Infographic with allergy facts

Asthma and exercise-induced asthma">
What you need to know about

Asthma

What is asthma?

  • A chronic inflammatory disease of the airways that’s complex, ever-changing and unpredictable
  • Affected by seasons, indoor and outdoor environmental conditions, allergen exposure and air quality

Symptoms

  • Recurrent episodes of wheezing
  • Shortness of breath
  • Chest tightness
  • Cough

Approximately 60-80% of pediatric patients will develop symptoms before the age of 5. Coughing is the most common symptom in children.

Triggers

Triggers are things that make asthma worse, and they can be different for each person. Allergies, especially airborne, can trigger this diseaseasthma, so it’s critical to identify and avoid these triggers to prevent an asthma flare.

  • Animal dander – Flakes of skin from animals
  • Pollen – Tiny dust-like spores sent into air by plants, grass, trees and weeds
  • Dust mites – Spider-like creatures that are too small to see and present in beds, furniture, rugs and house dust. People with asthma are allergic to their bodies and waste.
  • Cockroaches – Insects that live inside buildings. People with asthma are allergic to their bodies and waste, which can be present in house dust.
  • Mold, mildew – Grows in damp places and sends tiny spores into the air

Diagnosis and testing

  • Diagnosis made using lung or pulmonary function tests to measure reduced lung function caused by obstructed airways that prevent air from being exhaled at normal rate of speed
  • Measured using medical equipment that determines lung capacity and exhalation speed
  • Classified using National Heart, Lung and Blood Institute guidelines:
  • Mild intermittent
  • Mild persistent
  • Moderate
  • Severe persistent

Prevention

(Read more about environmental control)

Housekeeping

  • Vacuum and dust with a wet rag weekly.
  • Use dust-proof covers on mattresses and pillows. Ask your doctor where to get these.
  • Don’t introduce pets into your home if you don’t already have them.
  • Use dehumidifiers to take dampness out of air. Mold, mildew and dust mites all need dampness to live.
  • Keep windows closed when pollen levels are high. Pollen seasons are spring and fall, with levels highest in morning.
  • Don’t let your child play in leaves and freshly cut grass.
  • Get rid of things that collect dust, especially in children’s rooms, including rugs, curtains, shelves and objects stored under the bed.

Illness

  • Colds and flu viruses can trigger asthma, so practice good prevention measures:
    • Wash hands often.
    • Avoid touching eyes, nose and mouth.
    • Get flu vaccine.

Tobacco smoke

  • Children who live with smokers are more likely to get this diseaseasthma, and their asthma tends to be worse.
  • After an asthma flare, they may take longer to get well.
  • Adults with asthma should avoid smoking.

Cold air

  • Dry, cold winter air can trigger asthma.
  • In winter, put a scarf over your or your child’s nose and mouth. This warms air before it gets to lungs. Warm air is less likely to trigger this diseasease

Exercise

  • Although it can trigger asthma, exercise is important and we encourage patients to be active.
  • If exercise triggers asthma, tell your doctor.
  • Certain medicines can be taken before exercise to keep asthma flares from starting.
  • Many star athletes have this condition.
  • The best sports are those with rest periods, such as baseball and football.

Treatment

Treatment plans are developed based on asthma classification. The goal of asthma management is to allow patients to live a normal life with minimal flares. We want adults and children to participate fully in normal activities of living, physical education and sports.

Asthma action plan

  • Written  management program including instructions on how and when to watch for triggers, monitor peak flow rates and increase medications for flares
  • Call your doctor if unresponsive to action plan or exhibiting any of these signs:
    • Cough, shortness of breath, rapid breathing
    • Chest pain, inability to lie flat
    • Difficulty talking
    • Ribs and neck muscles show when breathing
    • Facial appearance that’s pale or dusky in color
    • Mood changes
    • Extreme fatigue
    • Rescue medications not working

Environmental control

  • Identify and control environmental triggers, such as pollen, mold, dust mites, pet dander, and cockroaches.
  • Allergy skin testing is used to identify triggers. (Read more about allergy skin testing)

Medication
Anti-inflammatory

  • Inhaled corticosteroids, combination of inhaled corticosteroids and long-acting bronchodilator and leukotriene modifiers
  • Typically taken every day to prevent the lungs from becoming inflamed

Quick relief

  • Short-acting bronchodilators
    • Used for treatment of acute episodes or flares, every 4-6 hours as needed
    • Open inflamed lung airways quickly
    • Treatment intensity depends on severity of flare
    • Include short-acting beta2-agonists such as albuterol that relax the muscles lining the small airways and anticholinergics that do the same for the large airways
    • Daily or increasing use may indicate need for additional long-term controller medication or adjustment in therapy

Oral steroids

  • Short courses are often used for more severe flares

Anti IgE therapy
Treatment that interferes with the function of IgE, an immune system antibody. Also known as immunotherapy. (Read more about immunotherapy)


What you need to know about

Exercise-induced asthma (EIA)

What is exercise-induced asthma (EIA)?

  • Asthma that occurs when airways become partially blocked during physical activity
  • Also called exercise-induced bronchoconstriction or bronchospasm (EIB)
  • Can occur in patients who show normal lung function at rest and affects:
    • More children and young adults than older adults
    • Up to 90% of all patients with asthma
    • Significant numbers of patients with allergic rhinitis
    • Up to half of patients taking daily inhaled steroids/controller inhalers

Signs and symptoms

  • Shortness of breath
  • Cough
  • Chest tightness
  • Wheezing (whistling sound when breathing in or out)
  • Poor stamina

Symptoms usually occur within 6-10 minutes of beginning exercise, peak 8-15 minutes after activity stops and resolve within an hour.

Aggravating factors

Exposure to cold air, low humidity

Nasal blockage, viral respiratory tract infections

Air pollutants, high pollen counts

Certain sports like jogging or biking in cold months/locations

Diagnosis and testing

  • Involves formal exercise challenges and lung function testing
  • Is important to diagnose early since young children with EIA may have trouble keeping up with peers and avoid strenuous activity – both of which can negatively affect their physical and social well-being
  • Is key to help adults with EIA understand why they see no improvement in stamina or performance despite regular exercise
  • Allergist testing for EIA includes:
    • Pre-visit preparation, which may include prescription for inhaler medication to use before exercise and request to wear comfortable clothes and shoes for running tests
    • Thorough medical history and physical exam
    • Pulmonary function (breathing) tests at rest and after exercise if needed

Prevention and treatment

  • Choose physical activities carefully:
    • Walking, light jogging, leisure biking and hiking may be better than more strenuous sports.
    • Indoor swimming is ideal due to warm, humid atmosphere, year-round availability and horizontal position that may help move mucus from bottom of lungs.
    • Sports such as baseball, football, wrestling, short-distance track and field events, golfing, gymnastics and surfboarding that require short bursts of energy are better than endurance or cold-weather sports such as basketball, soccer, field hockey, skiing, ice hockey or long-distance running – though asthmatics can participate in most any sport with proper training and medical care.
  • Take pre-exercise medication such as albuterol, metaproterenol, terbutaline, cromolyn sodium, nedocromil or theophylline if prescribed.
  • Warm up gradually to avoid the symptoms that often occur within 15 minutes
  • Restrict exercising during viral infection, when pollen or air pollutions levels are high or when temperatures are extremely low.
  • Adopt breathing techniques such as pursed (narrowed) lip breathing to reduce airway obstruction and breathing through nose or facemask while exercising in cold weather to reduce heat and moisture loss.