Serevent (Salmeterol)

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CHILDHOOD ASTHMA: EXERCISE AND SPORT
Many renowned sportsmen and women have suffered with asthma in childhood – the cricketer Ian Botham is perhaps the most famous. It should be the aim with all asthmatic children to achieve a degree of control so effective that they are not restricted in any sport they wish to undertake. There are two problems that can arise during exercise, and these are well illustrated by the following two children, both of whom I saw in my asthma clinic recently.
Jayne is a 9 year-old who had suffered with quite severe asthma attacks since the age of 3. She had lived in the middle of Manchester until the age of 8 and I am sure the pollution in the inner city had been mainly responsible for her frequent wheezing episodes. Since moving to a more rural area her asthma had considerably improved and because of this Jayne became rather lax at using her inhalers. Although she no longer had any major attacks Jayne often found that she was short of breath and wheezy when doing games at school. Netball was not too bad but worst of all was cross-country running, which basically consisted of two laps around the school field. The first lap was usually alright but she became very short of breath on the second and usually had to stop and walk.
On checking her peak flow at rest I discovered that it was 325 when her predicted level was 375. During exercise more oxygen is needed by the muscles and therefore the lungs have to work harder. If the breathing tubes are already narrower than they should be, then the lungs have to work even harder to take in the extra oxygen, so the shortness of breath becomes more severe and the wheeze more pronounced. Jayne therefore was an example of a child whose asthma in general was poorly managed and this showed itself when she exercised. All that was needed in her case was to make sure that her preventive inhaler – Becotide 50 – was taken in the correct dose of two puffs twice a day. In fact I noticed from her case records that she had not had a new inhaler for nearly three months, indicating that Jayne had hardly been using it at all. An average inhaler contains 200 puffs and at 4 puffs a day should last 50 days, less than two months. When she went back to the recommended dosage her peak flow rose to 395 which then left her plenty in reserve for when she exercised. She is now able to complete two laps of the school field without any sign of problems.
There is also a specific condition called ‘exercise-induced asthma. Certain asthmatic children, although able to exercise perfectly freely, find they become increasingly wheezy when the exercise has finished. Twelve year-old Neil was typical in that he was very keen on all sport but – particularly after a hard cross-country race at school – he found that his asthma was very troublesome. Everyone becomes short of breath on exertion but this normally settles quickly when the exercise is finished. However Neil found that, instead of being able to relax and ‘get his breath back’, a paroxysm of wheezing would overtake him. This is proof of exercise-induced asthma, as no other form of chest disease is associated with breathlessness which becomes worse immediately after the exercise has finished. With Neil the wheezing reached a peak after a few minutes and could take up to an hour before there was any relief, even when using his inhalers.
During the course of exercise it is difficult to make accurate measurements of the width of the airways. However, the information that is available does suggest that in most people, including asthmatics, the airways actually widen during exercise, i.e. the peak flow increases. It is what happens after that provides the crucial difference. In normal people, the airways quickly revert back to their previous state, but in the asthmatic this is not so. For some reason the airways continue to narrow for up to five minutes, remain at that level for some time and then slowly widen out again. The extent of the change can be quite considerable and certainly this was the case with Neil. His normal resting peak flow reading was 450 but when measured five minutes after the end of a grueling cross-country race at school it had fallen to 220. In other words there was a 50 per cent reduction in lung capacity in just five minutes, so it was not surprising that Neil was so distressed.
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