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Ramachandran HJ, Jiang Y, Shan CH, Tam WWS, Wang W. A systematic review and meta-analysis on the effectiveness of swimming on lung function and asthma control in children with asthma. Int J Nurs Stud 2021; 120:103953. [PMID: 34051586 DOI: 10.1016/j.ijnurstu.2021.103953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Swimming has been considered the most appropriate activity for children with asthma for its lower asthmogenicity compared to land-based activities. However, the benefits of swimming have been hampered by reports of increased asthma risks, airway inflammation and bronchial hyper-responsiveness from exposure to chlorine by-products in swimming pools. Thus, the role of swimming for children with asthma remains unclear. OBJECTIVES To determine the effectiveness of swimming as an intervention on lung function and asthma control in children below the age of 18 years. Any adverse effects from swimming on asthma were also examined. METHODS Searches were performed across six databases systematically (PubMed, CINAHL, Embase, CENTRAL, Scopus, and PsycINFO). Randomized controlled trials (RCTs), quasi-experimental studies and interventional studies with at least one control/comparator group that were published in English were included. All eligible studies were screened with risk of bias examined by two independent reviewers. Meta-analyses were conducted using Review Manager 5.4 software while narrative syntheses were performed where meta-analysis was inappropriate and heterogeneity was present. RESULTS 1710 records were retrieved from the search. A total of 9 studies with 387 participants were included in this review after screening. Swimming was found to have favourable effects on forced expiratory volume in one second (L) and forced vital capacity (%), but not for forced expiratory volume in one second (%) and peak expiratory flow (%). Narrative synthesis on asthma control and adverse effects were in favour of the swimming group. CONCLUSION Future studies that are adequately powered, involve swimming interventions of sufficient intensity, frequency and duration, examine cumulative exposures to chlorine by-products and take into account potential cofounders are warranted.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Coral Hui Shan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
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Nitter TB, Hirsch Svendsen KV. Covariation amongst pool management, trichloramine exposure and asthma for swimmers in Norway. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 723:138070. [PMID: 32217397 DOI: 10.1016/j.scitotenv.2020.138070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/27/2020] [Accepted: 03/18/2020] [Indexed: 06/10/2023]
Abstract
The association between asthma and exposure to the air in swimming facilities has been acknowledged. However, the variation in, long-term exposure to and management of the respiratory irritant trichloramine (NCl3) is not well understood. In this study, 313 swimmers above 18 years of age licensed by the Norwegian Swimming Association answered a questionnaire about health and swimming. The prevalence of asthma amongst the most-exposed swimmers was 36%. Two facilities, those with the highest and lowest reported prevalence of asthma, were chosen for further investigation. For each facility, a one-week-long monitoring campaign was performed, during which pool management, air and water quality were investigated. The results of this study showed that time of day, occupancy and pool management affect the concentration of NCl3, which ranged from 58 μg/m3 to 461 μg/m3. Furthermore, in one of the facilities, the concentration of CO2 was measured to evaluate whether this contaminant could be used to predict the number of pool occupants as well as the concentration of NCl3 in the air. The concentration of CO2 was significantly correlated with occupancy level (ρ = 0.82, p = 0.01) and NCl3 concentration (r = 0.80, p = 0.01). Furthermore, according to the random intercept model the concentration of CO2 explained 52% of the variation observed in the air concentration of NCl3. CO2 sensors to control the air supply can help reduce the air concentrations of NCl3 and balance the air supply based on occupancy level.
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Affiliation(s)
- Therese Bergh Nitter
- Department of Civil and Environmental Engineering, Norwegian University of Science and Technology (NTNU), Norway; Department of Industrial Economics and Technology Management, NTNU, Norway.
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Dogra S, Patlan I, O’Neill C, Lewthwaite H. Recommendations for 24-Hour Movement Behaviours in Adults with Asthma: A Review of Current Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1789. [PMID: 32164176 PMCID: PMC7084595 DOI: 10.3390/ijerph17051789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
Background: Many countries have clinical practice guidelines (CPG) for asthma that serve as an important resource for healthcare professionals and inform the development of policies and practices relevant to asthma care. The purpose of this scoping review was to search for CPGs related to asthma to determine what recommendations related to the 24-h movement behaviours are provided. Methods: We searched for the most recent CPGs published by a national authoritative body from 195 countries. Guidelines were reviewed for all movement behaviours; that is, physical activity, sedentary behaviour, and sleep. Results: In total, 82 documents were searched for eligibility and 19 were included in our review. Of these, only 10 CPGs provided information on physical activity; none provided recommendations consistent with the FITT principle, while seven recommended activity levels similar to the general population. None of the guidelines included information on sedentary behaviour. Nine guidelines included information on sleep: recommendations mostly focused on changes to medication to reduce disruptions in sleep. Conclusions: It is recommended that future work be conducted to create comprehensive movement behaviour guidelines accompanied with relevant precautions and strategies to ensure that adults with asthma are able to safely and effectively engage in movement behaviours throughout the day.
