Asthma

Exercise-induced asthma can be controlled with medication

 

icordle@MiamiHerald.com

Chandra Sekhar loves to bike ride with his kids, go to the gym, swim, jog and play volleyball. But he found himself avoiding exercise because he would get breathless and wheeze.

So the 43-year-old software engineer went to the Cleveland Clinic, and learned he was suffering from exercise-induced asthma.

For the last nine months he has used an inhaler nightly, and can do all the sports he wants.

“Now I am a perfectly normal person,” said Sekhar, who lives in Pembroke Pines with his wife and two children. “So anyone who has exercise-induced asthma, I strongly suggest they go to the doctor and take some kind of medication, because there is no reason they should stay at home and not do any activities.”

Asthma is a chronic inflammatory condition of the airways associated with recurrent episodes of coughing, wheezing and shortness of breath. It can be triggered by environmental factors, particularly tobacco smoke, outdoor air pollution, dust, cockroach allergen, pet fur, mold, chemicals, fragrances and humidity, as well as by physical exercise, according to the Centers for Disease Control and Prevention.

About 80 percent of people with asthma have exercise-induced asthma, said Dr. Gustavo Ferrer, a pulmonologist and director of the Cough Center at the Cleveland Clinic in Weston. And for some people, exercise may be the only trigger.

When children or adults exercise, they tend to inhale short, shallow breaths, which takes in cold, dry air, resulting in the contraction of airway muscles. The airway becomes narrow, bringing on asthmatic symptoms like coughing, wheezing and shortness of breath.

“The nose is the gatekeeper of the lungs, and the job is to have the air that we breathe prepare for absorption. So the nose will filter dust and warm up the air, and then that air will go slowly into the lungs,” Ferrer said.

“When we exercise we breathe shallow, short and fast, so we don’t allow the nose to do its job, warming up the air [to body temperature],” he explained. “So we are inhaling in a large amount of air that is kind of cold,” which can lead to inflammation.

Exercise-induced asthma can be diagnosed using breathing tests that measure lung function, and can be found in children or adults.

“Sometimes kids had asthma as a child and when they reach their teens it gets better. But there is good tendency that the exercise-induced asthma comes back in the 20s,” Ferrer said. “Asthma doesn’t get cured; you still have the predisposition to have it come back at any time. But it can be controlled.”

To treat asthma, doctors use both rescue and preventative therapies. Rescue therapies include bronchodilators, such as Albuterol, which are used to relax the bronchial tubes and relieve the spasm in the airways when someone is having an asthma attack.

Others medications are preventative, such as inhaled corticosteroids — including Flovent, QVAR, Pulmicort and others, which are designed to be used every day.

Bill Cox, 69, a runner, began having asthmatic symptoms about a year and a half ago. He said he would have bronchial contractions and felt like he was unable to get enough oxygen when he ran.

He saw Ferrer at the Cleveland Clinic and learned he had exercise-induced asthma.

Now he is back to running 20 to 30 miles, five days a week. He uses inhalers: Advair twice a day and Albuterol 30 minutes before he runs.

“It has been working,” said Cox, a retiree who lives most of the year in Tamarac and spends summers in Pennsylvania. “I’m really happy. I would hate it if I had to stop running.”

Doctors have an arsenal of medications that can help asthmatics continue to exercise, said Dr. Agueda Hernandez, medical director of the Baptist Health Medical Group Family Medicine Center at West Kendall Baptist Hospital.

“What we aim to do in the treatment of asthma is that the patients’ symptoms are controlled so they don’t need the rescue inhaler frequently,” said Hernandez, who is also the associate director for the West Kendall Baptist Hospital/FIU Family Medicine residency. “We want them to continue to exercise, because in the long run, exercise is good for a number of different reasons.”

Hernandez is herself a “mild, intermittent asthmatic,” so she knows about it first-hand.

“Thankfully, we have much better medicines than when I was a kid that can keep the symptoms, keep the asthma, under control,” she said.

Dr. Moises Simpser, a pediatric pulmonologist and director of the Asthma Center at Miami Children’s Hospital, said it is important that parents of children who suffer from asthmatic symptoms when they exercise not stop their children from engaging in sports, under the false belief that they are protecting them.

Instead, the child should use medication and continue his or her activities, he said.

“For children who feel they can’t breathe, it should not be an excuse not to do P.E. or do exercise,” said Simpser, who is also director of the VACC Camp, a free camp for ventilator-dependent children.

Medication will help the child breathe better and help with exercise, he said.

“I think all of us should do exercise,” Simpser said.

“And if they start early, it’s even better because then they will do it all their lives.”

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