Wheezing: Whining or Winning?

Many people with asthma avoid exercise because they’re afraid it could trigger symptoms such as shortness of breath, wheezing or a full-blown asthma attack.

However, a new report from The Cochrane Library turns these fears on their head. The authors conclude that not only is it safe for people with asthma to exercise, but it could also reduce their risk of asthma symptoms or attacks!

Study author, Kristin Carson, from The Queen Elizabeth Hospital, Clinical Practice Unit, Adelaide, Australia explains that over time patients with asthma who avoid exercise can become out of shape, losing muscle mass and cardiovascular fitness. That makes any future attempts at physical activity significantly harder, increasing the chances that patients will become fatigued and breathless and further discouraging physical activity. “This results in a spiraling cycle,” she says, in which patients are even more likely to avoid exercise.

To determine whether exercise was a danger to asthmatics, Carson and her colleagues reviewed previous studies that looked at the effects of physical training on people with asthma comparing patients who received no or minimal physical activity to those who exercised for at least 20 minutes, twice a week, over the course of four weeks.

The researchers found that the patients who had exercised, using physical training such as running outdoors or on a treadmill, cycling, swimming or circuit training were no more likely to have a serious asthma-related problem than those who weren’t exercising or who did light exercising such as yoga.

The patients who exercised also improved their cardiovascular fitness, which in turn can reduce asthma symptoms over time. There was also some evidence to suggest that exercise improved patients’ quality of life.

We found no reason for people with stable asthma to refrain from regular exercise,” Carson said. “Physicians should encourage their patents with stable asthma to engage in physical training programs.”

Even though this research suggests that exercise is safe for asthmatics, we suspect that many people will still think they can use their asthma as a reason to avoid physical activity.

Well now there is no excuse, and just in case you’re in any doubt consider the following list of people who never let asthma stop them:

Do you have any asthma and exercise stories to share?

Daily Asthma Treatment No Different from Intermittent Treatment in Toddlers

As most parents of toddlers with asthma know, a daily dose of an inhaled steroid is usually prescribed to keep the frequent bouts of wheezing at bay. But, the results of a recent study published in The New England Journal of Medicine could likely change all that.

A group of pediatric asthma researchers nationwide, found that daily inhaled steroid treatment was no better at preventing wheezing episodes than treating the child with higher doses of the drug at the first signs of a respiratory tract infection.

They also found that daily treatment was comparable to use of the inhaled steroid intermittently at decreasing the severity of respiratory-tract illnesses, reducing the number of episode-free days or school absences, lowering the need for a “rescue” inhaler for acute asthma symptoms, improving quality of life or reducing visits to urgent care or the emergency room.

The researchers, from the National Institutes of Health (NIH)-funded Childhood Asthma Research and Education (CARE) Network, studied nearly 300 preschool-age children with frequent wheezing in a trial called MIST (Maintenance and Intermittent Inhaled Corticosteroids in Wheezing Toddlers).

We wanted to understand how to best treat young children who have repeated episodes of wheezing, most of whom appear symptomatic just when they have colds,” says Leonard B. Bacharier, MD, a Washington University pediatric asthma and allergy specialist at St. Louis Children’s Hospital. “Our goal was to start therapy at the first signs of a viral respiratory tract infection or cold to interrupt or slow the progression of symptoms. This trial was aimed to try to prevent wheezing severe enough that requires oral steroids and really gets in the way of children’s lives.”

Children in the yearlong MIST trial were between 12 and 53 months old, had recurrent wheezing and were at high risk for a worsening of asthma-like symptoms that could require treatment with oral steroids and/or a visit to urgent care or emergency room. During the trial, the children received either a dose of budesonide once a day through a nebulizer or a placebo.

At the first signs of a respiratory tract illness, those children who received the inactive placebo received a higher dose of budesonide twice a day, while those who received daily budesonide received a placebo twice daily and kept taking their regular budesonide. Neither the patients nor the physicians knew who received the active drug until the trial was over.

During the study, parents were asked to keep a daily diary of symptoms, such as coughing, wheezing, difficulty breathing or other symptoms that interfered with normal activities, as well as a list of medications, visits to a health-care provider or absences from daycare or school.

Because previous studies had shown that daily inhaled corticosteroid therapy was more effective than placebo, the researchers expected to see the same in the MIST trial. But that’s not what they found.

The two groups were comparable in terms of episodes requiring oral steroids, symptom days, albuterol use and the time before oral steroids were needed,” Bacharier says. “All of the relevant indicators of disease activity were comparable.”

These results indicate that there are a variety of treatments physicians can consider for children with frequent wheezing, who are not compliant with daily therapy.

Olympic Wheezers

This week, some of the world’s premier athletes will gather in Vancouver for the 2010 Winter Olympics.  As a group, they carry not only their nation’s hopes but also a disproportionate tendency to wheeze when exercising.

Half of all elite cross-country skiers and almost as many world-class ice skaters and hockey players have been diagnosed with a condition known as exercise-induced bronchospasm (EIB) in which asthma-like symptoms appear only in association with vigorous exercise.

As the winter athletes exercise, their breathing becomes faster and they inhale air that is drier and cooler than that in the respiratory tree.  The resulting loss of heat and water from the lungs causes damage to airways which triggers inflammation and narrowing and produces the characteristic wheeze.

According to Dr. William Storms, a member of the Sports Medicine Committee of the U.S. Olympic Committee and author of Challenges in the Management of Exercise-Induced Asthma, “The next 5 years will bring increased awareness of EIB along with a better understanding of how exercise and air quality affect lung symptoms. In the meantime, we probably will see more athletes using masks to filter, warm, and humidify their inhaled air.”

For our non-Olympian readers of Word on Health, there are simple steps that you can take to reduce the risk of asthma symptoms during cold weather. Breathe through your nose rather than your mouth, cover your mouth with a face mask or scarf to warm and humidify the air being inhaled, and warm-up before exercising. If symptoms continue, then it is time to consult a doctor and perhaps consider an indoor gym.

In the meantime, while watching the downhill drama and the spectacular skaters, keep an eye out for wheezing among the winners.