Asthma - a guide for teachers

How would you respond to a child having an asthma attack in the following sorts of situations?

• Play time
• Sports days
• School trips
• Residential visits
• Fieldwork

Exercise can often trigger asthma - research indicates that about 80% of people with asthma have symptoms triggered by exercise^1,2. For most people with asthma exercise is just one of a number of different triggers. Exercise-induced asthma can affect anybody with asthma including recreational sports people or elite athletes. This article examines the symptoms and what to do in case of an acute attack while exercising.

What is asthma?

Asthma is an inflammatory process affecting the airways of the lungs. People with asthma have airways that are almost always red, inflamed and swollen. This redness, inflammation and swelling means that the airways are overly sensitive to various stimuli, which will set off asthma symptoms - these are called triggers. When the airways come into contact with a trigger, the muscles that wrap around the airways react by tightening and constricting the airways.

The trigger can also cause further swelling in the lining of the airways, which causes the airways to narrow even more. The combination of the swelling and tightening results in breathing difficulties. Asthma affects individuals in different ways and triggers vary. Respiratory and viral infections, pets, house dust mites and cigarette smoke, to name a few, can make the airways narrower in people with asthma.

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.

Symptoms

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 15 minutes after exercise stops. Research shows that if exercise is attempted again within three hours the symptoms are less severe³. As with all asthma symptoms, there is a wide variation between different people at different times.

Tips to prevent exercise-induced asthma

These should be used with any medications:

• Warm up and down - a 10 minute warm up period can be helpful. Useful exercises include 30 seconds of vigorous activity to stimulate the system.
• Avoid the cold air - it can help to cover the nose and mouth in cold weather with a scarf; this warms and humidifies the air, which may reduce the trigger effect of cold air.
• Fitness - good aerobic fitness can also help.

What should you do in an asthma attack

When someone is having an asthma attack, if any of the following happen:

1. The symptoms (cough, wheeze, tight chest, breathlessness) are getting worse.
2. The reliever (blue) inhaler does not help their symptoms.
3. The person is too breathless to speak.

Then you must:

• Get the person with asthma to take their usual reliever inhaler straight away.
• Keep calm and try to relax the person as much as possible.
• Sit them down, don't lie them down.
• Rest their hands on their knees for support.
• Try to slow their breathing down as this will make them less exhausted.
• Wait 5-10 minutes.
• If the symptoms disappear, the person should be able to go back to whatever they were doing.
• If the reliever has no effect, call a doctor or ambulance.
• Continue to give the person their reliever inhaler every few minutes until medical help arrives. It is not possible to overdose on reliever.

Medication

It is important that asthma is well-controlled before exercise. Regular inhaled preventer treatment as prescribed by a doctor is the main means of control. Medications allow the control of symptoms. Different medications are chosen for different people.

• Inhaled steroids (brown / red / orange inhalers) - used to prevent asthma symptoms. Controlling your asthma symptoms using regular inhaled steroids will reduce the trigger effect of exercise.
• Short - (blue inhalers) and long-acting beta agonists (green inhalers) - 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.

Important note

Asthma should be no obstacle to exercise, playing sport and keeping fit. Many Olympic competitors, footballers and other top sportspeople have asthma, including Paula Radcliffe and Paul Scholes.

References

1. Inman M. Management of Exercise Induced Bronchoconstriction. Canadian Respiratory Journal 1999;6:345-354
2. Milgrom H. et al. Keeping Children with Exercise Induced Asthma Active.Paediatrics 1999;104:38
3. Wilkerson L. Exercise Induced Asthma. Journal of American Osteopathic Association 1998; 98: 211-5p

Resources and further reading

• The National Asthma Campaign produces fact sheets, booklets and other information on asthma. Contact 020 7226 2260.
• National Asthma Campaign Scotland. Telephone: 0131 226 2544. Website www.asthma.org.uk
• Asthma Helpline 0845 7010203. Monday to Friday 9.00am-7.00pm. Calls charged at local rate.
• Morgan M. How Does Exercise Trigger Asthma? Asthma: ask the experts. National Asthma Training Centre. Class Publishing 1997.
• Adams F. Exercise and Asthma. The Asthma Source Book. Contemporary Books 1995. TEX

This article has been reproduced with permission from SportEX Health magazine. The author, Jo Viner Smith, is health promotion manager at the National Asthma Campaign. SportEX Health magazine contains articles on the benefits of physical activity for health.

First published in Teaching Expertise magazine, Issue 1 Autumn 2003