What Is Exercise-Induced Asthma?
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Most kids and teens with asthma have symptoms when they exercise. But some people (including those who don't have asthma) have asthma symptoms only during or after exercise. This is known as exercise-induced asthma (EIA) (also called exercise-induced bronchoconstriction, or EIB).
What Are the Signs & Symptoms of EIA?
Symptoms of exercise-induced asthma include wheezing, tightness or pain in the chest, coughing, and in some cases, lasting shortness of breath.
Someone with EIA may:
- get winded or tired easily during or after exercise
- cough after coming inside from being active outdoors
- not be able to run for more than a few minutes without stopping
Kids with EIA often begin having symptoms 5–10 minutes after starting to exercise (though some kids only get them after they stop being active). Symptoms usually peak 5–10 minutes after stopping the activity and may take an hour or longer to end.
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Of course, there's a difference between someone with exercise-induced asthma and someone who's out of shape and winded. It takes much longer for someone with EIA to recover. And temperature extremes, especially cold weather, can make it even worse.
What Causes EIA?
Inhaling cold, dry air during exercise is thought to be the main cause of EIA symptoms. When kids exercise or play hard, they tend to breathe quickly, shallowly, and through the mouth. So the air reaching their lungs misses the warming and humidifying effects that happen when they breathe more slowly through the nose. The cool, dry air makes the airways in the lungs narrower, which blocks the flow of air and makes it harder to breathe. This is called bronchoconstriction.
It's important to remember that staying fit and exercising regularly can actually help to reduce asthma symptoms. So kids and teens with asthma should exercise as much as they can.
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How Is EIA Diagnosed?
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A doctor will ask about the family's asthma and allergy history and about the symptoms and what has triggered them in the past.
After taking a medical history and doing a physical exam, the doctor may ask your child to take a breathing test after exercising. This can be done in the office on a treadmill, after your child runs outside for 6 to 8 minutes, or after doing an activity that's triggered flare-ups in the past.
How Is EIA Treated?
Doctors sometimes recommend pretreatment for EIA. This means taking medicine before exercising or being very active. The medicine often is the same quick-relief medicine (also called rescue or fast-acting medicine) used during flare-ups. Taking it before exercise can help prevent the airway narrowing triggered by exercise.
If pretreatment doesn't control symptoms, the doctor may recommend using long-term control medicine (also called controller or maintenance medicine). This asthma medicine is usually taken regularly over time to reduce airway inflammation.
If your child still has breathing trouble during exercise, let the doctor know. The medicine dosages may need to be adjusted for better control.
Which Activities Are OK for Kids With EIA?
Exercise is a great idea for everyone, including kids with exercise-induced asthma. Besides keeping kids fit, exercise can improve lung function by strengthening the breathing muscles in the chest.
Encourage your child to be active while also keeping asthma symptoms under control by following the asthma action plan. Ask your doctor which exercises, sports, and activities are safe for your child.
These activities usually are OK for people with EIA:
- easy walking, jogging, or hiking
- golf
- baseball
- football
- gymnastics
- shorter track and field events
Endurance sports (long-distance running, cycling, etc.) and those requiring extended energy output (like soccer and basketball) can be more challenging. So can cold-weather sports, like cross-country skiing and ice hockey.
But that doesn't mean kids can't play these sports if they enjoy them. In fact, many athletes with asthma have found that with proper training and medicine, they can do any sport they choose.
Tips for Kids With Exercise-Induced Asthma
For the most part, kids with exercise-induced asthma can do anything their peers can do. But be sure to follow the suggestions given by your child's doctor.
Here are some tips for kids and teens:
- If symptoms start, don't exercise until they stop.
- Warm up before exercise to prevent chest tightening. (Warm-up exercises can include 5–10 minutes of walking or any other light activity, plus stretching or flexibility exercises.)
- Take quick-relief medicine as close to the start of exercise as possible.
- Breathe through the nose during exercise.
- Take brief rests during exercise and use quick-relief medicine, as prescribed, if symptoms start.
- Cool down after exercise to help slow the change of air temperature in the lungs.
It's also best not to exercise outside during very cold weather. If your child plays outside when it's cold, wearing a ski mask or a scarf over the mouth and nose should help.
If air pollution or pollen are triggers, your child may want to exercise indoors when air quality is poor or pollen counts are high. And kids shouldn't exercise when they have a cold or other upper respiratory infection.
Kids should always have access to their quick-relief medicine. Keep extras on hand and be sure to check all supplies so your child isn't carrying an empty inhaler.
Date reviewed: March 2018
My Exercise + Kids + Plug & Player
'Suggested tattoo for trainers, therapists, and athletes: Tighter does not equal stronger. It’s just tighter.” Katy Bowman
A few years ago, Katy Bowman kicked up a dust storm when she offered not the standard “do your kegels” for a strong pelvic floor (PF), but this following advice:
A Kegel attempts to strengthen the pelvic floor, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to pelvic floor disorder (PFD). Zero lumbar curvature (missing the little curve at the small of the back) is the most telling sign that the pelvic floor is beginning to weaken. An easier way to say this is: Weak glutes + too many Kegels = PFD.
Katy’s recommendation? Developing an (eventual) deep squatting habit (picture going to the bathroom while camping) to create the posterior pull on the sacrum and balance the work of the pelvic floor.
