Exercise as it relates to Disease/Exercise in the treatment of childhood asthma

Asthma

Asthma is a chronic inflammatory disorder of the airways. This inflammation of airways causes a number of symptoms (see below), plus a related increase in airway responsiveness to a variety of stimuli. Asthma is the leading cause of chronic illness in children, and it can have a considerable impact on the daily life of these patients. Asthma causes substantial morbidity and is one of the most frequent causes for hospital admissions, emergency department visits, school absenteeism and missed parental work days.

Classification

Table 1. Classifications of asthma in children over 5 years old

Classification	Daytime symptoms between exacerbations	Night-time symptoms between exacerbations	Exacerbations	PEF or FEV1*	PEF variability**
Infrequent intermittent	Nil	Nil	Brief, Mild, Occur less than every 4 – 6 weeks	More than 80% predicted	Less than 20%
Frequent intermittent	Nil	Nil	More than 2 per month	At least 80% predicted	Less than 20%
Mild persistent	More than one per week but not every day	More than twice per month but not everyday	May effect activity and sleep	At least 80% predicted	20 - 30%
Moderate persistent	Daily	More than once per week	At least twice per week restricts activity or affects sleep	60 - 80% predicted	More than 30%
Severe persistent	Continual	Frequent	Frequent, Restricts Activity	60% predicted or less	More than 30%

FEV1: Forced expiratory volume in 1 second; PEF: peak expiratory flow.

* Predicted values are based on age, sex and height
** Difference between morning and evening values

Signs/Symptoms

Common signs and symptoms of asthma include: - Wheezing - Shortness of breath - Dry, continual coughing - Tightness in the chest

These signs and symptoms can vary a great deal. They often peak at night and early morning or if the sufferer is exposed to cold air. The severity of the signs and symptoms can also vary from sufferer to sufferer.

Diagnosis in Children

- In young children, the diagnosis of asthma can be confirmed by a clinical response to an inhaled bronchodilator. - In children aged 7 years and over, use spirometry to confirm the diagnosis of asthma. - In young children, care is needed to exclude non-asthma causes of wheeze. - When cough is the predominant symptom of suspected asthma, careful assessment is needed to avoid making an incorrect diagnosis of asthma, or instigating inappropriate management. - Exercise-induced dyspnoea is not always due to asthma, even in children with a confirmed diagnosis of asthma - Asthma management in children should be based on a careful assessment of the pattern of asthma.

Prevention

A bronchodilator (type of reliever) can be used to stop an asthma attack if symptoms arise. Steps can be taken to minimise the chances of asthma attacks occurring in the first place by avoiding triggers. Triggers may include cigarette smoke, dust or polluted air, pet hair & skin and cold air. Preventers can be used to reduce the effects of inflammation. There are also cells within the airways that cause inflammation and preventers can minimise their effects. Preventers can include inhaled steroids such as beclomethasone (Qvar) or budesonide (Pulmicort). If the asthma symptoms aren't managed, and the sufferer is more than 5 years old, then a controller may be prescribed. A controller works like a long-acting reliever such as salbutamol (a beta-2 agonist). Controllers can only be used when in combination with a preventer. These combination inhalers include Seretide and Symbicort.

Treatment

Asthma First Aid

1) Sit the person upright. Be calm and reassuring. Do not leave them alone. 2) Give medication: Shake the blue reliever puffer. Use a spacer if you have one. Give 4 separate puffs into the spacer. Take 4 breaths from the spacer after each puff. Giving blue reliever medication to someone who doesn’t have asthma is unlikely to harm them. 3) Wait 4 minutes. 4) If there is no improvement, repeat step 2. If there is still no improvement call emergency assistance (DIAL 000). Tell the operator the person is having an asthma attack. Keep giving 4 puffs every 4 minutes while you wait for emergency assistance. Call emergency assistance immediately (DIAL 000) if the person’s asthma suddenly becomes worse.

Exercise Limitations

Exercise presents a challenge for children with asthma. They show a reduced tolerance to exercise as a result of breathlessness, exercise induced bronchoconstriction, and restriction of activities secondary to medical advice and family influence. Due to a fear of breathlessness many children experience a fear of participating in regular exercise so as to avoid any unpleasant feelings. Many studies have concluded that asthmatic children have a lower cardiorespiratory capacity than their counterparts due to chronic deconditioning.

Asthma sufferers can benefit from exercise because it can improve the function of their airways by strengthening the breathing muscles. If sufferers are fit, they can cope better and experience fewer asthma attacks. Doctors need to be consulted to prescribe exercises for each individual. Popular conditions include warm and humid environments, swimming is a good exercise for this. Other exercises that shows great benefits for asthmatics are walking, golf, cycling and hiking. Exercise doesn't have the ability to cure asthma but it is a vital part of asthma management.

Recommendations

1) Asthma research lacks studies which track the long term effects of asthma. This research should include the severity of asthma and the health backgrounds of children. 2) There is a lack of larger sampling into what exercise is the most beneficial in improving quality of life in children. 3) Lack of well designed and published studies has been to the detriment of understanding the relationship between lung function and physical training in children with asthma.

Further Readings and contacts

http://www.nationalasthma.org.au/ http://www.kidswithasthma.com.au/ http://www.aihw.gov.au/asthma/