Abstract

Generally, children with asthma feel good they are active that by participating in school physical exercises in school and over the weekend at home. Experts argue that at the initial stage exercise helps to identify the condition of the child by bringing out the symptoms of asthma which are like cough and dyspnea and also the chest tightness which is easily noticeable. Exercise is believed to the most cause of asthma in children. Hence it should be looked into when being conducted by children who are asthmatic in that case. Therefore, exercise is believed to be the most reason that keeps the asthma children active regardless of what they are living but if they engage in any sports which acts as a body exercise.

Parents are always in shock when they know that their children are suffering from the asthmatic condition which many do not accept readily. Children may mention shortness of breath while playing, chest tightness or difficulty in breathing in the air the reason which takes over their daily activity. Parents are typically not aware of the child’s respiratory symptoms in the school gym as most teachers spend much time with the child. Further inquiry may reveal symptoms associated with activities at home or with sports when they are exposed to the exercises.

Physical examination is rarely helpful when the asymptomatic child is seen in the office or clinic, and spirometry is normal unless the child has mild or moderate persistent asthma. Occasionally, a child with a low normal forced expiratory volume in 1 s will have a significant response to a bronchodilator in the pulmonary function laboratory. Studies involving athletes have shown that the typical symptoms associated with asthma are neither sensitive nor specific for identifying individuals with exercise-induced asthma. It has been recommended that exercise testing with bike or treadmill, or even a sports-specific exercise challenge that simulates the training and competition environment, be performed. Other causes of exercise-associated symptoms, such as VCD, need to be considered as well as symptoms arising from poor physical fitness, occasionally related to obesity. The clue to VCD is inspiratory stridor from partial vocal cord closure and normal oxygen saturation during exercise and, in the obese child, dyspnea without coughing. The author prefers the term EIA as long as it is understood that practice is a trigger of pre-existing asthma and not a cause of asthma. The term ‘exercise-induced bronchoconstriction’ is preferred by others, mainly when used to describe individuals not known to have asthma but with bronchoconstriction associated with exercise.

Several theories have been proposed to explain EIA, which is reported to occur in 80% to 90% of asthmatics. Inspired air is generally heated to 37°C and thoroughly saturated with water vapor by the airways. The first theory proposed is that rapid breathing during exercise causes heat and water loss. This is compounded by breathing air that is dry and cold. Airway cooling causes reflex bronchoconstriction and, at the end of an exercise, rebound vasodilatation occurs, causing mucosal edema, which leads to airway narrowing. The second theory suggests that hyperventilation causes airway drying, which eventually leads to the release of mediators that cause bronchoconstriction. Others have shown that exercise-induced deep inspirations mechanically stretch the airway smooth muscle Broncho dilating the lower airways. Bronchoconstriction occurs following exercise when the airways rewarm, leading to engorgement of the vascular bed. For years, it was taught that the symptoms of EIA occur following practice. We now know that this is not necessarily the case, particularly in children.

For symptoms occurring at school, the parents should meet with the child’s teacher and the gym instructor or coach. Modifications to the activity or sport, if possible, can be helpful when the symptoms are limiting the child’s participation. Avoiding running during warm-ups before ball games, volleyball and taekwondo may be beneficial. Shorter distances of track and field, long jump or high jump do not require prolonged rapid breathing and allow the child to participate. The author has seen many discouraged cross-country runners limited solely by their EIA. Becoming a fullback in soccer or engaging in shorter distances in paddling may be helpful. The author is aware of several asthmatic children who excelled as goal-keepers in soccer and could play the entire game without symptoms, something they otherwise would not have been able to do. Predictably, they experience their symptoms during practices when they are required to run laps around the field with the other players. If the child reports that they are goalkeepers in hockey, soccer, lacrosse or field hockey, do not miss the opportunity to ask them why they chose that particular position.

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