Asthma, Sports, and Kids
When a young soccer player has a wheezing fit on the field, you can bet there's an extremely worried parent on the sidelines. What can a parent do when a child's favorite sport sets off asthma attacks? The natural reaction may be to pull him off the team and have him do something safer, like play video games. After all, no parent wants to hear a child wheeze and gasp.
But before you make your child turn in his shoulder pads, consider this: Researchers at the Johns Hopkins Children's Center say that about 20 percent of kids who have asthma don't get enough exercise -- partly because their parents think it's too risky. However, with the right treatment, most children with asthma can enjoy any sport they choose. Additionally, the latest government guidelines stress that keeping children fit by maintaining a healthy weight and exercising may also improve their asthma control. In fact, many Olympic athletes have asthma. Like them, your child can enjoy the many benefits of sports and exercise without jeopardizing his health.
A common source of asthma attacks
When a person has asthma, the bronchial tubes (the passageways that carry air to the lungs) become extremely sensitive. If they're exposed to something unusual, the tubes can suddenly squeeze tight, making it difficult for air to pass through. This is called an asthma attack, and it can be touched off by anything from cold air to a speck of dust, from tobacco smoke to magic marker fumes.
Unfortunately, an attack can also be sparked by one of the healthiest things a kid can do: exercise. In fact, many children have "exercise-induced asthma," which means they have asthma only when they're getting a workout. Even kids with persistent asthma may notice breathing problems primarily during physical exertion.
Exercise is good for the lungs, but it causes the airways to lose both heat and moisture, especially if the air is cold and dry. This can irritate the bronchial tubes and cause them to swell, creating the conditions for an attack.
If your child has asthma, she may cough, wheeze, feel tightness in her chest, or become extremely short of breath right after exercising. Less often, a child will have these symptoms in the middle of an activity.
Different sports, different risks
Some sports are especially likely to cause asthma attacks. Vigorous sports performed in cold air -- such as cross-country skiing, ice skating, and ice hockey -- top the list. Sports that require intense effort with little or no letup rank second, including soccer, long-distance running, and competitive cycling.
Swimming, on the other hand, which is done in a humid environment, rarely brings on attacks. And stop-and-go sports such as baseball, softball, karate, sprinting, and golf are low-risk workouts for asthma sufferers.
Staying in the game
Asthma doesn't have to keep your child out of the game. The right treatments can usually prevent asthma attacks in any sport. If your child's disease is severe, however, he may need to stick with swimming, baseball, or other sports on the safe end of the scale.
For many people -- both adults and children -- the best defense against exercise-related asthma is an inhaler filled with a quick-acting bronchodilator such as albuterol or pirbuterol. Many doctors recommend taking one to two puffs 15 minutes before exercising to prevent exercise-induced asthma symptoms. If the attacks continue, your child's doctor may prescribe additional inhaled medications such as cromolyn or nedocromil. If your child isn't able to take medications right before exercising, ask your doctor about the long-acting bronchodilator drug salmeterol, which can keep her attack-free for 12 hours or more.
No matter what medication he takes beforehand, the child should keep an inhaler handy while he exercises. All students with asthma should have a rescue inhaler available during games and practices, and the certified athletic trainer (i.e., coach) should carry an extra rescue inhaler for each team member with asthma, according to National Athletic Trainer Association (NATA) guidelines. (Some schools unwisely prohibit kids from carrying their inhalers; in that case, ask your child's coach or gym teacher to keep the inhaler on hand in the event of an emergency. And if your child goes on a field trip or sports event away from the school, he should have immediate access to an inhaler, if necessary.) If he starts to have an attack, a couple puffs of albuterol or a similar medicine can open his airways and restore his breathing. Remember: An untreated attack can be dangerous, even deadly.
Your child can also carry a peak-flow meter, and take a reading both before and after a workout. This small, handheld device measures the force of the breath. When asthma narrows the airways, the reading will drop. If she has a low reading before or during a workout, she may need extra medication or she may have to stay out of the game -- for a while. When the readings are back to normal, she can exercise with confidence.
Your child shouldn't be the only one around who understands his condition. Make sure his teachers, particularly the coach or gym teacher, know how to handle the disease. A coach may assume that children with asthma should stay on the sidelines. If appropriate, assure everyone concerned that your child can play as hard as anyone -- with the proper precautions. You should also make sure the coach can recognize an asthma attack and knows where your child's inhaler is kept.
A few simple changes in your child's exercise routine can also help prevent attacks. Encourage her to warm up by walking, stretching, and briefly running in place before exercising. When the game's over, a little more walking and stretching can help keep her airways from tightening up. If possible, have her avoid exercising in places where she'll be exposed to extra irritants, such as dust, pollen, animal dander, or air pollutants. And if she's exercising in the cold, a scarf or a mask around her mouth and nose area can be a big help.
Above all, encourage your child to stay active. Regular exercise is good for any kid, asthma or no asthma. And once your child controls his asthma on the basketball court or the soccer field, he'll have the confidence to control it in the rest of his life.
American Academy of Allergy, Asthma, and Immunology
American College of Allergy, Asthma, and Immunology
American Lung Association
Asthma and Allergy Foundation of America
National Athletic Trainers Association Position Statement: Management of Asthma in Athletes, 2005.
Evrard, HM M.D. Coaching the coaches - Managing exercise induced asthma at school. Asthma Magazine.
Storms, WW. Exercise-induced asthma: diagnosis and treatment for the recreational or elite athlete. Medicine and Science in Sports and Exercise,S33-S38 pp.
American Academy of Allergy Asthma and Immunology. Allergies, asthma and the Olympics.
Low Activity Levels in Kids with Asthma Due to Parental Health Beliefs. Johns Hopkins University Gazette. .
National Heart, Lung, and Blood Institute and National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf