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Exercise induced asthma.

One of the first things medical students learn about asthma is "Not all that is asthma wheezes, and all wheezing isn't asthma." Medical students quickly learn that there are many types of asthma including cough-variant asthma (the only symptom is coughing and not wheezing).

Exercised-induced asthma (EIA) is a type of asthma that affects people only when they are exerting themselves, thus the name. Many athletes, including Olympians, have EIA and don't let it interfere with their athletic performances.

What Are The Symptoms?

Children with EIA develop wheezing and shortness of breath during or after exercise. Short bursts of exercise (under five to six minutes) may not cause any symptoms. In most people with EIA, the symptoms occur after five to twelve minutes of exertion. Some people also experience a second attack three to eight hours after the first attack.

The most common symptoms of EIA are wheezing and shortness of breath. Other symptoms include coughing and chest tightness. Sometimes a panicky feeling occurs.

What Causes E.I.A.

The cause of EIA, and specifically why exertion causes asthmatic symptoms, isn't known. Some doctors believe loss of heat and water from the lungs may play a role. The rewarming and return of normal hydration to the lungs may also be important in the onset of the symptoms.

No one knows why certain children develop EIA and others don't. However, those with it shouldn't let their EIA interfere with their activities. Certain sports, especially those that require high levels of exertion for intermediate to long duration, are more likely to cause symptoms. Cold and dry environments are also more likely to cause wheezing and other EIA symptoms. Sports such as basketball, soccer, and track are typical of high intensity sports.

What Can My Child With E.I.A. Do.

Swimming, baseball, and golf are sports less likely to cause EIA. They involve short bursts of energy or are not physically demanding sports. Endurance sports, such as long distance running, that require long term exertion are also less likely to cause EIA.

There is no reason why EIA should prevent a child from participating in sports. With proper treatment, EIA can be completely controlled. There are two ways to treat EIA: prevention and control of symptoms once they occur.

How Is E.I.A. Treated?

Drugs used to prevent EIA include cromolyn, nedocromil, and ipratropium. These drugs are taken on a regular basis when the child has no symptoms. They are designed to allow children to participate in sports and not develop any wheezing or other EIA symptoms.

Another class of drugs, beta agonists, such as albuterol, bitolterol, metaproterenol, pirbuterol, and terbutaline, are used either when the symptoms occur or just before an activity that may cause symptoms. These drugs usually work fast and usually take the symptoms away. A new beta agonist, salmeterol, works like the others but is long acting. It is usually taken twice a day to prevent wheezing. However, it is not a fast acting drug and shouldn't be used to treat EIA symptoms once they occur.

What Can My Child Do To Prevent E.I.A. Attacks

There are things children with EIA can do to prevent their symptoms from occurring.

* Using inhaled medicines before exercise (if so prescribed by the doctor) should become a part of the child's routine warm-up routine.

* Warm up with 10- 15 minutes of mildly strenuous stretching exercises.

* Use beta agonist inhalers as soon as wheezing or other EIA symptoms occur. Waiting, hoping the symptoms will go away, usually doesn't work and increases the chances the symptoms will get worse.

* If exercising in cold weather, the child should wear a face mask or scarf over his mouth and nose. This helps to warm the air and prevent loss of humidity.

* Many children with EIA find that a cool down routine performed after exercising helps to prevent post-exercise EIA.

With proper preparation, education, and medications, there is no reason why exercised induced asthma should interfere with your child's activities or life.
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Publication:Pediatrics for Parents
Date:Jun 1, 1995
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