asthma should be a temporary situation. If this occurs regularly, see your healthcare provider to review your asthma management plan. With proper asthma management, you should be able to exercise.