Managing Exercise-Induced Asthma

WebMD Live Events Transcript

Experts agree that all but those with the most severe asthma should be able to participate in sports and exercise. The key is to manage your asthma instead of letting it manage you. Asthma expert Clifford Bassett, MD, joined us on Aug. 18, 2004, to discuss creating an asthma management plan that lets you in the game.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome, Dr. Bassett. With the emphasis on being active and fit, what challenges are presented by having asthma?

BASSETT:
About 7% of the U.S. population, or about 18 million Americans, are reported to suffer from asthma. With exercise, many individuals can experience asthma symptoms. Approximately 40% of patients with seasonal or indoor allergies may have exercise-induced bronchia spasm, otherwise known as exercise-induced asthma.

About 10% of nonasthmatics may also experience exercise-induced symptoms. These symptoms can include wheezing, chest tightness, coughing, chest pain, and also prolonged shortness of breath after beginning exercise. Other individuals may experience fatigue, as well as a decrease in their exercise performance due to this condition.

If you have asthma it's important to understand how to plan and deal with your breathing issues to allow you to participate in sports. Exercise-induced asthma can affect up to 20% of highly competitive or elite athletes, including many Olympic athletes. In the 1996 Olympic Games it was reported that up to 17% of the athletes had a history of asthma.

I'd like to take just a moment or two and give a couple tips that are quite useful when dealing with asthma and exercise"

  • If you have exercise-induced asthma, symptoms can be prevented by using a short-acting inhaler about 10 to 15 minutes prior to exercise. This will certainly help to ease any respiratory symptoms that should occur, and this form of treatment may last up to four to six hours.
  • It's also quite important to have an exercise warm-up from six to 15 minutes before beginning a full exercise program.
  • Drink plenty of fluids, especially during hot weather time periods. A good rule of thumb is to drink at least 8 ounces of water prior to exercise and at least 8 ounces or one cup of water or equivalent for every 30 minutes of prolonged exercise.
  • Stop exercising if respiratory symptoms should arise.
  • It's important to cool down at the end of your exercise and not stop abruptly, as this will prevent any respiratory symptoms and provide safer exercise to all individuals with these conditions.
I'm often asked which activities are best for those with asthma or exercise-induced asthma (exercise induced asthma can affect 90% of all asthmatics). In general, swimming is the sport of choice for individuals with asthma, due to its many beneficial factors such as a warm, humid environment, as well as the strengthening and toning of upper body muscles. Other sports or exercise such as walking, leisure biking, have also been thought to be good activities for individuals with asthma.

Activities that have been associated with an increased likelihood of worsening asthma include cross-country skiing, ice hockey, basketball, and long-distance running.

"In general, swimming is the sport of choice for individuals with asthma, due to beneficial factors such as a warm, humid environment, as well as the strengthening and toning of upper body muscles."

MEMBER QUESTION:
I have severe asthma and of course it causes exercise-induced attacks. I use Medrol 5 milligrams, Q-Var 80 and Intal BID, and Proventil before exercising (swimming). I am a Masters swimmer and swim outside. I have frequent attacks if I push too hard. If I use Proventil to keep airways open wouldn't I breathe more allergens (molds, pollens, chlorine, and chemicals from the pool, etc.) to make airways more spasmed? Is this a "catch 22?"

BASSETT:
In general preventative pre-exercise medications, which include inhaled beta 2-agonists (bronchodilator), are the drug of choice for the prevention of exercise-induced asthma. They have a fairly rapid onset of action, within four to five minutes time, and can have a prolonged effect. They can prevent asthma symptoms in 90% of patients.

Some individuals have discussed with me their perception of chlorine and other pool chemicals that have bothered them while participating in swimming. In general, swimming has turned out to be a wonderful sport for many asthmatics and this has not proved to be a significant problem for many individual swimmers with asthma, but there can always be an individual who is predisposed to certain irritants or respiratory triggers in an environment. The use of a bronchodilator, in combination with other anti-inflammatory treatments in asthma, can actually reduce the allergic and environmental triggers for individuals who require as needed or daily treatment.



