EXERCISE & ASTHMA

The respiratory improvements reaped by exercise not only boost self-esteem and confidence but also encourage children to lead a more normal and less compromised lifestyle.

Often children with exercise-induced asth- ma symptoms will be found playing in goal on the football field because the position keeps exertional opportunities to a mini- mum, while still enabling the child to take part in sport. It is important that these children are recognised to have exercise- induced symptoms and that the asthma is treated appropriately to control the exer- tional symptoms. When asthma is well-con- trolled exercise activities should be encouraged.

Many children avoid exercise to limit the effects on their asthma.

This ‘dislike’ of

sporting activities may be their way of cop- ing and may underestimate the variability and severity of their disease. Encouraging children to stay indoors is also unlikely to help. A study in the USA suggests that modern changes in lifestyle and the increased opportunity for indoor entertain- ment results in greater allergen exposure as well as reduction in exercise (3).

Exercise testing Exercise testing is a simple test, which can be used to confirm the diagnosis and

Trisha Weller is co-ordinator of profes- sional education at the National Asthma and Respiratory Training Centre (NARTC). The Centre has trained over 12,000 health professionals in respira- tory management. For more information telephone the NARTC on 01926 493313.

FACTS

● Approximately 7% of the UK population suffer from asthma (3.9 million people)

4Training and conditioning

Recent studies have reported that swim- ming training improves aerobic capacity and protects against exercise-induced asthma (7), and that cycle training improved the aerobic capacity in less fit children which enabled inhaled and daily steroids use to be reduced in the short- term.

This was independent of disease sever- ity (8).

5Recommended exercise

Sporting activities should be strongly encouraged in children. Some activities such as cross country skiing (cold air) and scuba diving may have an adverse effect on an individualís asthma and

expert medical advice should be sought. There is no reason why children with asthma cannot take part in competitive sporting activities. If their asthma is well controlled it

should be encouraged but it is important to register the condition with the gov- erning body of the relevant sport and confirm with their medical officer the current permitted medications. These lists are constantly changing but

generally inhaled steroids and short and long-acting beta2 stimulants are accept- able but non-selective ones such as inhaled fenoterol and oral beta2 stimu- lants are not. Oral leukotriene receptor antagonists,

although they are not yet on the list in the British National Formulary, are per- mitted.

● One in seven children aged 2- 15 years have current asthma symptoms requiring treatment. This is equivalent to over 1.5 million children

● In a recent international study of teenagers and asthma (1), almost 1 in 5 had had treatment for asthma in the last year, while 21% reported having had a diag- nosis of asthma at some stage

● The NAC (1996) reported that 86% of respondents in a large survey of asthma patients felt asthma affected their ability to exercise or take part in physical activity

SportEX 15

severity of asthma, that can be carried out in the GP surgery.

Pre-exercise measure-

ments of peak expiratory flow (PEF) are fol- lowed by 6 minutes of exercise such as run- ning with subsequent PEF readings carried out at 5, 10 and 15 minutes after the exer- cise period. A drop of 15% or more in PEF confirms a positive exercise test. An initial slight increase in PEF may be seen and is normal. Unfortunately it is not possible to obtain accurate and reliable lung function measurements in children under 6 and therefore a careful symptom history is essential.