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Asthma is characterized by episodes of transient airflow obstruction that make breathing difficult.
These episodes are commonly referred to as asthma attacks and are a result of the smooth muscle
surrounding the bronchioles contracting (bronchoconstriction), and fluid (oedema) accumulating
within these narrowed airways. The classic symptoms of an asthma attack are therefore: a
shortness of breath (dyspnoea), chest congestion and tightness, wheezing and coughing.
DIAGNOSIS
Asthmatics will exhibit significant postexercise bronchoconstriction whereas non-asthmatics exhibit
slight bronchodilation.
EXERCISE-INDUCED
Exercise-induced asthma (EIA) affects about 4% of people who do not experience asthma
symptoms at rest. In addition to asthmatics exhibiting impaired lung function during an asthma
attack, about 8090% of asthmatics are susceptible to EIA. Breathlessness is a normal response to
sustained exercise of a strenuous intensity. However, it should not develop during or after exercise
of a relatively mild or moderate intensity, but if it does, it may indicate that the person suffers from
EIA. Exercise-induced asthma typically occurs 5 to 20 minutes after exercise and in most cases it
will resolve spontaneously within 45 to 60 minutes. Symptoms of breathlessness during exercise are
generally attributed to poor conditioning and pre-existing obstruction rather than EIA, as respiratory
assessments indicate bronchodilation rather than bronchoconstriction to dominate during exercise.
Assessment of EIA Clinical assessments for the diagnosis of EIA generally involve an exercise bout
of 6 to 8 minutes at an intensity of 6575% of predicted VO2max. Running, during which large
volumes of cold dry air are inhaled, is most likely to induce EIA, whereas swimming far less so,
since the inhaled air is already saturated with water vapour and hence has little evaporative effect on
the fluid within the lungs.
BREATHING TECHNIQUE AND AIDS One of the proposed causes of the bronchoconstriction
and inflammation associated with an asthma attack is the inhalation of cold dry air. During
strenuous exercise, pulmonary ventilation will be very high, sometimes exceeding 150 litres per
minute in fit athletes, and this rate far exceeds the ventilation rate that could be achieved through
nasal breathing alone, which is approximately 40 litres per minute. Thus oral breathing is required
during strenuous PA/exercise. To facilitate strenuous exercise in cold dry environments the
asthmatic can try using a facemask that warms and humidifies the inhaled air.
PHYSICAL ACTIVITY/EXERCISE
The health benefits gleaned by the asthmatic from PA/exercise participation are primarily the same
as for non-asthmatics. Subjective reports also suggest that exercise can facilitate improvements in
the quality of life of asthmatics, and perceptions of a reduced impact of asthma upon their life. The
physiological adaptations induced by exercise training for asthmatics are the same as those for non-
asthmatics, including a reduction in the relative exercise intensity of a specific workload, such as a
particular walking or jogging speed. One of the consequences of this is reduced pulmonary
ventilation at each speed or workload, which will thereby reduce the likelihood of adverse
evaporation and cooling of the airways, and hence reduce the risk of an EIA attack being triggered.
Adaptations to physical training
Specific improvements following cardiovascular exercise training therefore include increased
capacity to utilize oxygen (VO2max), maximum minute ventilation (VEmax), anaerobic threshold
and oxygen pulse. These are manifested by a reduced perceived exertion, lower heart rate, lower
pulmonary ventilation and lower concentrations of lactate at submaximal exercise intensities.
EXERCISE PRESCRIPTION Given the large spectrum of severity for the asthmatic condition,
exercise prescription will clearly relate to each individuals situation. For example, the goals of an
exercise programme may be orientated towards participation in a particular sport and/or be directed
towards increasing their capacity to perform activities of daily living and health-enhancing physical
activity. Likewise, as for nonasthmatics, exercise adaptations will be in accordance with the type,
intensity and duration of exercise undertaken. Therefore exercise programmes may be targeted
towards improving cardiovascular and/or musculoskeletal fitness.
POST-PHYSICAL ACTIVITY/EXERCISE
After PA/exercise, asthmatics should ensure that they do not become cold and should change into
warm clothing, as they may be susceptible to sudden changes in temperature. Respiratory infections
will increase the asthmatics susceptibility to EIA and therefore they should take precautions to
minimize infection, such as avoiding people with colds and other upper respiratory tract infections.
It has been suggested that exercises for breathing control be included at the end of each exercise
session, including diaphragmatic (abdominal) breathing and breathing against a resistance to
increase the strength and endurance of respiratory muscles.