Asthm

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

 Airway of the bronchial tube during asthma.

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.

Asthma Signs & Symptoms

Wheezing
Frequent Cough- more
common at night, you may or
may not cough up mucus.
Shortness of Breath
Chest tightness- especially
during cold weather or
exercise.
Combination of these

EIA Signs & Symptoms

People dont realize that they are experiencing EIA because the signs and
symptoms are so similar to the feeling of being out-of-shape or out-of-breath.
Breathlessness during or after light exercise
Similar symptoms to asthma (e.g. SOB, coughing, tight chest, wheezing,
etc.)

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.

Tests & Evaluation

Assessment of function should include cardiopulmonary capacity, pulmonary
function (pre/post exercise), and oxyhemoglobin saturation levels.
Spirometry
Lung volume tests (Flow-Volume Loop)
6 min walk test can be used for those with moderate-severe persistent
asthma when needed equipment is not available.
Dyspnea can be measured through the Borg CR10 Scale.

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.

Acute Medical Treatment

These medicines are used during asthma attacks to provide quick relief. They include:
Short- Acting 2 agonists (e.g. Albuterol) Most effective for EIA. Cause smooth muscle relaxation.
Anticholinergics
During server attacks: inhaled pulmicort or flovent and orally prednisone or corticosteroids.

Agonists

Long- Term Medical Treatment

These medicines are used only when needed to control asthma and prevent attacks. They include:
Long- acting 2 agonists (e.g. Salmeterol and Formoterol) and Inhaled corticosteroid (ICS)
combinations.
Leukotriene modifiers- single daily dose that can last over 24hr with no major side effects and
no development of tolerance. Provide protection against leukotriene's which are
bronchoconstrictors.
Cromolyn Sodium- not commonly used before exercise due to its sympathomimetic effects
(tachycardia).
Theophylline
Thiazide Diuretics
Nutrition: dietary factors can be implemented to help control inflammatory reactions, smooth
muscle reactions, and pulmonary volume and pressure. (e.g. reduced salt intake, antioxidants,
fish oil, caffeine)

Effects on Ability to Exercise

If EIA is controlled then no effect on exercise training will take place and improvements in
fitness will happen.
When EIA is experienced than participants will not be able to increase intensity enough to see
fitness improvements but will improve in endurance.
During EIA narrowed airways can lead to:

Limited ventilation and oxygen uptake

Lower arterial oxygen saturation
Higher levels of CO2 in the blood
Respiratory muscle fatigue

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.

Effects of Medication on Exercise

2 Agonists improve asthma symptoms during exercise but can cause
tachycardia and palpations.
Anticholinergics cause bronchodilation which help improve asthma symptoms
during exercise.
Methlyxanthines can cause tachycardia, heart dysrhythmias, and increased
dyspnea.
Sympathomimetic bronchodilators can cause tachycardia.
Loop and thiazide diuretics can cause hypokalemia which can lead to heart
dysrhythmias and muscle weakness.

Acute Effects of Exercise

As a trainer be aware of how your client is feeling during exercise. Watch for
signs and symptoms of EIA.
Asthma attacks (bronchospasm) can occur during exercise.
https://www.youtube.com/watch?v=4aK76DoxKGk

Chronic Effects of Training

Help control frequency and severity of attacks
Improvement of VO2 max
Improvement of oxygen consumption
Improvement of work capacity
Improvement of heart rate

Exercise Testing
Testing Procedure:
1.

The test should be a single-stage, continuous test lasting 6-8min.

2.

Intensity should be 65-75% VO2max or 75-85% HRmax

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%

Exercise Prescription- Aerobic

( Large muscle activities- walking, cycling, swimming)
Goals
Increase VO2 max
Increase lactate &
ventilatory threshold
Become less sensitive to
dyspnea
Develop more efficient
breathing patterns
Improvement in ADLs

Intensity, Frequency, &

Duration
RPE 11-13/20
(comfortable, pace, and
endurance)
Monitor dyspnea
1-2 sessions, 3-5
days/week
20-30 minutes (shorter
at first may be
necessary)
Focus on progression of
duration not intensity

Time to goal
2-3 months

Exercise Prescription- Strength

Training
(Free weights & isokinetic/isotonic machines)

Goals
Increase max number of
reps
Increase isokinetic work
Increase lean body mass

Frequency, Intensity, &

Duration
Low resistance, high
reps
2-3 days/week

Time to goal
2-3 months

Exercise Prescription- Flexibility

Goals
Increase ROM

Frequency, Intensity, &

Duration
3 sessions/week

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.