MEMBER QUESTION:
What type of exercise regime do you recommend for those of us with a more severe disease? My FEV1 is constantly and consistently at 40%-50% of my predicted value, yet I am still encouraged to exercise when many activities cause issues.

BASSETT:
A question we often get in our office is what exercises can a person with asthma be involved in, in order to allow them to participate in sports. As you may know, for people with exercise induced asthma some forms of physical activities are better tolerated than others. Sports that involve prolonged periods of exertion, such as in soccer, long-distance running, and basketball, probably will not be as well tolerated in an individual with more significant asthma and reduced lung capacity.

A measurement of your own lung capacity can be assessed through two separate techniques. First, by visiting an allergist and/or an asthma specialist, you may be able to have a spirometry, which is a lung function test, in order to evaluate your respiratory capacity. The FEV1, which stands for forces expiratory volume in one second, is a very important indicator of respiratory functioning. In asthma, and other lung diseases, this number may be mildly or substantially reduced as compared with normal.

Proper medical management by the asthma specialist will dictate which short- and long-term medications are appropriate, as well as, which physical activities will be best tolerated to maintain an active lifestyle, which is so important for both physical and emotional well-being.

The second technique to monitor your breathing capacity is to perform peak flow rates with the use of a peak flow meter. This is a way to gauge your own lung capacity with the use of a simple device at home. These measurements will assist the asthma specialist in recommendations of daily and/or physical activities that involve additional and increased efforts for an individual with asthma.

During strenuous activity, people tend to breathe through their mouths, thus allowing dry air to reach to lower respiratory passages without the benefit of the humidifying and warming effect of the nose and sinuses. This can sometimes aggravate or bring on symptoms, such as breathing difficulty, chest tightness, and coughing, in addition to fatigue and reduced performance with and after prolonged exercise.

Other factors that can influence and affect how well a person with asthma can tolerate his or her exercise program include air pollution, high pollen count, and time of day (pollen counts can generally be higher for most seasonal pollens in the morning). Recommendations are to exercise indoors on very high pollen days or perhaps later in the day, during early evening hours, when at least some pollen counts are typically lower. One can check the local pollen count in your community by logging on to the American Academy of Allergy, Asthma, and Immunology web site at aaaai.org for further information.

"The use of a heart rate monitor is an excellent tool in evaluating your own individual response to prolonged exercise."

MEMBER QUESTION:
As a triathlete I train with a HR monitor about 95% of the time. I notice the days that I take Ventolin for symptom relief my HR while exercising is higher. Is it safe to recognize that this a side effect, and exercise at a HR that is maybe five to 10 beats higher than normal?

BASSETT:
As many individual patients with asthma already are aware, the use of a short or long-acting inhaled bronchodilator can be associated with some side effects, such as an increase in heart rate and occasional episodes of palpitations due to the mechanism of these bronchodilator drugs. The use of a heart rate monitor is an excellent tool in evaluating your own individual response to prolonged exercise. Measurement can also be done, if needed, in an office setting via the use of an exercise challenge to determine specific physiological assessments with given amount of exercise over a period of time.

Speak with your medical professional and/or asthma specialist regarding any specific questions you have on what your target goals should be and physiological parameters, such as heart rate, blood pressure, and any symptoms you may be experiencing, when exercising.

One should always consult with your personal physician before beginning or accelerating an exercise program, particularly if you have asthma, other respiratory problems, as well as heart disease, for optimal safety.

MEMBER QUESTION:
I want to be a police officer, and in order to get into the police academy I have to run a mile in under seven minutes. How do I go about training to be able to run that? As of right now I can't run at all without wheezing, even when taking meds.

BASSETT:
I would certainly recommend to you, because of your planned future occupation and general health reasons, to consult with your personal physician as to an evaluation of your present respiratory symptoms in order that he or she may provide the best possible advice and treatment to allow you to feel well and continue to be active.



MEMBER QUESTION:
Generally speaking, how long after a major flare should a person wait to start back with an exercise program? I am currently hanging in my yellow zone and just getting over a round of pneumonia. Just wondering what a good rule of thumb is?

