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Asthma and athletics | Are spring sports leaving your child breathless?

tsai_ped_pulmonary

May is Asthma Awareness Month. We asked Wan Chong Tsai, M.D., section head, Pediatric Pulmonology at Beaumont Children’s Hospital, to answer a few questions about asthma, exercise and spring sports.

How much hard breathing is normal during exercise?

That depends. It is normal to take deeper breaths and breathe a little faster in response to exercise. However, having more symptoms than that is not normal and may represent a narrowing of the airway with exercise – a condition called exercise-induced bronchoconstriction (EIB). If your child experiences shortness of breath, chest tightness or coughing 10 to 15 minutes after starting exercise, she may have EIB. These symptoms typically resolve with rest after 30 to 60 minutes, but a trip to your primary care physician may be warranted. Adults can also have EIB.

If my child has these symptoms, does she need to stop playing sports?

asthma and athleticsChildren with EIB should not consider it an impediment to their participation in exercise and sports. With the appropriate treatment regimen to normalize the airways, every child should have the chance to reach full athletic potential.

Is EIB the same as “exercise-induced asthma?”

Parents often hear of this condition but the term can lead to confusion. First, exercise does not cause asthma, but is frequently an asthma trigger. Secondly, almost all chronic asthmatics have at least some difficulty with EIB and some people who do not have asthma can experience EIB.  The majority of people with EIB (up to 80%) are asthmatics who experience symptoms during exercise.

Are some activities more likely to cause EIB than others?

EIB seems to be a more significant problem with sports that involve longer periods of exertion, such as running, soccer, tennis and basketball, compare to activities like swimming or biking. People with EIB can have an especially difficult time with basketball because the sport combines aerobic running with the repeated action of raising the arms up and down that can affect the body’s ability to take deep breaths.

What triggers EIB?

Exactly what triggers EIB is somewhat of a gray area. Unrecognized asthma may present initially as EIB. Allergy is a potent trigger for EIB in both non-asthmatics and asthmatics.  Changes in weather such as temperature and humidity may trigger airway constriction leading to EIB. It is important to consider all of these possibilities in order to manage the EIB appropriately.

How do we manage EIB?

The first thing is to determine whether children with EIB have asthma or allergies and then controlling the underlying condition(s) with appropriate medications.  EIB specifically can be prevented with inhaled medications, including short-acting bronchodilators like albuterol used 10-15 minutes prior to the start of exercise. For kids with EIB who participate in sports spread out over a longer activity period, such as gymnastics or figure skating, a combination inhaler of long-acting bronchodilator that lasts 12 hours combined with a steroid may be more useful. In addition to inhaled medications, some EIB patients may do well with a leukotriene modifier available in pill form such as montelukast.

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