Wednesday, December 14, 2011

Asthma in the World of Physical Education

            When I was in the second grade I was running the mile in my physical education class for my physical fitness test, when I finished I realized that I could not breathe.  My teacher brought me into the nurse’s office where she told me that I had the characteristics of a medical condition called asthma.  When I went to the doctors, I was diagnosed with exercise and environmental induced asthma.  Asthma is the most common chronic condition in children and adults worldwide (Caple and Schub 2011).  With having asthma, it can lead to the fear of not want to exercise or play sports due to the fear of not being able to breathe.  Another factor that can lead to the inactivity is children who are obese that also have asthma.  The purpose of this paper is to give more background on asthma, introduce exercise induced asthma, and relate the relationship of physical activity and asthma, then ways to help better manage asthma in children.
            Asthma is the most common chronic condition amongst children and even adults worldwide that also leads to the most missed school days by children and work days by adults.  According to Caple and Schub, asthma is a “chronic disease characterized by the reversible airflow obstruction due to inflammation and narrowing of the airways” (2011).  Asthma can be separated into four different categories based off how severe and how often the symptoms are: intermittent, mild, moderate and severe persistent (Caple and Schub 2011).  Depending on how bad the child’s symptoms are will depend on what category they are.  For example, a child with mild persistence, the child only experiences their symptoms sometimes compared to a child who has severe persistence who has their symptoms all the time.  One thing that can be very fearful to child would be a status asthmatic, or an asthma attack.  An asthma attack can be very dangerous because it can lead to respiratory failure and even death.
            Asthma affects people of all ages, sex, ethnicity, and status’ in the world.  Granted, it is more prominent in certain areas of these four things.  Thirteen percent of children are affected by asthma compared to the seven percent of adults who are affected by it (Caple and Schub, 2011).  According to the article Asthma Prevalence, females have a higher prevalence of asthma compared to males and this is because as child boys have a higher prevalence than girls but as they get older it changes to girls (Akinbami et. al 2005).  Having asthma can affect people of all backgrounds and ethnicity, like people who are American Indian, Alaskan, Puerto Rican etc. have a higher chance of being asthmatic compared to people who are white.  Another factor that can increase the asthma prevalence is the status of a family in the economy.  People who have a lower income that is below the federal poverty level can lead to people having a higher chance of getting asthma (Akinbami et. al. 2005).
            In 2008, children ages 5-17, who had one asthma attack per year, missed at least 10.5 million days of school (Akinbami et. al. 2005).  By missing school, children are missing classes along with being physically active which can lead to their activity level being lower than that of their peers.  This can allow the students to slip below where students are supposed to be on the state standards.  5.5 percent of the children who missed class had an excused activity limitation.  According to the article Asthma Prevalence, activity limitation is:
A long term reduction of a person’s capacity to perform the usual kind or amount of activities associated with his or her age group as a result of a chronic condition. Akinbami et. al. 2005
            With this, like stated previously, the children were not able to participate in physical education class because of their activity limitation.  Without being able to participate in some sort of physical activity, there can be more of a chance of child obesity.  The symptoms of asthma are dry couch, wheezing, chest pain (mostly in children), shortness of breath, rapid breathing, fatigue and having a difficulty activity level compared to their peers.  Reduction of these symptoms can happen with prescription medicine along with keeping away from irritants that can trigger asthma.  Some of these irritants are smoke, allergies, stress, respiratory infections, and also exercise. 
            Exercise induced asthma (EIA) is just one of the many different kinds of asthma; it is a condition where there is respiratory distress that is triggered by aerobic exercise.  With having exercise induced asthma there is a problem when it comes to performing any type of aerobic exercise, a person may experience coughing, wheezing, a shortness of breath, tightness in the chest, fatigue after exercising.  These symptoms can occur during and even after exercise and can last for up to an hour until they finally cease (Buckley and Schub 2011).  There are real no reasons as to why this occurs but a theory is that there is a loss of heat or water in the lungs during activity from heavy breathing or heavy exertion.  Exercise induced asthma should not be confused with bronchitis or pneumonia or any other type of respiratory infections (Buckley and Schub 2011). 