BASSETT:
Since you have just recovered, or are recovering from a systemic lung infection, such as pneumonia, it would be quite helpful to you and your treating physician to undergo lung function testing in order to evaluate your readiness and ability to engage in some form of physical activity. It is so important to tell your doctor if you are having problems with physical activities, so steps can be taken to improve the situation. After careful physical examination and discussion with your physician, appropriate treatment will hopefully allow you to benefit from a modified exercise program.

MEMBER QUESTION:
My 4-year-old son's asthma isn't primarily exercise induced but we've gone through numerous flares when we simply go for walks or he runs a little too hard, goes up stairs, playing tag with his friends etc. I usually watch close and have his inhaler close by if needed! He's starting preschool next month; I'm concerned he'll be even more active where I won't be able to be there just in case. I haven't talked to his doctor about exercise-induced asthma because it's not been a key problem, but I know it can be. Do you recommend a watch-and-see scenario? Should I talk to his doctor about extra precautions to be used?

BASSETT:
Approximately 90% of individuals with asthma also have exercise-provoked worsening of their asthma. It is essential for you to utilize your asthma action plan that has been prescribed by his physician for activities, both in school as well as recreational activities at home.

This time of the year many families are on vacation or traveling and it is quite important to have all of your anticipated medications readily available, if needed. If your child also has seasonal allergies, monitoring the daily pollen counts, as well as reviewing your child's allergy test results with your allergist can be very helpful in preventing allergy associated respiratory problems.

I would certainly discuss with your treating pediatrician the role and benefit of an allergy test if you, your child, or family member have symptoms consistent with asthma and other related problems, such as hay fever and/or sinus problems, as well.

"It is so important to tell your doctor if you are having problems with physical activities, so steps can be taken to improve the situation."

MEMBER QUESTION:
My husband, teen children, and I all have asthma. Usually, we are able to function pretty well -- hubby and kids with NO meds. The kids generally only need rescue medication (albuterol or MaxAir) a few times/month, generally in connection with strenuous exercise (running or swimming). At what point should we consider having them take maintenance asthma meds rather than the rescue/pretreat albuterol/MaxAir as needed? Thanks!

BASSETT:
Inhaled corticosteroids are the mainstay of asthma treatment for individuals with chronic, persistent asthma. It is quite important to understand differences between an individual with occasional symptoms, perhaps several times per month related to exercise or with respiratory infections, and an adult or child with asthma that has symptoms greater than several times per week, including daily symptoms.

Appropriate anti-inflammatory medications, including the use of inhaled corticosteroids, have been recommended for individuals with asthma-type symptoms more than several days a week for preventing long-term damage to an individual's lungs as can be seen in patients with progressive and/or persistent asthma without appropriate contemporary medical treatment for symptoms, as well as the underlying physiological mechanisms in the respiratory passages in a patient with frequent and/or persistent asthma.

MODERATOR:
Dr. Bassett, before we wrap things up for today, do you have any final words for us?

BASSETT:
Asthma symptoms can be well controlled through proper medical management, and the good news is that almost all individuals with asthma can participate in physical activities and have an outstanding quality of life when this condition that affects almost 20 million Americans is treated correctly, preventatively, and in a comprehensive way.

As we come through the remaining days of summer, there are many wonderful physical activities that individuals with asthma can enjoy. Proper treatment for asthma is early, ongoing treatment, and therefore the best possible treatment practices can allow almost all patients with asthma to benefit from recent advances in both allergy and/or asthma pharmacotherapy for all those affected.

A recent study looked at U.S. Olympians who have won medals in the past several Games and it appears that of athletes who have asthma there is an equal number of Olympians who have won medals as compared with nonasthmatic elite athletes. For an everyday athlete, success is normal participation in physical activities.

For more information about asthma and related respiratory and/or allergic conditions, please visit the American Academy of Allergy, Asthma, and Immunology educational web site, at aaaai.org or call their information line at 1-800-822-2762. You can also visit my web site at bassett.yourmd.com.

MODERATOR:
Our thanks to Clifford Bassett, MD, for joining us today.

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