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EXERCISE FOR ASTHMATIC CHILDREN
Exercise can be taken in many different ways and not all appear to be equally potent stimuli for exercise-induced asthma. In some children simply jumping about in the bedroom is sufficient stimulus and I have known my own son Ross to wheeze after the effort of laughing at a comedy programme on television. Both Jayne and Neil developed it after running and certainly I have found this to be the commonest precipitating cause. Indeed, only six to eight minutes of running is needed to bring on a severe attack of asthma and many will become wheezy in less time than this. Cycling will also produce breathing problems but less consistently, perhaps because only the legs are used. Swimming seems to be the most innocuous of all and can be recommended to everyone with asthma. In everyday life the asthmatic child will find that the severity of wheezing is less with shorter periods of exercise and with light as compared to heavy exertion. Quite hard sports, for example playing football or cricket, can be tolerated by the asthmatic, provided it is in brief bursts with some respite in between.
Almost all asthmatic children have exercise-induced asthma, so what can be done to prevent it? Without becoming too technical, it seems that an attack comes when the muscles of the airways are stimulated by the release of chemical substances. Exercise causes the release of these chemicals, but they have not yet been identified. It is interesting to note that if further exercise is taken within one or two hours then the degree of wheezing produced is much less. This suggests that the first bout of exercise depletes the stores of these chemicals and that it takes some time for them to be replenished.
The prevention of exercise-induced asthma is very simple: as it is caused by muscle spasm a dose of one of the bronchodilator drugs is the treatment of choice. You will remember that this can be given either in the form of Ventolin or Bricanyl through a pressurized inhaler, a turbohaler, a rotahaler or a diskhaler. While it can be given when the child becomes wheezy it is far more effective if given just prior to the exercise starting. Let us consider this in practice with the case of 12 year-old Neil. Neil’s main preventive medication was a Becotide inhaler. It has no real effect on muscle spasm, so increasing the dose would not prevent exercise-induced asthma. His main bronchodilator or anti-spasmodic was Bricanyl and by taking three puffs of this just prior to running Neil found that he was virtually free of wheezing after the race. Unfortunately he found that the Bricanyl, as it does in some children, made his legs feel weak and tired. While this was of no consequence in normal living it reduced his running performance. By switching to a Ventolin inhaler Neil found his running times improved. Ventolin has the side-effect of producing a slight tremor; this is harmless but in school Neil found it affected his writing. It did not, however, make any difference to his running. He was in a situation therefore of using a Bricanyl inhaler for normal wheezing episodes and a Ventolin inhaler for his exercise-induced asthma. Occasionally if it was before an important race he would use Ventolin via a nebulizer before leaving home. Personally I doubt if this is really necessary as the simple inhalers are most effective and I suspect with Neil there was an element of nervous asthma related to the tension of a big event. In summary, the key to preventing exercise-induced asthma is to give a bronchodilator about ten minutes before exercise begins. This sounds easy but in younger children is often forgotten, especially at school. It is important to discuss this carefully with your child’s teacher so your son or daughter does not feel self-conscious or embarrassed about using it. Whichever bronchodilator your child normally uses should be used to prevent the exercise-induced asthma, i.e. it can be a pressurized inhaler, a turbohaler, a rotahaler or a diskhaler. Always remember that exercise is not harmful to an asthmatic child. It is very often frustrating and annoying not to be able to engage in vigorous sports because of shortness of breath. Physical fitness is as beneficial – if not more so – to an asthmatic child as it is to anyone else. For this reason this important aspect of asthma control should never be ignored.
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