When Dr. Max Testa sees a parent or coach at a youth sporting event yelling at a wheezing or off-his-game kid to "toughen up," he shudders. As a physician and sports medicine expert, he recognizes a child who's in exercise-induced respiratory distress. Parents and coaches sometimes don't.
"These kids are tough. That's why sometimes they don't get diagnosed," he said. "Kids are competitive, and it's not often they don't push to their limit. If a kid is not pushing as hard, especially in spring, I have to think something is going on."
That something may be exercise-induced asthma or bronchospasm. And it's important to treat it because exercise is important to all aspects of health.
"The main goal is to stay active. We rate success by the ability to let them go out and exercise," Testa said.
Exercising safely in the face of respiratory challenge (including pollution) is the topic of today's Deseret Morning News/Intermountain Healthcare Hotline. From 10 a.m. to noon, Testa and exercise physiologist Carrie Petteys, both of the Orthopedic Specialty Hospital, will take phoned-in questions. The number is 1-800-925-8177.
Petteys said studies clearly show that people with asthma or other bronchospasms should not avoid exercise. Increased fitness decreases severity of symptoms.
It can be done, she said. As many as half of elite athletes suffer from exercise-induced asthma and "train at very high levels and win medals."
Symptoms can also be caused by serious lung disease or heart disease. Diagnosis is key.
Testing begins with a thorough history, then a single-breath capacity test to see how much and how fast someone can exhale. Breathing cold air or hyperventilating or running on a treadmill and checking pulmonary function at intervals to see if it deteriorates may be used, he said.
Treatment is based on frequency and severity. A bronchodilator containing a beta-2 agonist may be prescribed. The short-acting helper can be used before exercise by people who tend to go into bronchospasm. When someone is actively training, though, Testa instead counsels a longer warm-up. "If you use it too long or too much, it can become less effective," he said.
Patients who also have allergies or other issues may be sent to a specialist to deal with that. Controlling allergies can reduce asthma. Medication options vary. Selective anti-inflammatories work on swollen lung tissue. They're slower-acting and will likely be needed for a long time, so they're less responsive to exercise stress. Different medication may help children who play off and on all day and for whom an inhaler isn't the best choice, he said.
A chromalin inhaler modulates the immune response and has no major side effects. "They've been proven effective in reducing exercise-induced bronchospasm." A doctor might prescribe that long term and a beta-2 agonist just when needed.
Another option is corticosteroids, perhaps combined with a long-acting beta-2 agonist. There's a potential downside: long-acting beta-2 agonists may mask asthma attacks longer and they become harder to treat.
With warm weather, more people will exercise outdoors. But it's often a high-pollution time. And it's the peak of bloom time for plants that spark allergic reactions, too. Antihistamines can help there, combined with other medications to treat bronchospasm.
On bad-air or high-allergy days, Petteys and Testa encourage patients to wear surgical masks to reduce contact with what ails them, especially when they don't have to compete.
Warming up is extremely important, Petteys said. "It helps to decrease the response of our airways when we have these symptoms." Professionals disagree on how to warm up. One camp says 15 to 30 minutes of light to moderate exercise. The other says short bursts of higher intensity intervals is better. And because symptoms often show up after exercise, a longer cool-down period is needed.
Mild symptoms may simply resolve, much as a child may outgrow allergies.
Bronchospasms can be dangerous. And it's one of the few diseases where the death rate seems to be increasing, Petteys said."It's a disease you have to be on top of."