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What is it?
Asthma:
Asthma is a chronic lung disease. There is no cure for asthma, but it can be managed so
you can live a healthy normal life.
Characterized by bronchial hyperresponsiveness, airway obstruction, and inflammation. This
inflammation causes wheezing, breathlessness, tight chest, and coughing. It creates an
environment in your airways that makes them highly sensitive to things in the environment,
also known as triggers.
Exercise-Induced Asthma (EIA):
Defined as a 10% or greater post-exercise reduction of forced expiratory volume compared
to pre-exercise values, after submaximal exercise.
Mild
10-24% fall in FEV1
Moderate 25-39% fall in FEV1
Severe 40% or greater fall in FEV1
Epidemiology
In 2010, the CDC reported that 25.7 million people had asthma: 18.7 million
adults (age 18+ years) and 7 million children (age 0-17 years).
Asthma prevalence has increased from 7.3% in 2001 to 8.4% in 2010.
Results in 100 million days of restricted activity
470,000 hospitalizations per year
5,000 deaths per year in the U.S.
Causes
Genetics. Asthma tends to run in families. If your mom or dad have asthma
you are more than likely to get it as well.
Allergies.
Respiratory Infections. Certain respiratory infections have been known to
cause lunge tissue damage. This can lead to asthma.
Environment. Coming in contact with allergens, air pollution, certain
irritants, or being exposed to viral infections during early child development.
Triggers
When asthma is triggered, the inside of your airways become even more inflamed,
mucus builds up, and smooth muscle begins to tighten around your bronchial tubes and
makes it very difficult to breathe. This is commonly referred to as an asthma attack,
asthma episode, or asthma flare-up. Triggers include:
Exercise
A cold
Weather
Chemicals
Smoke
Pet Dander
Stress/Anxiety
Laboratory Diagnosis
Diagnosis is obtained through physical examination, presence of symptoms,
clinical history, and measured lung function.
Lung function tests (Spirometry) show if there is airway obstruction. After
the administration of bronchodilators a relief of the obstruction will be
measured.
Flow-Volume Loop
Complications
Test are difficult to perform in children younger than 6 years old, therefore
diagnoses is dependent on symptoms only.
Vocal Cord Dysfunction is frequently misdiagnosed as asthma.
Untreated asthma can lead to emphysema due to the repetitive stretching of
the bronchial sacs during an asthma attack at which point they loose their
elasticity and no longer function correctly.
Agonists
Most asthmatics do not show symptoms until 10-15min after exercise has stopped.
Bronchoconstriction most likely reverses and goes back to normal 45-60min after exercise. If
recovery doesnt take place then medication will be needed.
Some develop a second reaction which happens 3-4hrs after exercise has stopped.
Exercise Testing
Testing Procedure:
1.
2.
3.
Subject must wear a nose clip to make sure that air is not being humidified or warmed through the nose.
4.
5.
Take pre-exercise lung function measurements via spirometer of FEV 1 and FVC. Repeat same measurements
every 5 min for 40 min after exercise.
A drop in FEV1 of 10% or more indicates EIA.
Testing Contraindications:
. Test should take place in an environment that wont trigger asthma.
. Subjects should not take medication at least 24hr, but preferably 48-96hr before testing.
. Vigorous exercise should be avoided for at least 12hr before testing.
. Caffeinated food should be avoided for at least 6hr before testing (due to bronchodilator effect).
Test should be terminated if oxyhemoglobin desaturation reaches 80%
Time to goal
2-3 months
Goals
Increase max number of
reps
Increase isokinetic work
Increase lean body mass
Time to goal
2-3 months
Time to goal
Ongoing
Summary
Asthma is a life-long disease, with no cure, that effects many people, but it
can be managed so you can live a healthy life.
During exercise watch your client for signs and symptoms of asthma. If
symptoms of asthma occur cease exercise until airway function has
improved.
There are many benefits that can help with asthma when following an
exercise program which include, reducing the frequency/severity of asthma
attacks, increased VO2max, improving heart rate, improving oxygen
consumption, and improving work capacity.
Questions??
References
American College of Sports Medicine. (2014). ACSMs guidelines for exercise testing and prescription, 9th ed. Baltimore:
Lippincott Williams & Wilkens, 331-334.
American College of Sports Medicine. (2009). Asthma ACSMs Exercise Management for Persons with Chronic Diseases and
Disabilities, (3rd ed.). Champaign, IL: Human Kinetics.
American Lung Association. Learning More About Asthma. Retrieved from
http://www.lung.org/lung-disease/asthma/learning-more-about-asthma/
American Lung Association. Symptoms, Diagnosis, and Treatment. Retrieved from
http://www.lung.org/lung-disease/asthma/learning-more-about-asthma/symptoms-diagnosis-and-treatment.html
Brehm, Barbara A. (1990, March). Fitness Management Magazine. 60-61.
Centers for Disease Control and Prevention. (2012). Trends in Asthma Prevalence, Health Care Use, and Mortality in the
United States, 2001-2010. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db94.htm
Cerny, F, And K.W. Rundell. (2012). Physical Activity and the Treatment of Asthma. ACSMs Health & Fitness Journal, 16
(1): 19-26.
Compendium of Patient Information.
Morton, A.R. and K. D Fitch. (2005). Asthma in Exercise Testing and Exercise Prescription for Special Cases, 3 ed. James
Skinner, ed. Baltimore: Lippincott Williams & Wilkens, pp. 257-271.