Spring is here! So, too, is allergy season and spring sports! It seems this every year at this time a young little league baseball player wheezes as they cross home plate and desperately tries to catch their breath. Players, coaches, umpires, parents watch in dismay, deciding whether they need to call an ambulance. Minutes later the player recovers from this scary situation…until the next time. Could this be an example of exercised-induced asthma (EIA)?
Dr. Gregory Cali, a local pulmonologist, (lung doctor) was gracious enough to participate in an interview about this problem…exercise-induced asthma (EIA). The topic was chosen in response to an email question from a concerned mother of an athlete with asthma. Dr. Cali informed me that the first thing to know about exercise induced asthma (EIA) is that EIA is not a distinct disease in itself-but is one manifestation or presentation of asthma. Putting it simply, EIA occurs in patients who have develop narrowing of the bronchial tubes ( bronchoconstriction) when they exercise. Some experts would rather we use the phrase exercise induced bronchoconstriction which is what happens when someone has an asthma attack. This bronchoconstriction occurs because of spasm of the tiny muscles of the airways, plugging of the airways with thick mucous, and swelling or edema of the cells lining the airways.
In fact, it is inflammation of the airways, mostly due to allergies, that is at the root of most cases of asthma. This inflammation causes the bronchial tubes to become over-reactive-and predisposed to narrowing- when exposed to certain triggers. Exercise is one of those triggers in susceptible people. The patient with EIA complains of chest tightness, wheezing, and shortness of breath when exercising. Some patients only experience coughing with exercise. Symptoms are usually worse in cold, dry air. This is believed to be due to the drying and cooling of the airways, which occurs with exercise, especially if the patient opens his or her mouth while exercising. Nasal breathing is much better at warming and humidifying air and may help to reduce EIA.
Dr. Cali feels that the most important point about EIA is to make sure a specific diagnosis is made. It is difficult at times to differentiate asthma from the normal breathlessness, which occurs with exercise. The feature of EIA that distinguishes it from normal breathing, or being "out of shape" is the fact that EIA is ALWAYS associated with a decrease in airflow. This can be measured with either a peak flow meter or a spirometer. It is also important that a specific diagnosis be made so that a person will not be labeled as asthmatic when they may be "normal" or have other conditions such as heart problems or anemia.
Dr. Cali also recommends before a person is labeled asthmatic, they have spirometric testing. An improvement in airflow after inhaling. A bronchodilator is an important indicator of asthma. Sometimes a bronchial challenge test is needed to diagnose asthma. In this test, the subject breathes in a known bronchoconstrictor in small quantities and the response is noted. Patients with asthma almost always respond to the inhaled agent by a reduction in airflow.
Inform Coaches – If coaches are made aware, than they can be prepared for the onset of EIA. Provide emergency contacts and medications with instructions, such as inhalers, should be available.
Warm and Moisten Air - Whatever the patient can do to warm and moisten the inhaled air can help prevent EIA. Nose breathing during exercise or wearing a loose covering over the mouth in cold weather may help. Sometimes, in severe cases, switching to an indoor sport like swimming may be necessary.
Start Out Slowly - It is important to start out slowly and warm up first before exercising at full tilt. Slowly jog around the track or field before practice or a game to prepare your lungs for full-speed.
Medications – are often necessary. Quick- acting bronchodilators like Albuterol, used 15-20 minutes before planned exercise, is recommended. This can be repeated once more during the exercise, but if tightness or wheezing occurs, the exercise should be stopped. Many patients with asthma require preventative treatment with anti-inflammatory medications. Inhaled steroids and/or leukotriene inhibitors may have to be added if the asthma is not controlled with Albuterol alone. In fact, some patients with asthma who are overly reliant on quick acting bronchodilator medications can get into serious trouble if they do not use inhaled steroids. Be sure to communicate your needs with your coaches.
Play Smart - In conclusion, people with asthma should not shy away from exercise. With proper precautions, people with asthma should be able to participate in all kinds of sports activities: baseball, football, soccer, swimming, tennis and running (even a marathon)! The key point is that the asthma needs to be under control and monitored by the patient, parents, coaches and doctor as a team.
Visit your doctor regularly and listen to your body.
Medical Contributor: Gregory Cali, DO, pulmonary specialist, Dunmore, PA
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
