Exercise-Induced Asthma in Children

Asthma is a long-term disease of the lower airways in the lungs that affects both adults and children.

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What is Asthma?

Asthma is a chronic (long-term) disease of the lower airways in the lungs.

The most important feature of asthma is the increased sensitivity of the airways to many factors in the environment. 

These triggers, though variable from patient to patient, include allergens (e.g. house dust mites, pollen and pets), pollution and viral infection of the airways (such as common colds). The airways become swollen and narrowed, making breathing difficult and noisy (wheezing).

Asthma Symptoms in Children 

Asthma in kids can appear at any age. However, trigger factors can vary according to age. In young children (under the age of three years), asthma is usually by viral infection, while in older children, allergy becomes a more important trigger for asthma.

Symptoms of asthma can appear suddenly (attacks) or be chronically present (persistent). Symptoms include coughing (especially a chronic cough and dry cough at night or after exercise), wheezing (whistling noise in the chest), shortness of breath and tightness of the chest. The most typical sign of asthma is the so-called asthma attack, during which the child experiences sudden wheezing, coughing and shortness of breath. These attacks can be mild or severe and may need emergency treatment.

Common Triggers for Asthma in Children 

Asthma triggers can cause an asthma attack or make the asthma worse. Controlling your child’s asthma involves recognising the child’s triggers. Allergy tests can help identify these triggers. 

Common triggers for asthma in children include:
Infections, especially upper respiratory tract infections (colds or flu)
Dust and dust mite allergens
Pollen
Animal dander (dogs, cats and birds)
Cold air (however, most children can sleep in air-conditioned rooms without any problems)
Weather changes, including the haze
Cigarette smoke
Exercise — all children with asthma should exercise as it is good for their general health and for their asthma. However, if the asthma is not well-controlled, they may not be able to exercise and will need to see their doctor for further treatment. Children with exercise-induced asthma (EIA) can still exercise with proper medications.

Food is usually NOT an asthma trigger — this includes cold drinks, ice cream and chocolates. 

Diagnosis of Asthma in Children

A paediatrician is usually able to diagnose asthma based on medical history and a clinical examination. Special tests may be needed to help in the further evaluation or management of your asthmatic child.
Spirometry: spirometry is a lung function test that measures airflow obstruction. It can be used to support asthma diagnosis, assess severity and evaluate response to treatment. Children above six years old are usually able to perform this test reliably.
Oscillometry: oscillometry is a special lung function test that requires minimal patient cooperation. Even children between the ages of two and six years can perform this test reliably.
Exhaled nitric oxide: exhaled nitric oxide measurements are used to determine the severity of lung inflammation in asthma and to measure the dose of preventer medication required.
Exercise challenge tests: EIA is confirmed with an exercise challenge test. The child exercises for six to eight minutes on a treadmill machine. The child's lung function is assessed before the exercise and at various intervals after the exercise. A decrease of at least 12 to 15 percent in lung function parameters measured is diagnostic of EIA. Children above five or six years old are usually able to perform the test reliably.
Allergy tests: allergy tests are useful in detecting the allergens that your child may be sensitive to. Commonly-used allergy tests to diagnose for asthma include skin prick tests and blood tests. Children of any age (including babies) can undergo allergy testing. Knowing and avoiding the allergens that act as triggers will help in managing your child's asthma. 

Medications for Asthma in Children

Preventers or Anti-inflammatory Agents
Reduce chronic inflammation of the airways 
Are required for long-term control of asthma, and should be taken daily when prescribed by the doctor 
Are usually in the form of inhaled cortocosteroids (e.g. beclometasone, fluticasone, budesonide), the treatment of choice for most people with asthma
Inhaled long-acting beta agonists (e.g. salmeterol and formeterol) are also used as an “add-on” treatment 
Other forms of preventers (e.g. leukotriene modifiers, such as monteleukast and zafilukast) may be taken orally

Relievers
Used when the child has asthma symptoms or during an asthma attack
Short-acting beta agonists can be inhaled (salbutamol, ventolin or terbutaline) or taken orally (salbutamol or terbutaline)
Anti-cholinergics (e.g. ipratropium bromide) can be inhaled
Cortocosteroids (e.g. prednisolone, hydrocortisone) can be taken orally or injected
Formoterol, a long-acting beta agonist that acts quickly, can also be used as a reliever

Severe Asthma Attack in Children 

If your child has an asthma attack, keep calm. 
If the child has been given an inhaler by the doctor, let him/or her use it to open up the narrowed airways for immediate relief. Repeat every 20 minutes, or as advised by the doctor.
Keep the child comfortable — loosen clothing around his/her neck, get him/her to sit upright and let fresh air into the room.
In a severe asthma attack, the child may be unable to speak and is struggling to breathe. The attack can become life-threatening if not treated properly. Take your child to the doctor immediately or call for an ambulance.

Exercise-induced Asthma in Children

What Is Exercise-induced Asthma in Children?
When the child wheezes or coughs when exercising, he/she may be suffering from exercise-induced asthma (EIA).

Children with EIA have airways that are very sensitive to changes in temperature and humidity, especially when breathing cold, dry air. When children with EIA exercise, the airways narrow abnormally, resulting in symptoms, such as wheezing and coughing, minutes after exercise. These symptoms usually reach their peak five to 10 minutes after stopping the activity.

Managing Exercise-Induced Asthma in Children

Swimming is often considered the sport of choice for children with asthma because of positive factors, such as incorporating deep-breathing exercises, and also being least likely to trigger asthma symptoms.
Although some sports are better for exercise-induced asthma, children with EIA can and should participate in all physical activities (e.g. badminton, basketball, soccer and long-distance running) with proper control and medications.
Inhaled medications taken prior to exercise are also helpful in preventing and controlling EIA.

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