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Asthma is one of the most common chronic medical
conditions of childhood, affecting up to 15% of all children.
Nearly all people with asthma have symptoms triggered by or
exacerbated by exercise. Asthma
induced by exercise, or exercised-induced asthma (EIA), affects
patients with asthma, as well as a number of individuals without
previously recognized asthma. As
many as 10% of high school and college athletes have been diagnosed
with EIA. Still, asthma
and EIA are underdiagnosed in part because symptoms of EIA often
manifest after, not during, exercise and may resolve spontaneously.
History
EIA is most likely to occur with or after a
period of relatively intense exercise of at least 6-8 minutes.
If the outside air is cold and dry, the likelihood of an
episode is increased. Signs
and symptoms can include any one or combination of coughing, wheezing,
chest tightness, difficulty breathing, or chest pain.
Symptoms typically last from 10-60 minutes.
Physical Examination
The athlete with EIA will often have a normal
physical examination between episodes.
Careful attention to the nose and sinuses may reveal chronic
changes from allergies because of the association between asthma and
allergies. Children with
asthma may not take good breaths, and expiration may produce coughing
or wheezing.
Mechanism of EIA
The airways normally warm and humidify air before
it reaches the deep airways. When
the air outside is cold or dry, or when breathing is increased with
exercise, warming and humidifying is difficult.
The cool dry air is a major stimulus for EIA.
The resulting bronchospasm and airway inflammation cause airway
constriction and produce coughing, chest tightness and shortness of
breath. Allergy triggers
and particles in the air make symptoms worse.
Diagnosis
Diagnosing EIA is usually relatively
straightforward. An
athlete who coughs, wheezes, reports chest tightness, or has
difficulty breathing during or after exercise is likely to have EIA.
Diagnosis can be established by a therapeutic trial of an
inhaler 15 minutes before exercise, or an exercise challenge test can
be performed.
Treatment and prevention
Usually, EIA is easily treated and prevented.
If EIA occurs, two puffs of a B-agonist inhaler such as
Albuterol will almost always relieve the symptoms.
Prevention should be the preferred method of treatment, instead
of relying on rescue treatment. The
first step in prevention is taking 2 puffs of a B-agonist inhaler such
as Albuterol 15 minutes before exercise.
Some patients with asthma require maintenance on an inhaled
corticosteroid. Treating
allergies often helps reduce the incidence of asthma.
Most patients with EIA can prevent symptoms by
modifying the intensity of their activity, avoiding cold, dry air, or
allergens, or by pretreating with appropriate inhalers.
If these preventive tips are followed, a child with
well-controlled asthma or EIA should be able to participate in
virtually any sport.
If your child has any of these symptoms with
exercise or after exercise, contact your physician for appropriate
diagnosis and treatment.
For appointments, call Hoffman Family
Practice Associates at 817-916-5180.
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