Asthma patients need physical activity

Encourage your patients with asthma to participate in regular physical activity, but make sure their asthma is properly controlled and preventive measures to minimize exacerbations are in place, say the authors of an article recently published in Seminars in Respiratory and Critical Care Medicine.

Among asthmatic patients, exercise is often misunderstood as a trigger for exercise-induced bronchoconstriction (EIB), which is manifested as symptoms that can include breathlessness or chest tightness. Incorrect management of these symptoms, along with nonoptimal treatment, can also discourage asthmatic patients from engaging in exercise or training.

For this reason, patients with asthma are often not as physically fit as those without asthma,¹ and do not reap the health and psychological benefits afforded by exercise. The effects of regular exercise on asthma in the general population include increased exercise capacity and quality of life, and decreased asthma symptoms, airway responsiveness, risk of asthma exacerbations, and EIB.

It seems ironic that high-level athletes are at a much higher risk of developing asthma, airway hyperresponsiveness (AHR), and EIB, which can all occur after intense training over many years and extended exposure to environmental triggers including cold air, pollutants, and allergens. Indeed, asthma and AHR are the most common conditions among the athletes participating in the Olympic Games.²

To reduce the incidence of EIB, recommended treatments include daily corticosteroid use or, immediately before exercise, a fast-acting bronchodilator. Patients may, however, develop a tolerance to the effects of inhaled, fast-acting β₂-agonists, so their use should be limited to not more than three times a week.

Patients should also be cautioned to adhere to their maintenance therapy and seek treatment for any coexisting conditions, such as colds or even gastroesophageal reflux.

Nonpharmacologic methods to prevent EIB include:

• Avoiding or reducing exposure to environmental triggers
• Exercising regularly
• Avoiding exercising in areas that are highly polluted, when there are high allergen levels, or in extreme temperatures
• Warming up before exercise
• Using mechanical barriers—such as a scarf or mask—when exercising in the cold
• Brushing up on asthma self-management techniques

As their physician, you can ensure that your asthma patients are properly educated to recognize their symptoms and practice good inhaler techniques while engaging in regular exercise.

“In conclusion, regular exercise is beneficial to asthmatic subjects and should be suggested for all those suffering from this condition, while ensuring adequate asthma control and promoting preventative measures. Education about the positive effects of exercise in asthmatic patients and their entourage, especially for asthmatic children, should be offered broadly,” concluded authors Andréanne Côté, MD, Julie Turmel, PhD, and Louis-Philippe Boulet, MD, FRCPC, University of Calgary, Alberta, Canada, and the Quebec Heart and Lung Institute, Laval University, Quebec, Canada.

References

1. Clark CJ, Cochrane LM. Assessment of work performance in asthma for determination of cardiorespiratory fitness and training capacity. Thorax. 1988;43(10):745-749.
2. McKenzie DC, Fitch KD. The asthmatic athlete: Inhaled beta-2 agonists, sport performance, and doping. Clin J Sport Med. 2011: 21(1):46-50.