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Affiliation(s)
- Shilpa Dogra
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, ON L1G 0C5, Canada; (I.P.); (C.O.)
| | - Ilana Patlan
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, ON L1G 0C5, Canada; (I.P.); (C.O.)
| | - Carley O’Neill
- Faculty of Health Sciences (Kinesiology), University of Ontario Institute of Technology, Oshawa, ON L1G 0C5, Canada; (I.P.); (C.O.)
| | - Hayley Lewthwaite
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC H2W 1S4, Canada;
- Innovation, Implementation and Clinical Translation in Health (IIMPACT), School of Health Sciences, University of South Australia, Adelaide 5001, Australia
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Carew C, Cox DW. Laps or lengths? The effects of different exercise programs on asthma control in children. J Asthma 2017; 55:877-881. [PMID: 28872938 DOI: 10.1080/02770903.2017.1373806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Exercise training has been shown in numerous studies to improve lung function and asthma control in children with asthma. Swimming has been shown to be of benefit in children with asthma, but which form of exercise is better for asthmatics has not been determined to date. The aim of this study was to examine if swimming improved lung function and asthma symptoms in asthmatic children when compared with different forms of exercise and a control group. METHODS Subjects with asthma were randomly assigned to either one of three different exercise training groups (swimming, football, and basketball) or a control group. Spirometry was performed before and after and the subjects were asked to keep asthma diaries and perform daily peak flow measurements. RESULTS 41 children and adolescents between the ages of 9 and 16 participated in the study. After completing the training, children across all three exercise programs had significantly higher forced vital capacity (FVC) percentage values when compared to the control group. The swimming group demonstrated a significant increase in the percentage peak expiratory flow (PEF) following the exercise program when compared with the control group (78.3 ± 9.3 versus 89.0 ± 14.9, p = 0.04). All children on exercise training programs reported an improvement in their asthma symptoms via asthma diaries. CONCLUSION This study suggests that a swimming training program is more beneficial in terms of peak flow measurements when compared with other exercise training programs.
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Affiliation(s)
- Chris Carew
- a Respiratory Department , Our Lady's Children's Hospital , Crumlin, Dublin , Ireland
| | - Des W Cox
- a Respiratory Department , Our Lady's Children's Hospital , Crumlin, Dublin , Ireland
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Prevalence and characteristics of asthma in the aquatic disciplines. J Allergy Clin Immunol 2015; 136:588-94. [PMID: 25819982 DOI: 10.1016/j.jaci.2015.01.041] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the health benefits of swimming as a form of exercise, evidence exists that both the swimming pool environment and endurance exercise are etiologic factors in the development of asthma. The prevalence of asthma in swimmers is high compared with that in participants in other Olympic sport disciplines. There are no publications comparing the prevalence of asthma in the 5 aquatic disciplines. OBJECTIVE The purpose of this study is to examine and compare the prevalence of asthma in the aquatic disciplines and in contrast with other Olympic sports. METHODS Therapeutic Use Exemptions containing objective evidence of athlete asthma/airway hyperresponsiveness (AHR) were collected for all aquatic athletes participating in swimming, diving, synchronized swimming, water polo, and open water swimming for major events during the time period from 2004-2009. The prevalence of asthma/AHR in the aquatic disciplines was analyzed for statistical significance (with 95% CIs) and also compared with that in other Olympic sports. RESULTS Swimming had the highest prevalence of asthma/AHR in comparison with the other aquatic disciplines. The endurance aquatic disciplines have a higher prevalence of asthma/AHR than the aquatic nonendurance disciplines. Asthma/AHR is more common in Oceania, Europe, and North America than in Asia, Africa, and South America. In comparison with other Olympic sports, swimming, synchronized swimming, and open water swimming were among the top 5 sports for asthma/AHR prevalence. CONCLUSION Asthma/AHR in the endurance aquatic disciplines is common at the elite level and has a varied geographic distribution. Findings from this study demonstrate the need for development of aquatic discipline-specific prevention, screening, and treatment regimens.
