For Patients

Most children with asthma cough or develop a tight chest after certain kinds of exercise. The physical triggers that cause the tightness, such as cold or dry air, make the smaller air pipes in the lungs to narrow. If they narrow slightly, the child simply coughs after the exercise. If they narrow up more, the chest becomes tight.

This occurs after about six to ten minutes of exercise, and may interfere with continuation of that sport. If not recognised, the child will perform the exercise with a partially tight chest. The tight chest may open on its own after an hour or two, or it may become necessary to consult a doctor.

This coughing or tightness of the chest after exercise is part of asthma and expected in this condition. It is easily prevented with safe medications.

Some children�s symptoms after exercise are the only sign of asthma as they do not cough or wheeze at other times.

Definitely yes. This is one of the goals of successful asthma management. Correct use of simple medications should prevent symptoms that follow exercise in asthmatic children (cough, chest tightness).

• Swimming is a good sport for asthmatic children
• Short burst types of exercise are better e.g. sprinting

Longer distance running, where an asthmatic child runs at about three quarters pace for 6 – 10 minutes, is more likely to cause coughing and tightness of the chest e.g. cross country running, marathon running.

Encourage them to continue running. Use the simple methods outlined below to block this response.

Use the recommended asthma pumps to prevent exercise related chest tightness. Encourages fitness and normal activity as exercise is good for everyone. This usually allows children to cope better with asthma.

By using simple safe medications (asthma pumps) before exercise, exercise related coughing or wheezing can be prevented.

Examples of effective medications include (see booklet Asthma medicines and how they work).

• Reliever bronchodilator inhalers pumps e.g. fenoterol (Berotec) 1 puff, salbutamol (Ventolin or Venteze) 1-2 puffs, or terbutline (Bricanyl) 1 puff 10-15 minutes before exercise.
• Reliever bronchodilator dry powders e.g. Berotec inhalets, Bricanyl turbohalers, or Ventolin rotacaps or Ventodisks.
• Preventer mast cell stabilisers e.g. sodium cromoglycate (Lomudal) – 1 puff.
• Reliever nebulised bronchodilators – effective but cumbersome.

Use a reliever bronchodilator. Sodium cromoglycate, theophyllines and inhaled steroids will not relieve symptoms once they have started.

• Prevention is always better than cure.
• If the attack occurs despite use of a reliever mediation before the exercise, repeat this medication during the exercise when the chest gets tight. If the symptoms persist, the exercise should probably be stopped.

Yes. This is an important clue for diagnosing asthma. It can easily and effectively be treated. It may mean that an asthmatic child with exercise induced difficulty needs more medication, and that the asthma is not properly controlled.

Many Olympic medals have been won by people with asthma. Also, many children with asthma achieve provincial and national colours for their sports.

• Inhaled corticosteroids are not the same as anabolic steroids used by some athletes to improve their performance.
• Inhaled corticosteroids for asthma are allowed by sporting regulating agencies. However, the sporting authorities need to be informed about the use of inhaled steroids permission obtained for their use before the event(s).

• All children get breathless after exercise. If exercise is followed by coughing, wheezing or chest tightness, exercise induced asthma is very likely.
• Your child can blow into a simple tube for measuring breathing (peakflow meter) before and after exercise. If the reading (peak flow)on the meter drops by 15% or more, it confirms that your child is getting exercise induced asthma (see booklet A guide to peakflow in childhood asthma).

Usually children whose peak flow reading has returned to within 80% of the value expected for their height, are able to exercise normally and safely. Your doctor can assist you in making this decision.

Yes.

As the medications are safe, using them is the best way to control exercise induced asthma. However, if you warm up first with some stretching and slow running, the exercise that follows will be managed better.

This probably means that your child�s asthma is under treated. Consult your doctor to choose the preventer treatment best suited to your child�s needs.

Children whose asthma is correctly managed and well controlled can usually play the sport of their choice. The only sport that asthmatic children should participate in with caution is Scuba diving.