Not all cases of shortness of breath and wheezing that follow a young person's workout point to the same cause.
Although as many as 90 percent of children with asthma have symptoms when they exercise, not all exercising children with asthma symptoms have exercise-induced asthma.
"Exercise-induced asthma is often a misnomer," said Dr. Dennis W. Rajtora, a physician in the Medical Associates Clinic Department of Allergy. "The true concept was a very specific entity. For people who developed asthma with a certain amount of exercise, you had to achieve enough of a heart rate to induce it. Usually, this was the only time these people had asthma."
Asthma is the most common chronic disorder in childhood, currently affecting an estimated 6.8 million children younger than age 18.
The cold, dry air that is inhaled into the lungs during exercise is believed to be the main cause of exercise-induced asthma.
Children exercising strenuously tend to breathe quickly, shallowly and through the mouth -- meaning the air reaching their lungs misses
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"When asthma is induced by exercise, usually that means the asthma is poorly controlled," Rajtora said. "What we see around here is all kinds of kids with inhalers, and most of those kids haven't been instructed how to use those inhalers. For most of those inhalers to work, you have to use them correctly."
Some children with true exercise-induced asthma have lungs that are overly sensitive to this sudden change in temperature and humidity. Their airways become irritated, triggering asthma symptoms. Variations in the amount of sensitivity mean that the severity of symptoms is different from person to person.
"Exercise-induced asthma is found more in children, but that might be because they are exercising more," said Karen Rausch, respiratory therapist at Mercy Medical Center-Dubuque. "Any kind of asthma can happen at any time to anybody, but typically it is more school-aged children."
Standard asthma medications are typically used to control the symptoms of the exercise-induced variety. "It is very easily treated," Rajtora said.
Treatments can include:
* A short-acting inhaled medicine such as albuterol (Proventil, Ventolin, ProAir) or pirbuterol (Maxair), used 15 minutes before exercise to prevent symptoms for about four hours.
* A mast cell stabilizer such as cromolyn sodium (Intal) or nedocromil sodium (Tilade), used 15 to 60 minutes before exercise to prevent symptoms for about four hours.
* A long-acting beta-2 agonist such as salmeterol (Serevent Diskus) and formoterol (Foradil), taken 30 minutes before exercise to relieve symptoms for up to 12 hours.
* A leukotriene modifier such as montelukast sodium (Singulair) or zafirlukast (Accolate), for effects lasting up to 24 hours.
"Sometimes we will put them on there all football season," Rajtora said.
* A corticosteroid inhaler such as fluticasone (Flovent), mometasone (Asmanex), budesonide (Pulmicort) or triamcinolone (Azmacort). These drugs reduce inflammation.
"One of the problems we see are these kids who are out of shape -- they don't really have exercise-induced asthma," Rajtora said.
Seasonal allergies also can mimic asthma.
"Some people have hay fever that is poorly controlled; sometimes these kids will have some bronchial spasms," Rajtora said. "That is another confounding factor why you see so many of these kids running around with inhalers."
