Teens: Being a Sport with Exercise - Induced Asthma : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Swimming in an indoor pool may be the ideal exercise for asthmatics because the warm, humid air keeps the airways from drying and cooling. However, "with proper management, virtually no sport is off-limits," says Szefler.

Proper management of EIA, Szefler says, includes monitoring air flow with a peak-flow meter, avoiding allergic triggers, and using medication before exercise.

Asthma symptoms can change a lot. They are often worse at night than during the day. They may be worse in the winter or during "allergy seasons" when pollen counts are high. The new National Heart, Lung, and Blood Institute guidelines recommend that people 5 years or older who have moderate to severe asthma use a peak-flow meter twice a day (morning and evening).

A peak-flow meter measures how fast you blow air out of your lungs. When a person blows into the device — which looks something like a kazoo — a slide indicates the force of the exhaled air. The farther the slide is pushed, the greater the peak flow.

"Peak-flow meters can help asthmatics monitor their symptoms so attacks can be better anticipated," explains Michael Gluck, D.Sc., chief of FDA's anesthesiology and respiratory devices branch.

Once a doctor determines normal peak flow, a treatment approach can be tailored just for you. For instance, your doctor may instruct you to take more medicine than usual if your peak flow drops a certain amount, say 70 percent of normal, or to get medical help right away if it falls to 30 percent of normal.

"In the past, a vague sense of not feeling well was the only indication a person had that an asthma attack was imminent. By that time, it was often too late to head off the attack," says Gluck. "Peak-flow meters give you . . . a much earlier indication of an oncoming attack."

"Drugs that relax the muscle spasm in the walls of the bronchial tubes to open them are often the first line of treatment in preventing EIA," says Tunde Otulana, M.D., a medical reviewer in FDA's oncology and pulmonary drugs division. Such drugs are called bronchodilators. They are typically prescribed in aerosol (inhalant) form. They are sprayed into the mouth and breathed directly into the lungs. Doctors recommend using the medication from five minutes to an hour before exercise. If breathing problems develop during exercise, you may need to take another dose. The most common side effect of bronchodilators is feeling jittery, says Otulana.

Cromolyn sodium is often prescribed to treat athletes who have EIA. This drug, which is also an inhalant, prevents the lining of the airways from swelling in response to cold air or allergic triggers, explains Otulana, and must be taken on a regular basis for the treatment of asthma. Cromolyn sodium can be used up to 15 minutes before engaging in physical activity.

Cromolyn has few side effects, according to Otulana. "The most common complaint is that it leaves an unpleasant taste in the mouth for a few seconds. Some people may experience coughing due to dryness and throat irritation and, in rare instances, patients have become nauseated."

In addition to bronchodilators and cromolyn, which are used primarily to head off an attack of EIA, the National Heart, Lung, and Blood Institute treatment guidelines recommend the use of inhaled corticosteroids for patients with moderate to severe chronic asthma. "Instead of using a 'rescue' approach to treat episodes of breathlessness, doctors are now focusing on the big picture and using a preventive approach to treat airway inflammation, which is the underlying cause of asthma," says Szefler.

"Corticosteroids work by reducing swelling in the bronchial tubes and by enhancing the action of bronchodilators. They are meant to be used as preventive medication, usually on an ongoing basis," says Otulana.

Corticosteroid inhalants can occasionally cause throat irritation and thrush (a fungal infection in the mouth), says Otulana. (He advises gargling with warm water after using the inhaler to help avoid both side effects.) Prolonged use of very high doses may increase the risk of the same type of health problems associated with the drug in pill form: high blood pressure, diabetes, and softening of the bones.

"It is very difficult to recognize EIA, especially when exercise is the only trigger for asthma," says Weiler. "If you can't keep up with the other kids, can't seem to be able to 'get into shape' no matter how much you exercise, or experience problems after exercise that your classmates don't, EIA may be to blame."

Today, Nicholas carries a bronchodilator with him and uses cromolyn 20 minutes before gym class. Although he still dislikes exercise, he doesn't cut gym now that he can keep up with the other kids. "If I premedicate, I have no problems," he says. "Asthma can be a setback, but it doesn't have to be — if you learn how to deal with it."

Tips on Coping with EIA

• Start with a 15-minute warm-up to allow the lungs to adjust to the increased demand for oxygen.
• In cold weather, cover your mouth and nose with a scarf to help warm the air before it gets to the lungs.
• Avoid triggers that may cause or worsen EIA (for example, don't exercise outdoors when pollen counts are high).
• End with a 15-minute cool-down rather than stopping abruptly.
• Follow your doctor's instructions about using medication before or after exercise. If you're on a team, let your coach know about your doctor's instructions.
• If you have symptoms, use a bronchodilator right away. Remember, cromolyn and corticosteroids are not recommended during an asthma attack because they do not immediately open the airways.

About the Author

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