            Unlike regular asthma that has many other irritants that can trigger the symptoms, the only trigger for exercise induced asthma is exercise.  EIA is actually very common, it occurs in 12-15% of the general population, 35-45% of people who allergy rhinitis, and almost 90% of chronic asthma patients (Buckley and Schub 2011).  Even though exercise is one of the only triggers for EIA, another small trigger that can create on onset of EIA, is the cold weather.  Which is why it exercise induced asthma is higher in winter athletes who participate in winter skiing, ice hockey, and cross country skiing with about 30-50% of winter athletes having it (Buckley and Schub 2011).
            There are two ways to help manage exercise induced asthma, medicated and without medication.  With medication there are inhalers that can be taken before and after exercise, they help to reduce the swelling in the respiratory track and also improve breathing.  There is also something called a cell stabilizer that prevents manifestations and leukotriene inhibitors (Buckley and Schub 2011).  By learning how to breathe a different way can also help to manage EIA without medication.  In other words, breathing through your nose and not your mouth can help to decrease the symptoms.  Another way would be to change the exercise activity that someone is doing, like going from running and changing it to swimming.  Swimming is a lot less strainful on someone with asthma.  By increasing someone’s conditioning can help to lessen the EIA attacks along with help to improve it (Buckley and Schub 2011).  This is something that would be good for helping children because they will be able to still be fit, but also they will be able to reduce their asthma symptoms. 
            People who are at high risk of having exercise induced asthma are people who have chronic asthma, children, and winter athletes (like previously mentioned).  While having exercise induced asthma there are many risks that can help trigger symptoms to occur.  As previously mentioned cold air can help to trigger it, along with having poor air quality, a respiratory infection, having poor condition, and of course the major one, exercise.  Certain sports along with exercises will trigger it more than others.  For example, playing soccer compared to gymnastics will be more of a trigger due to the excessive running and high intensity compared the short bursts of running and low intensity level of gymnastics.  This can be extremely crucial to children who want to be involved in high intensity sports because their asthma ‘might hold them back’.  When it comes to exercise, any type of exercise that has a high intensity level or an aerobic exercise that last longer than ten minutes will trigger the symptoms of EIA (Buckley and Schub 2011).  As long as someone has total control over their asthma, knows what their limit is, along with take their inhaler before exercise, anyone can participate in high intensity exercise even with EIA.
            Exercise induced asthma is something that might hinder someone from playing sports or participating in physical activity, about 70 -90% of people have allowed it to hinder their participation (Kemp et al. 2004, page 861).  The thought of not participating in sports or participating in physical activity is mostly common in children due to the fear of not being able to breathe.  But this is not true, there have been many studies showing as long is someone is in good physical conditioning then they would be able to participate in sports or physical activity (Kemp et al. 2004 page 862).  There are many elite level athletes who have exercise induced asthma that still compete in the sports and activities they enjoy.  For example, in the 84’ and 96’ summer Olympics, at least 11-20% of athletes that participated had exercise induced asthma.  Then also in the 98’ winter Olympics, where EIA is more likely to be triggered, 23% of athletes had exercise induced asthma (Kemp et al. 2004, page 861). 
            There are many health benefits to participating in physical activity, it is a physical educators job to be sure that children are participating in physical activity due to the increase of obesity rates in children.  Some benefits include, a better aerobic fitness level, an improved performance in sports, and of course the decrease in a chance of obesity.  Inactivity in physical activity can lead to lower levels of aerobic fitness and an increased chance of being overweight that can lead to an increase in obesity rates.  By participating in physical activity, there is an increase in health benefits but also a healthier adulthood.  Asthma cannot be cured, but it can be managed, by improving physical conditioning and participating in physical activity.  Without the participation as a child, there is a chance that their asthma will not be controlled which can lead to an unhealthy adulthood because of the lack of control over their asthma (Kemp et al. 2004, page 862).