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Couillard S, Bougault V, Turmel J, Boulet LP. Perception of bronchoconstriction following methacholine and eucapnic voluntary hyperpnea challenges in elite athletes. Chest 2014; 145:794-802. [PMID: 24264387 DOI: 10.1378/chest.13-1413] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Self-reported respiratory symptoms are poor predictors of exercise-induced bronchoconstriction (EIB) in athletes. The objective of this study was to determine whether athletes have an inadequate perception of bronchoconstriction. METHODS One hundred thirty athletes and 32 nonathletes completed a standardized questionnaire and underwent eucapnic voluntary hyperpnea (EVH) and methacholine inhalation test. Perception scores were quoted on a modified Borg scale before each spirometry measurement for cough, breathlessness, chest tightness, and wheezing. Perception slope values were also obtained by plotting the variation of perception scores before and after the challenges against the fall in FEV1 expressed as a percentage of the initial value [(perception scores after - before)/FEV1]. RESULTS Up to 76% of athletes and 68% of nonathletes had a perception score of ≤0.5 at 20% fall in FEV1 following methacholine. Athletes with EIB/airway hyperresponsiveness (AHR) had lower perception slopes to methacholine than nonathletes with asthma for breathlessness only (P=.02). Among athletes, those with EIB/AHR had a greater perception slope to EVH for breathlessness and wheezing (P=.02). Female athletes had a higher perception slope for breathlessness after EVH and cough after methacholine compared with men (P<.05). The age of athletes correlated significantly with the perception slope to EVH for each symptom (P<.05). CONCLUSIONS Minimal differences in perception of bronchoconstriction-related symptoms between athletes and nonathletes were observed. Among athletes, the presence of EIB/AHR, older age, and female sex were associated with slightly higher perception scores.
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Affiliation(s)
- Simon Couillard
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada
| | - Valérie Bougault
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada; Université du Droit et de la Santé, Faculté des Sciences du Sport et de l'Éducation physique, Ronchin, France
| | - Julie Turmel
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada
| | - Louis-Philippe Boulet
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (Mr Couillard and Drs Turmel and Boulet), Québec City, QC, Canada.
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Beggs S, Foong YC, Le HCT, Noor D, Wood-Baker R, Walters JAE. Swimming training for asthma in children and adolescents aged 18 years and under. Cochrane Database Syst Rev 2013:CD009607. [PMID: 23633375 DOI: 10.1002/14651858.cd009607.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Asthma is the most common chronic medical condition in children and a common reason for hospitalisation. Observational studies have suggested that swimming, in particular, is an ideal form of physical activity to improve fitness and decrease the burden of disease in asthma. OBJECTIVES To determine the effectiveness and safety of swimming training as an intervention for asthma in children and adolescents aged 18 years and under. SEARCH METHODS We searched the Cochrane Airways Group's Specialised Register of trials (CENTRAL), MEDLINE , EMBASE, CINAHL, in November 2011, and repeated the search of CENTRAL in July 2012. We also handsearched ongoing Clinical Trials Registers. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs of children and adolescents comparing swimming training with usual care, a non-physical activity, or physical activity other than swimming. DATA COLLECTION AND ANALYSIS We used standard methods specified in the Cochrane Handbook for Systematic reviews of Interventions. Two review authors used a standard template to independently assess trials for inclusion and extract data on study characteristics, risk of bias elements and outcomes. We contacted trial authors to request data if not published fully. When required, we calculated correlation coefficients from studies with full outcome data to impute standard deviation of changes from baseline. MAIN RESULTS Eight studies involving 262 participants were included in the review. Participants had stable asthma, with severity ranging from mild to severe. All studies were randomised trials, three studies had high withdrawal rates. Participants were between five to 18 years of age, and in seven studies swimming training varied from 30 to 90 minutes, two to three times a week, over six to 12 weeks. The programme in one study gave 30 minutes training six times per week. The comparison was usual care in seven studies and golf in one study. Chlorination status of swimming pool was unknown for four studies. Two studies used non-chlorinated pools, one study used an indoor chlorinated pool and one study used a chlorinated but well-ventilated pool.No statistically significant effects were seen in studies comparing swimming training with usual care or another physical activity for the primary outcomes; quality of life, asthma control, asthma exacerbations or use of corticosteroids for asthma. Swimming training had a clinically meaningful effect on exercise capacity compared with usual care, measured as maximal oxygen consumption during a maximum effort exercise test (VO2 max) (two studies, n = 32), with a mean increase of 9.67 mL/kg/min; 95% confidence interval (CI) 5.84 to 13.51. A difference of equivalent magnitude was found when other