Exercise-Induced Asthma: Chat with a National Jewish Health Expert

The following information was taken from an online chat on the National Jewish Health Web site on May 24, 2001, with Andy Liu, MD.

Question: Can structured exercise actually benefit asthmatics?

Dr Liu's Answer: With asthma controlled, structured exercise will improve conditioning, reduce weight, and thereby reduce cardiopulmonary work for any daily activity; thus, asthma becomes more difficult to trigger. This may not seem significant, but I see many asthmatic children who are deconditioned due to inadequately controlled asthma and lifestyle. Their asthma can be triggered by going up a flight of stairs in school between classes, often each day. Exercise for asthma, and live longer and better as a bonus.

Question: How can I avoid the triggers for exercise-induced asthma?

Dr Liu's Answer: Almost all asthmatics have some degree of exercise-induced asthma. The differences between them are the amount of exercise that is required before someone has difficulty. Someone who is quite stable might not experience any difficulty at all unless extremely challenged. For those experiencing an infection with wheezing, it might take very little activity at all to cause difficulty. The main "trigger" for exercise-induced asthma is exercise. However, other factors (infection, allergy, changes in the weather) can make someone more sensitive to exercise. One way to deal with exercise-induced asthma is to pre-treat with a beta agonist right before activity.

Question: How do you handle fear that parents have of their children participating in exercise programs?

Dr Liu's Answer: This is a surprisingly common problem. First, the asthma must be controlled so that it does not trigger with exercise. Once that is achieved, then one can build confidence in exercise tolerance as exercise is increased. The main message is that for all except the rare severe asthmatic, you or your children should be able to completely control asthma while participating in the sport of your choice.

Question: Is outdoor exercise in reasonable weather good for the asthmatic if there is air pollution? Should asthmatics work on cardiovascular health year-round?

Dr Liu's Answer: Exercise outdoors for asthmatics is very good, despite the pollution or allergen exposure tradeoffs. Thus, the asthma needs to be controlled well enough to handle these exposures. Good cardiopulmonary conditioning for asthmatics is great and helpful for daily function. Note that this is also true for general good health.
Read more about cold-weather activities.

Question: What is the role of routine inhaled steroids in the control of exercise-induced asthma?

Dr Liu's Answer: Inhaled steroids play an important role. Controlling underlying inflammation reduces lung twitchiness in asthma, which males any asthma trigger less of a problem, including exercise.

Question: Are our maintenance asthma medications supposed to control our symptoms so well that we don't need to pre-treat to avoid exercise-induced asthma?

Dr Liu's Answer: Maintenance medications are supposed to help. Often, maintenance medications alone are not enough to provide complete control of exercise-induced asthma, especially the more vigorous the activity, or when exposed to pollution or allergens.

Question: Is it a reasonable goal for asthmatics to experience no symptoms and participate in all activities they desire?

Dr Liu's Answer: Yes. For most asthmatics, this is obtainable. A recent Asthma in America survey showed that most asthmatics were settling for substantially less. We shouldn't.