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Mythbuster - ‘I can’t do much exercise because of my asthma’

The myth

Asthma patients should do less exercise than others.

The reality

This couldn’t be further from the truth; in fact, some of our top athletes have asthma. Paula Radcliffe, David Beckham, Laura Kenny and Karen Pickering are just a few.

I had asthma as a child, but it didn’t stop me being in the school netball team or running in the cross-country championships. Asthma patients worry that exercise will trigger an attack. However, a recent survey by Asthma UK showed that 83% of parents who have children with asthma considered exercise to be good for their child.1

The goal for all asthmatics should be to lead a normal healthy life, which includes exercise. It is well known that we need exercise to strengthen our muscles, and our lungs are no different. Patients with long-term lung conditions often forget that it is okay to be breathless on exertion. They might associate breathlessness with poor asthma control rather than lack of fitness.

Improved fitness allows patients to feel less breathless in day-to-day activities, such as climbing the stairs or doing housework. It also improves confidence in managing their disease. Asthmatics who exercise regularly can maintain a healthy weight, and it is well known that asthma is harder to control for patients with obesity. Regular exercise also improves mental health and the immune system.

If asthma is well controlled, patients should be able to take regular exercise.1 They should take their preventive treatment (inhaled steroid) regularly. If exercise triggers asthma, this can be a sign that overall control is poor. The patient should be reviewed and given a new management plan.2

If they do have poor control they could begin by doing exercise such as walking, or team sports such as cricket or swimming. Even patients with severe asthma should be encouraged to exercise, even if the only level they can achieve is slow walking.

Patients should be advised to avoid exercise in situations that are likely to increase their risk of an attack, including running in very cold air or air that has high levels of pollution. Those who are sensitised to pollen should avoid exercising outdoors when the pollen count is high.

Asthmatics should always carry their reliever inhaler while exercising. If they develop symptoms, they should stop and use their inhaler and only continue once symptoms have subsided. Some patients may benefit from using their reliever before exercise. It is important that parents inform their child’s school or sports club that they may require their inhaler and that the adults are trained in how to administer emergency treatment during an asthma attack. But this should not be a reason for a child not to exercise or join a sports group.

Between 10 and 15% of the population may have exercise-induced bronchospasm. In these cases, the only trigger is exercise. This is not asthma.3 These patients may find that using a short-acting reliever prior to exercise is beneficial.

You should encourage asthma patients to exercise to improve their overall health and wellbeing. They should be reassured that exercise is safe, and that difficulty exercising may be a sign of overall poor control. In these patients, you should consider stepping up treatment; this could include adding in a leukotriene receptor antagonist. Patients who struggle to exercise because of asthma should be on regular preventive treatment with inhaled steroids as a minimum. 

You should advise patients on the difference between breathlessness due to poor fitness and asthma that is triggered by exercise. Patients with poor fitness will be short of breath during exercise but will recover quickly when they stop. Asthmatics will feel chest tightness, shortness of breath, may wheeze and may cough. These symptoms can occur during exercise or 20-30 minutes later, and may take up to 24 hours to resolve. All patients should have a written asthma action plan.

 

Sonia Greenwood is a lead asthma nurse specialist at Royal Derby Hospital

 

References

1 Asthma UK. Exercise and Activities. London; UK:2016

2 BTS/SIGN. SIGN153: British guideline on the management of asthma. Edinburgh; SIGN:2016

3 Parsons J. Exercise-induced bronchospasm: symptoms are not enough. Expert Rev Clin Immunol 2009;5:357-9