measures of exercise capacity were also pooled (four studies, n = 74), giving a standardised mean difference (SMD) 1.34; 95% CI 0.82 to 1.86. Swimming training was associated with small increases in resting lung function parameters of varying statistical significance; mean difference (MD) for FEV1 % predicted 8.07; 95% CI 3.59 to 12.54. In sensitivity analyses, by risk of attrition bias or use of imputed standard deviations, there were no important changes on effect sizes. Unknown chlorination status of pools limited subgroup analyses.Based on limited data, there were no adverse effects on asthma control or occurrence of exacerbations. AUTHORS' CONCLUSIONS This review indicates that swimming training is well-tolerated in children and adolescents with stable asthma, and increases lung function (moderate strength evidence) and cardio-pulmonary fitness (high strength evidence). There was no evidence that swimming training caused adverse effects on asthma control in young people 18 years and under with stable asthma of any severity. However whether swimming is better than other forms of physical activity cannot be determined from this review. Further adequately powered trials with longer follow-up periods are needed to better assess the long-term benefits of swimming.
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Affiliation(s)
- Sean Beggs
- Department of Paediatrics, Royal Hobart Hospital, 48 Liverpool Street, Hobart, Tasmania, Australia, 7000
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Abstract
Concerns have been expressed about the possible detrimental effects of chlorine derivatives in indoor swimming pool environments. Indeed, a controversy has arisen regarding the possibility that chlorine commonly used worldwide as a disinfectant favors the development of asthma and allergic diseases. The effects of swimming in indoor chlorinated pools on the airways in recreational and elite swimmers are presented. Recent studies on the influence of swimming on airway inflammation and remodeling in competitive swimmers, and the phenotypic characteristics of asthma in this population are reviewed. Preventative measures that could potentially reduce the untoward effects of pool environment on airways of swimmers are discussed.
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Affiliation(s)
- Valérie Bougault
- Department of Sport sciences and Physical education, Université Droit et Santé Lille 2, E.A. 4488, Lille F-59000, France.
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Philpott J, Houghton K, Luke A. Physical activity recommendations for children with specific chronic health conditions: Juvenile idiopathic arthritis, hemophilia, asthma and cystic fibrosis. Paediatr Child Health 2011; 15:213-25. [PMID: 21455465 DOI: 10.1093/pch/15.4.213] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As a group, children with a chronic disease or disability are less active than their healthy peers. There are many reasons for suboptimal physical activity, including biological, psychological and social factors. Furthermore, the lack of specific guidelines for 'safe' physical activity participation poses a barrier to increasing activity. Physical activity provides significant general health benefits and may improve disease outcomes. Each child with a chronic illness should be evaluated by an experienced physician for activity counselling and for identifing any contraindications to participation. The present statement reviews the benefits and risks of participation in sport and exercise for children with juvenile arthritis, hemophilia, asthma and cystic fibrosis. Guidelines for participation are included.
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10
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Shephard RJ. Lifestyle and the Respiratory Health of Children. Am J Lifestyle Med 2011. [DOI: 10.1177/1559827610378337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article offers a review of the potential influences of personal lifestyle on respiratory health in children, looking at both healthy individuals and those with respiratory disorders. As with many aspects of health, regular physical activity, an appropriate diet, and avoidance of obesity and cigarette smoke all contribute to optimal development of the healthy child. An active lifestyle is associated with greater static and dynamic lung volumes, greater efficiency of the ventilatory process, and an optimization of breathing patterns. The risk of upper respiratory infections is also reduced in those maintaining a moderate level of physical activity. Maternal smoking during pregnancy, as well as active and passive smoking, all have an adverse influence on lung function in the child, the largest effects being on dynamic lung volumes. The risk of developing asthma seems reduced in children who maintain a normal body mass and are physically active. A program of graded physical activity is of therapeutic value in a number of established respiratory conditions, including asthma, cystic fibrosis, and ventilatory impairment from neuromuscular disorders. Exercise carries a slight risk of fatalities from asthma and anaphylactic reactions. In designing an optimal physical activity program, it is also important to guard against the hazards of deep oronasal breathing, including the precipitation of bronchospasm by the inhalation of cold, dry air and pollens; an increased exposure to atmospheric pollutants (reducing and oxidant smog, fine and ultra-fine particulates, and carbon monoxide); and possible long-term dangers from chlorine derivatives in the atmosphere of indoor swimming pools.
