Exercise and Asthma

Factsheet • 36 • July 2000

Exercise and sports are good for everyone. Asthma is no obstacle to exercise, playing sport and keeping fit. Many Olympic competitors, footballers and other high level sportspeople have asthma including several gold medal winners.

This factsheet outlines

• exercise induced asthma

• playing sports and exercising with asthma

• certain adventure sports and asthma in more detail

Exercise-induced asthma

Exercise is a common trigger for asthma - research indicates that about 80% of people with asthma have symptoms triggered by exercise. For most people exercise is one of a number of different triggers. Exercise induced asthma can affect anybody with asthma - children, adults; recreational sportspeople or elite athletes.

Symptoms of exercise-induced asthma

Symptoms of exercise induced asthma include coughing, wheezing, chest tightness and difficulty in breathing that is triggered by exercise. Symptoms usually begin after exercise and worsen about fifteen minutes after exercise stops. Research shows that if exercise is attempted again within three hours the symptoms are less severe. As with all asthma symptoms, there is a wide variation between different people at different times.

Why does exercise trigger asthma?

It is not known exactly how exercise triggers asthma. When people exercise they breathe faster and this makes it more difficult for the nose and upper airways to warm and add moisture to the air breathed in. This results in the air breathed in during exercise being drier and colder than usual. It is thought that this cold, dry air in the airways triggers the symptoms of exercise induced asthma. This may explain why swimming is a good sport for those with exercise induced asthma. The humid air in the swimming pool does not act as such a strong trigger.

Diagnosing exercise-induced asthma

If you feel that exercise triggers symptoms of asthma in you or your child then it is important that you tell your doctor. The doctor will want to find out whether you have

• asthma for which exercise is one of the triggers

• symptoms of asthma that only occur when you exercise.

The treatment for these two conditions may be slightly different. The doctor may use the following methods to help diagnose exercise induced asthma.

• Medical history. For many people exercise induced asthma can be diagnosed by your doctor taking a simple medical history.

• Peak flow tests. These are simple to perform and are often used in children aged 5 and above. Readings are taken before and after exercise.

• Other breathing tests. These tests are used if the diagnosis is difficult to make or if symptoms have a large impact on life. More complicated methods are also used in more serious athletes. They will probably be performed in a hospital.

Benefits of exercise

Taking regular exercise and playing sports improves overall fitness and well being. People with asthma should be encouraged to participate in regular exercise, being fit helps the body to cope better with all conditions.

Managing exercise-induced asthma

Certain types of sport and exercise are more likely to trigger asthma. It may be useful for you to think about which sport you might like to play.

• Free running or events such as cross country running are particularly strong triggers. These sports are continuous in nature without short breaks and are usually undertaken outside in the cold air - all strong trigger factors. This does not mean that people with asthma can not enjoy long distance running.

• Team sports such as football, netball or hockey are less likely to cause asthma symptoms than running. These sports are played in brief bursts with short breaks in between.

• Swimming is an excellent form of exercise for people with asthma. The warm humid air in the swimming pool is less likely to trigger symptoms of asthma. Swimming increases fitness; assists weight loss and improves well being. Swimming in cold water or heavily chlorinated pools may trigger asthma.

• Yoga is a good type of exercise for people with asthma. It helps relax the body and may help with your breathing.

Asthma should not stop you doing any type of exercise as long as youconsult your doctor regularly

• keep your asthma well controlled

• take the correct medication

• work up to your sport gradually

You should also be aware of other triggers when you exercise, for example a high pollen count, low air temperature or existing cold or infection; these may affect the choice of exercise.

Preventative measures

There are several steps that can be taken to help reduce the symptoms of exercise induced asthma. These should be used with any medications that your doctor has prescribed.

• Warm up and down. A 10 minute warm up period can be helpful. Useful exercises include 30 second sprints. Warming down after exercise is of benefit too.

• Avoid the cold air. It can also help to cover the nose and mouth in cold weather. This warms and humidifies the air which may reduce the trigger effect of cold air. You can use a scarf to cover your nose and mouth. Alternatively where possible you could try to exercise indoors rather than outside. This would mean running on a treadmill in a gym instead of road running for example.

• Fitness. Good aerobic fitness can also help to reduce exercise induced asthma.

Medications

Your asthma must be well controlled before you begin to exercise or play a sport. Regular inhaled steroid treatment as prescribed by your doctor is the main means of control.

Medications can be very helpful in managing asthma allowing the control of all your symptoms.

Different medications are chosen for different people.

• Inhaled steroids. Used to prevent asthma symptoms. Controlling your asthma symptoms using regular inhaled steroids will reduce the trigger effect of exercise.

• Short and long acting beta2 agonists. Used to relieve asthma symptoms.

• Sodium cromoglycate or nedocromil sodium. Used to prevent asthma symptoms especially before exercise.

• Leukotriene receptor antagonists. Recently developed medications, in tablet form, which appear to be helpful in controlling exercise induced asthma.

