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Asthma is very common, affecting up to 15% of all children. About 90% of children with a history of asthma will have exercise-induced asthma (EIA). With careful testing, EIA has been diagnosed in almost 10% of all Olympic athletes, many of whom didn’t even realize they had the disease.

Knowledge about asthma is essential for understanding EIA. Picture the lungs as an upside-down tree, with the main airway in the neck (the trachea) being the trunk of the tree, and the tiny air sacs in the lungs as the leaves of the tree. Asthma is a “twig” problem, involving the airways deep in the lung. These airways have a thin lining (the same membrane that lines the nose and throat) and an outer layer of muscle to control their size. When the airway is irritated (or “triggered”), the muscles contract, and the lining swells and makes extra mucus. With mild airway narrowing, this causes cough and chest tightness; with more severe swelling, wheezing, cough, and respiratory distress develop.

Many things can trigger an attack in a child with asthma. Colds and cigarette smoke are the strongest triggers, but exercise is one of the most common. Within 5 to 10 minutes of starting vigorous exercise, cough and difficulty breathing develop and can last for the duration of the exercise and up to 60 minutes thereafter. Sometimes, an inability to perform as well as they feel they should is the only symptom children have. No one knows what causes EIA, but a combination of cooling and drying of the airway is suspected.

Sports performed in cold and/or dry weather (cross-country skiing, running, cycling) are more likely to provoke an attack than swimming or indoor (climate-controlled) sports.

Parents and coaches should suspect EIA when a child complains of cough, difficulty breathing, chest tightness, or wheezing either during or after exercise. Close attention should be paid to the presence of cough or any chronic respiratory symptoms between bouts of exercise, because EIA is frequently a sign of undiagnosed chronic asthma, which would be treated differently.

Special laboratory testing (pulmonary function testing with an exercise challenge) can be done to confirm the presences of EIA, but most doctors simply use a trial of inhaled medication before exercise to make the diagnosis. If symptoms are controlled, medicines can be continued. For individuals with asthma, increased use of long-term control medications may be necessary if symptoms occur with usual activities or exercise. Long-term control of EIA with anti-inflammatory medications (inhaled cortico steroids or leukotriene-inhibitors) can reduce the frequency and severity of EIA. For most patients, EIA should not limit participation or success in vigorous activities.

Other points to consider:

  1. Air that is cold and/or dry can trigger wheezing. In certain sports, a scarf or ski mask worn during exercise will help to warm and humidify air, alleviating symptoms. However, these are often not acceptable to athletes, except in certain sports (skiing, for example). 
  2. By warming up for 15 minutes (to the point of mild wheezing), followed by a cool down to normal breathing, many athletes can resume vigorous exercise for up to 2 more hours with minimal symptoms (refractory period). However, medications still need to be taken to control mild symptoms.
  3. Competitive athletes must disclose the medication they use and adhere to standards set by the US Olympic Committee. A complete, easy-to-use list of prohibited and approved medications can be obtained from the US Olympic Committee’s Drug Control hotline (1-800-233-0393).

Medications Used to Treat EIA – Acute Control (Consult your prescribing physician for exact dosage & usage)

Short Acting Beta2 agonists

How Given: By inhaler, frequently with a spacer, used shortly before exercise (or as close to exercise as possible)
Effects: Rapidly relieve bronchospasm, may be helpful for 2 to 3 hours
Side Effects: Tremors, nervousness, rapid heart beat

Mast cell stabilizers

How Given: By inhaler, 30 to 60 minutes before exercise
Effects: Act to decrease swelling and inflammation in the airway
Side Effects: Bad taste, cough, nausea, abdominal pain

Medications for Long Term Control (Consult your prescribing physician for exact dosage & usage)

Long Acting Beta Agonists (e.g. Salmeterol)

How Given: By inhaler, frequently with a spacer
Effects: NO RAPID ACTION – NOT USED TO TREAT ACUTE SYMPTOMS. May prevent EIA attacks for 10 to 12 hours
Side Effects: Tremors, nervousness, rapid heart beat

Inhaled cortico steroids

How Given: By inhaler, daily
Effects: No rapid action; work long-term to relieve inflammation
Side Effects: Sore throat, yeast infections in the mouth or esophagus

Leukotriene inhibitors

How Given: By tablet, once or twice a day
Effects: No rapid action; work long-term to relieve inflammation
Side Effects: May not work for all patients

 

Last Updated
5/11/2013
Source
Sports Shorts (Copyright © 2005 American Academy of Pediatrics) Conceptual design by the Ohio Chapter, American Academy of Pediatrics
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.