If you’ve read a lot of mainstream books about the pelvic floor, you’ll know why this assertion is still shocking today. When it comes to prenatal exercise, for example, Kegels are usually placed on the first place podium due to their effects on pelvic floor strength. But do they really strengthen the pelvic floor in the long run?
Katy (who is nearing the end of her own second pregnancy - that's her in the picture to the right) was kind enough to answer some questions for me about this important issue. She shared a bit about how she first discovered the relation between Kegels and PFD:
In graduate school (where I was getting my MS in Biomechanics) I focused my studies on “where pelvic floor disorders come from.” I found this important because in math and engineering fields, where I came from, you can’t work on a problem’s solution until the problem is well defined. In disease research, however, there isn’t really research into the why or the how - only on trying to figure out the remedy. In doing my research on the physics of the pelvis, movement, and how the pelvic floor works, it became clear that while the pelvic floor’s problem was weakness, it was weakness that is the result of too much tension - not weakness that comes from flopping around.
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Underlying the Kegel controversy is a very simple issue: what Katy calls an “overgeneralized theory of strength.” A Kegel is a muscular contraction. For women who have a tight pelvic floor, concentrically contracting the muscles regularly will simply aggravate the tension issue. “Muscle that is either too long or too short looks the same when you measure its force production. Which means just because something is weak or unable to do a bout of work does not automatically imply that concentric contraction is the correct prescription.”
“Squat 300 times a day, you’re going to give birth quickly.” - Ina May Gaskin
Never does pelvic floor strength seem so important as during pregnancy. How can pregnant women strengthen their pelvic floor without that daily Kegel checklist? By doing exercises that lengthen the pelvic floor and increasing their own awareness of pelvic alignment. Katy explained, “It’s the alignment of the pelvis and sacrum that gets out of whack, so knowing where your pelvis should be as you move throughout the day (sitting, standing and walking), done in conjunction with a few daily squats (get a squatty potty and this doesn’t even require extra time!) will get the full restorative effect your pelvic floor needs.”
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And this brings me to that lovely little exercise known as the squat. Really the squat isn’t an exercise at all, but a basic human movement that we used to do all the time. Three hundred times is a little extreme, but regular squats will definitely help lengthen the pelvic floor. I’m not even talking about weighted squats here. If you have other small children running around during your pregnancy, you are probably getting in your squats already, as long as you’re doing them correctly.
So how do you do them correctly? Here are a few tips from Katy:
- Joint Positioning: “Because the squat we are after is really a gluteal-using one, whole-body joint positioning is essential. To get a squat to move from the front of the body (think all quads) to the back (think all glutes) is by using SHIN position. The more vertical the shin (that’s the knee joint stacked over the ankle joint) and the more untucked the pelvis, the more glutes you’ll use. The more the knees are in front of the ankle and the more tucked the pelvis, the less glutes you’ll use.”
- Depth of the Squat: “How far you go down will be based on how well you can keep the shin and the pelvis where you want them. Most people who have not squatted to use the bathroom throughout a lifetime will find the range of motion of their 'glute squat' to be fairly small. Which is fine. It will improve over time, especially if you’re working on changing the habits of where you hold your pelvis throughout the day.”
- Length: “The amount of time you spend in a squat also depends. The glute action is primarily used on the way up - however lingering in a squat, especially if you can kind of relax, helps the muscles and involved joints change their tension patterns. Seriously. Doing a potty-squat gives you a more natural, real-world relationship with your squat.”
“…all women are not accustomed to being delivered in the same posture; some will be on their Knees, as many in the Country Villages; others standing upright leaning with the Elbows on a Pillow on the Table…but the best and surest is to be delivered in their bed, to shun the inconvenience and trouble of being carried thither afterwards…” - Francois Mauriceau
No article on squatting during pregnancy would be complete without some reference to squatting during labor, so let’s not ignore the elephant in the room. During my second pregnancy, my husband and I took a childbirth preparation class (we were hoping for a VBAC), where we watched one of those crazy videos about the tribal women squatting out a baby like it was no big deal. Definitely left an impression.
I asked Katy what she thought of the squatting position during labor. “I think squatting during delivery is awesome. It’s kind of like a DUH when you consider gravity and the fact that you want it out (out! out!) I also encourage people to remember that delivery is a huge physical performance. Prepare for it, with lots of walking, working on pelvic alignment, and releasing the hips, sacrum and those pelvic floor muscles - which will make them stronger, as weird as that seems.”
And there’s another elephant in the room that you might not have noticed. Just for the record, all this pelvic floor stuff isn’t just for pregnant women. It’s not even just for women. If you’ve ever heard people say pregnancy causes PFD, don’t believe it. Katy’s reaction to this assertion was quite adamant:
No, pregnancy does not cause PFD. Can I say that again? NO, PREGNANCY DOES NOT CAUSE PFD. How do I know? Because research shows that the category of ailments that fall into PFD occur equally in women who have and who have not delivered babies. There are also women who have had 10 or 12 kids who have no pelvic floor issues. And, P.S., Pelvic Floor Disorder in men is also extremely prevalent and on the rise. So dudes, you gotta read this info as well. Read it, and then talk about it with other dudes. While you’re squatting, of course.
To learn more about the pelvic floor, check out Katy's Down There For Women.