Special situations

• At school. Full participation in PE and sport at school should be possible for all but the most severely affected children with asthma. Make sure that your child's teacher knows they have asthma. Teachers can help children to remember to warm up, warm down and bring their reliever inhalers with them when they play sport. More information about how to manage asthma at school can be found in the National Asthma Campaign's Schools Pack, Asthma at School booklet and School Asthma Card.

• Competitive sport. None of the inhaled medicines commonly used for the management of asthma are banned in competitive sports. However the use of several medications may be restricted, for example to inhaled form only; in others forms they could be used by other athletes to enhance performance.

UK Sport regularly produces guidelines on substances which are banned or restricted in competitive sports. If you play sport competitively it is important that you inform your sport's governing body about any medications you may be taking. They will be able to provide you with up to date details on which substances are banned and give you information on registering your medicines.

Adventure sports

Adventure sports are increasing in popularity. These sports by their nature carry increased danger to all people; people with asthma may need to take special care. It is important that you contact your doctor before undertaking these activities.

It is vital when contemplating adventure sports that you tell the instructor of your asthma and carry easily accessible reliever medication. You should ensure that you mention your asthma on medical insurance, fitness declaration and medical waiver forms.

Scuba diving

Traditionally people with asthma have been prevented from scuba diving as it was considered too dangerous. In recent years medical opinion has recognised that people with controlled asthma symptoms can take part in scuba diving. However people with asthma are at a greater risk of the problems caused by scuba diving.

Always consult your doctor before you plan to scuba dive. Your doctor can obtain advice from medical advisors at the British Sub-Aqua Club if necessary.

There are several reasons why people with asthma may have greater problems when scuba diving. These include a number of triggers which you are exposed to when you scuba dive (cold air, exercise, emotion). Asthma can also increase the chances of developing one of the serious risks of scuba diving which can be fatal. Many people with asthma enjoy scuba diving and do not run into problems.

Advice and regulations vary between countries on diving by people with asthma; some countries do not allow anyone with asthma to scuba dive. It is important that you check the regulations of a particular country before you plan to scuba dive.

The British Sub-Aqua Club suggest that those with mild controlled asthma may dive provided that

• you don't have asthma that is triggered by cold, exercise, stress or emotion

• your asthma is well controlled

• you have not needed to use a reliever inhaler or had any asthma symptoms in the previous 48 hours

Mountaineering

The clean air of the mountain environment is ideal for those with pollution triggered asthma. On the mountainside you are unlikely to be troubled by house dust mites -a very common asthma trigger- as they can't live at the low temperatures above the snow line.

The mountain environment contains several triggers for people with asthma (cold dry air, altitude, and exercise). Altitude can affect anybody although people with asthma are more likely to be affected. Fact Sheet 13 Asthma and Altitude is a guide to this topic.

If you are physically fit with well controlled asthma and prepare adequately for your trip you should not be restricted in your activity.

Always consult your doctor before planning a trip. Medical advice on mountaineering at high altitudes is available from the British Mountaineering Council.

Skiing

Skiing holidays or competitive skiing involve many of the same asthma triggers as mountaineering. Cross-country skiing is thought to be a stronger trigger for asthma than downhill skiing or mountaineering. Cross-country skiing is continuous exercise with no short breaks in between bursts of activity.

People with well controlled asthma should be able to enjoy skiing safely. You should make sure that your asthma is well controlled before you go. Always take your medications with you when you ski and discuss your trip with your doctor in advance.

Parachute jumping/sky diving

Parachute jumping and sky diving has many of the triggers of mountaineering and skiing. Always consult your doctor before planning a parachute jump or sky dive. Medical advice on sky diving and parachuting is available from the British Parachute Association.

As a general rule you can undertake parachute jumping or sky diving if

• your asthma is completely controlled

• cold air is not a trigger for your asthma

• exercise is not a trigger to your asthma

Further information

The National Asthma Campaign produces fact sheets, booklets and other information on all aspects of asthma. To receive details please contact 020 7226 2260 or the Asthma Helpline on 08457 010203. Alternatively visit the website HYPERLINK http://www.asthma.org.uk www.asthma.org.uk

Particularly relevant information includes

• Fact sheet 13: Altitude and Asthma

• National Asthma Campaign Schools Pack

• Booklet: Asthma in daily life

Other organisations

British Mountaineering Council British Parachute Association
177-179 Burton Rd Wharf Way
Manchester M20 2BB Glen Parva
www.thebmc.co.uk Leicester LE2 9TF
0161 445 4747 www.bpa.org.uk
0116 278 5271

British Sub-Aqua Club Professional Association of Diving
Telford's Quay Instructors
Ellesmere Port Unit 6 Unicorn Park
South Wirral Whiteley Road
Cheshire CH65 4FC Bristol BS4 4EX
www.bsac.co.uk 0117 971 1717
0151 350 6200

UK Sport
40 Bernard Street
London WC1N 1BR
www.uksport.gov.uk
020 7841 9500

If you have any more questions about the information on this factsheet or anything else about asthma then you should discuss them with your doctor or the nurse at your surgery. You can also call the Asthma Helpline on 0845 7 01 02 03 (Monday - Friday 9.00am - 7.00pm) and speak to an asthma nurse specialist.