Exercising with asthma. Asthma can be life-threatening but, with asthma under control, most people can exercise (and some have even won Olympic gold medals).

Corticosteroids, such as beclomethasone (Beclovent, Vanceril), work by preventing certain cells in the lungs and breathing passages from releasing substances that can cause inflammation. They can be inhaled, taken orally or injected. When used regularly, inhaled corticosteroids decrease the frequency and severity of asthma attacks. Corticosteroids will not, however, relieve an asthma attack in progress.

Cromolyn sodium works by acting on specific inflammatory cells (most cells) in the lungs to prevent the release of substances (e.g., histamine) that can cause asthma symptoms or bronchospasm. When used prophylactically (i.e., as a preventive measure), cromolyn sodium reduces the frequency and severity of asthma attacks by decreasing inflammation in the lungs. Cromolyn sodium, however, has little if any effect when used after exercise.

Theophylline (available under various brand names) treats and/or prevents the symptoms of bronchial asthma by opening up the air passages of the lungs (bronchial tubes) and increasing the flow of air though them. The oral liquid, tablet and capsule dosage forms of theophylline can be used for either the treatment of an attack or for chronic (long-term) therapy. For best results, theophylline should be taken 30 to 60 minutes prior to the start of exercise. Theophylline is often given with a beta-agonist because the synergist combination of these medications can be more effective than either drug taken alone.

Although drugs are often helpful, asthmatics can take additional, specific steps to help alleviate their medical condition. At the very least, they should try to avoid the factors that cause their asthmatic symptoms as much as possible. Asthmatics should also consider adhering to the following recommendations:

Use a peak flow meter. A relatively inexpensive device, this apparatus measures how fast asthmatics are able to exhale air from their lungs. A precipitous drop in expired air (e.g., more than 10 percent) may be the signal of an increased level of airflow resistance in the lungs.

Use over-the-counter medications. Over-the-counter inhaled asthma medications should be used when a person does not have access to his or her regular medications during symptomatic situations.

Use a spacer. Use of a spacer will ensure that the medicine inhaled will reach the lungs and not simply coat the roof of the mouth or the back of the throat. Attached to an inhaler, a spacer allows asthmatics to better inhale their medicine by holding the medicine in "suspension," allowing those suffering from asthma to inhale several times to rapidly increase the efficiency of the medicine.

Adhere to recommended dosages. Excessive medication can produce adverse side-effects (e.g., rapid heart rate, dizziness, etc.).

Drink water. Consuming water after using inhalers helps clear the back of the throat of medicine.

Monitor air quality. Asthmatics should always be aware of what to do when confronted with various pollutants and pollens.

Use masks or scarves in cold weather. Wherever necessary, asthmatics should reduce the impact of cold air on their air pathways by masking their nose and throat.

Stay hydrated. Mucus plugging can result from an inadequate level of fluid intake (i.e., dehydration).

Be sensitive to asthma-related reactions. Some foods may lead to asthma attacks. For example, depending on the foodstuff (e.g., celery, carrots, peanuts, egg whites, bananas, shrimp, etc.), some individuals may increase the likelihood and severity of an asthma attack because of what they eat.

Enjoying asthma-free workouts

In recent years, some individuals have found that regular exercise can be a positive means of asthma therapy. Unfortunately, asthmatics often mistakenly believe that exercise is not a viable option for them. In reality, sensible exercise may actually help asthmatics to better cope with their sometimes debilitating medical condition.

The primary key to exercise effectiveness as a therapeutic option for asthma sufferers is that it makes breathing more efficient. Ample evidence suggests that proper exercise makes the airways of the lungs less sensitive to those factors that precipitate a bronchospasm.

Because exercise can, in some instances, trigger an asthma attack, it is extremely important that asthmatics, their personal trainers and their physicians work together to develop a comprehensive exercise and medication plan to deal with an asthmatic's medical condition. Keep in mind, however, that one individual's specific response to exercise may vary from another's. If exercise is approached in a sensible manner, asthmatics have much to gain from a program of regular physical activity, including an increase in their exercise tolerance and overall feelings of well-being.

Most physicians suggest that the first step in formulating an exercise program for asthmatics is to evaluate how the individual's body responds to progressive exercise to volitional fatigue. The next step is to develop an exercise regimen that meets the individual's needs and interests. Among the guidelines that asthmatics should follow to ensure that their exercise programs are both safe and effective are:

* Select an exercise that raises the heart rate, increases the respiratory rate, and is relatively easy on the lungs, such as swimming.

* Avoid asthma triggers as much as possible. For example, asthmatics allergic to pollen should exercise indoors.

* Avoid exercising outdoors on either polluted or cold, dry days. Wear a mask or a scarf to warm and moisten the inspired air if the exercise bout must occur outside on a cold day. Whenever possible, exercise in warm, humid air.

* Perform specific breathing exercises to strengthen the lungs.

* Use ratings of perceived exertion (refer to Figure 1) in conjunction with target heart rate to regulate exercise intensity, since many of the above-referenced medications can alter an asth-
matic's heart-rate response to exercise.

* Premedicate prior to exercising (within 30 minutes prior to engaging in activity).

* Keep an inhaler on hand while exercising.

* Perform extended warm-up exercises prior to working out.

* Avoid sudden, intense exercise for prolonged periods of time.

* Breathe through the nose as much as possible while exercising.

* Avoid hyperventilation by using a controlled breathing pattern.

Breathing easier

Fortunately, the innumerable benefits attendant to exercising on a regular basis are well within the reach of most asthma sufferers. In order to gain the most from their exercise programs, individuals who suffer from asthma should plan accordingly. Such planning requires several factors, including input from a personal physician, sensitivity to each individual's particular needs and the courage to embark on a reward-filled journey. By proceeding sensibly and purposefully in their quest to design and implement an appropriate exercise regimen, asthmatics can give their lungs a much-needed breath of fresh air.

REFERENCES

Afrasiabi, R., & S.L. Spector. Exercise-induced asthma: It needn't sideline your patients. The Physician and Sportsmedicine 19(5):49-62, 1991.

Franklin, B.A., S. Gordon, G.C. Timmis (eds.). Exercise in Modern Medicine. Baltimore, MD: Williams & Wilkins, 1989.

Kenney, W.L., R.H. Humphrey, & C.X. Bryant (eds.). ACSM's Guidelines for Exercise and Testing Prescription, 5th ed. Baltimore, MD: Williams & Wilkins, 1995.

Mahler, D.A. Exercise-induced asthma. Medicine and Science in Sports and Exercise 25(5):554-561, 1993.

Rupp, N.T. Diagnosis and management of exercise-induced asthma. The Physician and Sportsmedicine 24:77-87, 1996.

Skinner, J.S. (ed.). Exercise Testing and Exercise Prescription for Special Cases: Theoretical Basis and Clinical Application, 2nd ed. Philadelphia, PA: Lea & Febieger, 1993.

Cedric X. Bryant is director of sports medicine at StairMaster Sports/Medical Products L.P., Kirkland, Wash. James A. Peterson is a sports-medicine specialist residing in Mesa, Ariz. Barry A. Franklin is program director, Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, and professor of physiology, Wayne State University School of Medicine, Detroit, Mich. All are fellows of the American College of Sports Medicine.

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