Childhood Asthma Should Be No Hindrance To Exercise

LEXINGTON, Ky. (Oct. 12, 2011) - The following column appeared in the Lexington Herald-Leader on Sunday, October 9.

Childhood Asthma Should Be No Hindrance To Exercise

By Dr. Jamshed F. Kanga

Asthma is on the rise. More than 22 million Americans have been diagnosed, including 6 million children.

This increase has been attributed to many causes, including better and earlier diagnosis, and increased air pollution.

One proposed explanation, the "hygiene hypothesis," states that children are now being raised in a "sterile" environment and are not being exposed to germs and the usual childhood illnesses. Thus, their immune systems are moving from fighting infections toward a more allergic state.

Exercise-induced asthma affects about 10 percent of American children. Exercise is also a universal trigger for asthma in asthmatic children, and can even induce an asthma attack in someone who has no other signs of asthma. However, with education and good therapy, all children can exercise to their fullest potential.

Coughing, wheezing, shortness of air or tightness in the chest can all be signs of asthma.  Frequently, children who cough are not diagnosed with asthma, although this is probably the most common asthma symptom in all age groups.

If your child has asthma, it is important to work with your doctor to make sure the child is on appropriate treatment, especially asthma controller medication that must be used daily. I prescribe the following protocol for my patients to minimize the risk of an asthma exacerbation during exercise:

• Have your child take two to four puffs of a prescribed inhaler 15 minutes before exercise.

• Warm-up should include three minutes of exercise and then two minutes of rest and stretches, three cycles of increasing intensity prior to exercise.

• If your child becomes short of air or starts coughing during exercise: Stop. Have the child rest and get a drink of warm water. If your child is OK after five minutes, go back to exercise.

• If symptoms persist after five to 10 minutes of rest, the child can take two to four more puffs of the inhaler with no more exercising for the day.

The most commonly used inhalers — and the only ones that should be used while exercising — are short-acting beta agonists (SABAs), such as albuterol. SABAs are also referred to as "rescue medication," as they are very effective in helping with asthma symptoms. Children can use their albuterol inhaler 15 to 20 minutes prior to exercise, which is often the only treatment they need to control their asthma during exercise.

Evidence shows that heavier children are more likely to have asthma. Weight control is essential for all children, but in children with asthma, their condition worsens as they gain more weight. Being overweight also makes it harder for these children to exercise, and they get short of air and have asthma symptoms more quickly.

Children with well-controlled asthma can participate in normal everyday activities and sports. Most children with asthma will get better as they get older, and many children go off controller medication over time.

Dr. Kanga is a pediatric pulmonologist at Kentucky Children's Hospital, professor and chief, Division of Pediatric Pulmonology, and the Director of the Cystic Fibrosis Center at the University of Kentucky.