by: Allen White
The key to exercise or sports participation for anyone with asthma is to prevent the process that leads to airway narrowing. Traditionally, a bronchodilator is prescribed for use before exertion. This medicine is usually given by a metered dose inhaler (MDI) and a spacer. The bronchodilator works by relaxing muscles that surround the airways. When they are relaxed, the muscles can’t squeeze the airways, and the airways stay open.
Although this seems to work to some degree for many people, a bronchodilator before exercise may not be the most complete treatment because a bronchodilator does not treat inflammation. The swelling and mucus in the airways, therefore, can still be a problem. The bronchodilator before exercise treatment plan also does not cover the possibility of spontaneous exercise that is common among children, such as running outside to play ball with friends or racing to catch the school bus.
It is likely that many people who only have asthma symptoms with exercise have a low level of inflammation in their airways. In other words, their inflammation is not enough to cause symptoms while their bodies are at rest, but they do come on with exercise. These individuals may also experience mild symptoms during other times of biological stress, such as when they catch a cold. If this low-level inflammation exists, there may be long-term consequences as well. Some asthma researchers believe that constant inflammation can cause permanent damage to the airways. No studies have yet been done, however, to find out if there is long-term lung damage in people with asthma whose symptoms are brought on only with physical exertion.
The possibility of low-level airway inflammation raises this question: Should people whose symptoms only occur with exercise take a daily anti-inflammatory medicine? This therapy would decrease or eliminate the inflammation. Daily anti-inflammatory therapy would also allow for better tolerance of spontaneous exertion. It might also increase their breathing capacity more than if they used only a bronchodilator before exercising. Consider Scott’s situation:
Whenever ten-year-old Scott exercised, he coughed, wheezed, and had chest tightness and shortness of breath. He had occasional wheezing in the spring, but otherwise he had no symptoms or complaints. He used a bronchodilator when springtime symptoms appeared. As a competitive swimmer, he also used it before swim practice and team meets.
Halfway through the swimming season, his doctor suggested that Scott try an anti-inflammatory medicine, even though he had no symptoms. After a few weeks, his coaches noticed that Scott was swimming several seconds faster. Scott also became aware that he was able to swim faster for longer distances. His parents, however, did not renew the prescription for the anti-inflammatory medicine because Scott seemed better. Two weeks after stopping the medicine, Scott’s times fell back to where they were before he started the medicine. Scott also noticed the change and asked his parents if he could restart the anti-inflammatory medicine. Within two weeks of restarting the daily therapy, Scott was again swimming faster.
While daily anti-inflammatory therapy might improve the athlete’s performance, there is the increased cost of daily therapy in both time and money. Different health care professionals treat asthma differently, and each individual with asthma is unique. If your child has asthma symptoms when exercising or playing sports, talk to your doctor or nurse practitioner about whether a daily anti-inflammatory treatment is right for your child.
