Asthma is the most common chronic condition in children and one of the most frequent reasons for missing school and ER visits. Because asthma can be triggered by exercise, it is also a common concern among young athletes – but it does not mean asthmatic children cannot play sports.
Understanding your child’s asthma and developing an asthma action plan with your pediatrician are critical to keeping your athlete healthy.
What is asthma?
Asthma is a chronic breathing condition that inflames the lungs and narrows the airway, making it difficult to get air out of the lungs. Wheezing, coughing (especially at night), chest tightness or pain, and shortness of breath are common symptoms. In addition to exercise, common asthma triggers also include environmental and food allergens, upper respiratory infections and stress.
Exercise-induced asthma (EIA) is a type of asthma that causes airway hyper-reactivity, constriction and inflammation in response to exercise. EIA commonly produces difficulty breathing about 10 to 15 minutes after the start of exercise, and the symptoms can persist for more than 20 minutes after the exercise has stopped. The diagnosis is made based on a person’s description of their symptoms and special airway tests performed before, during and after exercise in an attempt to confirm the airway changes seen in EIA. Most people with chronic asthma will experience symptoms during exercise. However, there are many people without chronic asthma whole experience symptoms only during exercise.
How is asthma diagnosed and treated?
Common tests may include a chest X-ray, allergy testing and a pulmonary function test to assess how air moves in and out of the lungs. Asthma can be treated through a variety of medication options. In general, there are two large classes:
Reliever medicine is used to treat acute breathing difficulty. The most common rescue medicine is a quick-acting medicine called Albuterol. Once inhaled, these generally go to work to relieve breathing difficulty within 15 to 20 minutes and provide relief for at least three to four hours.
Control medicines are used to treat ongoing airway hyper-reactivity and inflammation. They are preventative medicines and are typically used daily, even if the child is not having any breathing difficulty. There are many different types of control medicines available. Some inhalers are combinations of both the reliever and the control medications to make using the inhalers easier for the patient.
How does exercise induce symptoms of asthma?
During normal breathing, people breathe in air through the nose, which warms and moistens the air. However, most people breathe through their mouth during exercise, bringing in colder and drier air. In some people, the tissues in the airway are sensitive to these changes in temperature and humidity, causing the surrounding airway muscle to contract. This results in EIA symptoms, which include coughing during or after exercise, shortness of breath or chest tightness during exercise, wheezing, unexpected fatigue during exercise, or inability to keep up with other athletes.
If my child has asthma, is it safe to play sports?
Yes! As long as it is well controlled with medication. If the child has severe asthma that is poorly controlled, they may be restricted from participating in sports until the asthma is under better control. If the child develops trouble breathing during sports, it is important to have a reliever medication like Albuterol with them at all practices and games. It is also important to let the athletic trainer, coach or team physician know about your child’s asthma and what medications the athlete is currently taking.
What are ways to prevent exercise-induced asthma?
The first step is to make sure that the asthma unrelated to exercise is well controlled with medication. Asthma inhalers or bronchodilators used prior to exercise can control and prevent exercise-induced asthma symptoms. The recommended method is to inhale a short-acting beta-2-agonist such as Albuterol 10 to 15 minutes prior to exercise. Only your child’s doctor can determine whether these medications are safe and appropriate for your child’s asthma.
In addition to taking medication, warming up prior to exercise and cooling down afterward will help minimize symptoms. Athletes should also avoid exercise in environments that are dry and cold, or have high pollen or high pollution. They should also avoid exercise when they have a cold or a respiratory infection. When exercising in the cold, wear a scarf or mask around the face to warm up and moisten the air.
What are the best sports for someone with asthma?
In general, if asthma is well controlled, any sport can be played. The best activities for people with exercise-induced asthma are sports that involve short, intermittent period of exertion in a warmer, more humid environment. Sports like volleyball, wrestling, baseball, softball, football, dance and gymnastics are generally well tolerated. Sports that involve longer periods of exertion like cross country, soccer and basketball are less tolerated, as well as sports played in the cold weather like ice hockey, ice skating and cross-country skiing. Swimming is an endurance sport but is generally well tolerated because it is performed in a warm, humid environment.
Asthma Care Resources
Work with your child’s doctor to develop and stick to an asthma action plan that can be shared with coaches, trainers, the school nurse and anyone who will be caring for your child. Children’s Health offers an Asthma Management Program to empower families to take control of their child’s asthma, including an environmental trigger home assessment, patient and family education, and ongoing family contact and reinforcement. Parents and teens can also use the My Asthma Pal app to manage daily asthma care. More information is available at www.childrens.com/asthma.
Dr. Troy Smurawa
Board-certified in both pediatrics and sports medicine, Dr. Troy Smurawa is the director of pediatric sports medicine at the Children’s Health Andrews Institute for Orthopaedics & Sports Medicine in Plano, Texas. Dr. Smurawa earned his medical degree from The University of Texas Health Science Center and did his residency in pediatrics at the University of Wisconsin. He completed a sports medicine fellowship at Children’s Hospital Medical Center in Akron, Ohio.