Written by Dr Nicola Wilson, honorary consultant paediatrician
How can I use my medication to avoid asthma on exercise?
There are two ways in which medication can be used to prevent asthma on exercise:
short-term protection
long-term protection.
Short-term protection
This lasts three to four hours and the inhaler is used before exercise. In general, if you need to use your reliever inhaler less than once a day, you don't need to use a preventer as well. If you use your reliever more than this you should also be using a preventer. Medications that can provide short-term protection include:
short-acting reliever inhalers, which open the airways and are often blue, such as salbutamol and terbutaline. These stop airway muscles contracting when the constrictor chemical is released.
instead of a short-acting reliever, a long-acting one, such as salmeterol
or formoterol (eg Foradil or
Oxis) taken morning and night, will give 24-hour cover. These should only be used without a preventer in special circumstances (for example, in a child with mild asthma on a day with a school sports lesson, when access to inhalers at school is a problem).
sodium cromoglicate or nedocromil sodium are less commonly used, but may be useful in amateur and professional athletes.
Long-term protection
These preventers work by reducing the inflammation in the airways that cause asthma. Overall improvement in asthma occurs, which includes asthma on exercise. To work, the preventers have to be taken every day for long periods of time. They do not work as a single dose before exercise and the benefit may not be noticed for at least a week. Medications that can provide long-term protection include:
inhaled steroids, such as beclometasone, fluticasone and budesonide through an inhaler.
leukotriene receptor antagonist tablets, such as zafirlukast or montelukast, are fairly new. It is not known how many people will benefit from them, or for how long you need to take the tablets before they work.
Other things I can do to reduce or avoid asthma on exercise
Avoid exercising outside on cold and frosty days, as cold air holds less water vapour, and drying and cooling of your airways acts as a stimulus for release of constrictor chemical.
Make sure you breathe through your nose because the nose warms and humidifies the air, which is then less of a stimulus to constrictor mediator release.
Before starting exercise, warm-up first, with short bursts of exercise because this may reduce the asthma that follows on more strenuous and prolonged exercise. The explanation for this is not quite clear, but two factors may play a part. Firstly, small amounts of exercise may actually improve your lung function (look at the graph, which shows an improvement in lung function during the early part of exercise). Secondly, even though the warm-up does not cause asthma itself, it may reduce the ability of your airway cells to release the constrictor chemical that causes the symptoms of asthma.
If running is a problem, try swimming because the humid air in the swimming bath may cause less drying of your airways. Try an intermittent sport (eg tennis, bowls) or exercise indoors on cold days (eg gymnastics, aerobics, badminton).
Choose sprinting rather than cross-country running, because you can run short distances at speed taking only a few breaths, so there is less drying and cooling of your airways.
Avoid exercising on days with high pollen counts if you are sensitive to pollen, or days with high pollution, because you may inhale more pollutants/pollen with the increased breathing needed during exercise. These generally aggravate asthma in people who are susceptible.
Keep fit because, as your fitness increases, you will breathe less heavily for a given amount of exercise and so reduce the stimulus for asthma.
Most importantly, keep your asthma under control.
Specific problems with exercise and asthma
Exercise anaphylaxis. This is a rare condition in which the combination of exercise and allergy to a particular food eaten immediately beforehand causes collapse and difficulty breathing (similar to the severe allergic reaction to peanuts experienced by some people).
Exercise associated with laughter and excitement (eg a birthday party, visits by friends and relatives) can be troublesome for some children. This should be anticipated and a reliever inhaler given beforehand.
Occasionally, people with severe asthma experience asthma on exercise in spite of high-dose medication. In these cases, gentler, less provoking activities such as bowls should be chosen.
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