            There have been many studies to show a relationship between the fitness levels of a child with asthma and a child with no asthma.  Based off the studies found by Kemp and others in the article Fitness and Physical Activity in Children with Asthma, there have been many different results, but a majority of the results end in children with asthma are capable of having the same fitness levels as a child without asthma (2004 page 865).  The rest of this paper is going to talk about some of these studies and their findings, along with how a physical educator can improve the physical activity levels of a child with asthma.
            Most of the studies in the article compare the maximal oxygen consumption (VO2 Max) between asthmatic children to non asthmatic children (Kemp et al. 2004, page 863).  One of the studies that Kemp and others found assessed “the maximal oxygen consumption of 20 mild to severely asthmatic boys on a cycle ergometer and concluded that even children with severe asthma have a normal maximal oxygen uptake capacity” (Kemp et al. 2004, page 863).  There have been many other studies that agree with this one, that asthmatic children are able to have normal VO2 Max levels the same as their no asthmatic peers.  Granted it might take some time for children to get to the same point as their non asthmatic peers, but there is still a chance for them to be physically fit.
            Granted there have been studies that found that children with asthma are able to have the same maximal oxygen uptake, there have also been studies that showed asthmatic children were able to have about the same aerobic fitness as children without asthma (Kemp et al. 2004, page 864).  One of the studies compared eighty asthmatic and nonasthmatic children who were measured on a maximal treadmill test and were matched up compared to their age, weight, and height.  The study showed that “as long as physical activity levels are comparable with that of normal children, asthmatic children are capable of achieving similar level of aerobic fitness” (Kemp et al. 2004, page 864).  With this information, it shows that asthmatic children are able to have the same levels of aerobic fitness of their nonasthmatic peers even if they have asthma.
Some ways to help children improve their asthma in the physical education setting can range from changing their activity levels to introducing them to a fitness plan to work with.  Instead of having children with low condition levels and asthma perform all the same tasks as children without asthma at the same level, possibly have the asthmatic children start at a lower less intense level.  It is almost like modifying the equipment for students, but instead it is modifying the activity level.  Another idea to help children improve their asthma through physical activity would be to introduce them to a fitness plan to help them outside of the school setting.  Even if it consists of starting a program after school for children to go to play organized games that have different levels of physical activity.  Even though these are just ideas, they are ways to possibly help keep children with asthma active in and outside of the physical education setting that way their conditioning levels do not decrease.
            To conclude, asthma is a worldwide disease that is not cure able but it can be managed.  In order to help manage asthma, improving physical conditioning along with increasing the participation in sports with children can lead to a healthier adulthood.  Exercise induced asthma can be trigger mostly by exercise, especially of high intensity like soccer.  But that does not mean that someone who has EIA cannot participate in high intensity exercise or sports.  Children fear the idea of physical activity because of how scary asthma can be to a child.  As a physical educator, asthma can affect how a child participates in class because they might not want to play games or run around because of their asthma.  Even though studies have shown that physical activity actually helps children decrease their asthma symptoms. 
Akinbami, Lara J., Xiang Lui, and Jeanne E. Moorman.  (2011). Asthma Prevalence, Health Care Use, and Mortality: United States, 2005-2006.  National Health Statistics Reports. 
Buckley, Leonard L. and Tanja Schub.  (2011). Asthma: Exercise Induced.  Quick Lesson About….
 Caple, Carita and Tanja Schub.  (2011). Asthma: Child/Adolescent.  Quick Lesson About….
Kemp, Justin G., Richard G.D. Roberts, and Liam Welsh.  (2004). Fitness and Physical Activity in Children with Asthma.  Sports Medicine.  Pages 861-868.

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