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Affiliation(s)
- Roy J. Shephard
- Faculty of Physical Education and Health, University of Toronto, Toronto, ON, Canada,
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Päivinen MK, Keskinen KL, Tikkanen HO. Swimming and asthma: factors underlying respiratory symptoms in competitive swimmers. CLINICAL RESPIRATORY JOURNAL 2010; 4:97-103. [PMID: 20565483 DOI: 10.1111/j.1752-699x.2009.00155.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Swimming is recommended for asthmatics. However, many competitive swimmers report asthmatic symptoms. While some studies identify the swimming environment as a trigger for allergy and asthmatic symptoms, even more studies suggest swimming to be suitable for people with allergies and asthma. The factors behind the symptoms were studied first by determining the prevalence of asthma, allergy and self-reported asthmatic symptoms in experienced Finnish swimmers and then by examining the relationships between the reported symptoms and the main triggering factors: medical history, environment and exercise intensity. MATERIALS AND METHODS Top swimmers (n = 332) of the Finnish Swimming Association registry (N = 4578) were asked to complete a structured questionnaire on their medical history, swimming background, swimming environment and symptoms in different swimming intensities. Two hundred experienced swimmers, 107 females and 93 males, with an average age of 18.5 [standard deviation (SD) = 3.0] years and a swimming training history of 9 (SD = 3.8) years completed the questionnaire. RESULTS Physician-diagnosed asthma was reported by 32 swimmers (16%), including 24 (12%) with exercise-induced asthma. Physician-diagnosed allergy was reported by 81 (41%) swimmers. Asthmatic symptoms during swimming were described by 84 subjects (42%). Most symptoms occurred when swimming exceeded speeds corresponding to the lactic/anaerobic threshold. Family history of asthma was significant and the most important risk factor for asthmatic symptoms. CONCLUSIONS The prevalence of asthma in swimmers was higher than in the general population but not different from that in other endurance athletes. Family history of asthma and increased swimming intensity had the strongest associations with the reported asthmatic symptoms.
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Affiliation(s)
- Marja Kristiina Päivinen
- Unit for Sport and Exercise Medicine, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.
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12
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Physical activity recommendations for children with specific chronic health conditions: juvenile idiopathic arthritis, hemophilia, asthma, and cystic fibrosis. Clin J Sport Med 2010; 20:167-72. [PMID: 20445355 DOI: 10.1097/jsm.0b013e3181d2eddd] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As a group, children with a chronic disease or disability are less active than their healthy peers. There are many reasons for suboptimal physical activity, including biological, psychological, and social factors. Furthermore, the lack of specific guidelines for 'safe' physical activity participation poses a barrier to increasing activity. Physical activity provides significant general health benefits and may improve disease outcomes. Each child with a chronic illness should be evaluated by an experienced physician for activity counselling and for identifying any contraindications to participation. The present statement reviews the benefits and risks of participation in sport and exercise for children with juvenile arthritis, hemophilia, asthma, and cystic fibrosis. Guidelines for participation are included.
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13
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Bougault V, Turmel J, Boulet LP. Bronchial challenges and respiratory symptoms in elite swimmers and winter sport athletes: Airway hyperresponsiveness in asthma: its measurement and clinical significance. Chest 2010; 138:31S-37S. [PMID: 20363843 DOI: 10.1378/chest.09-1689] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
UNLABELLED This study was aimed at the following: (1) the prevalence of airway hyperresponsiveness (AHR) and exercise-induced bronchoconstriction (EIB) in swimmers and winter sport athletes according to the previously recommended regulatory sport agencies criteria, (2) the relationship between respiratory symptoms and AHR/EIB, (3) the impact of the chosen cutoff value for AHR on its prevalence, and (4) the effect on the prevalence of the positive eucapnic voluntary hyperpnea (EVH) test of using the highest vs the lowest spirometric post-EVH values to calculate the magnitude of the airway response. We compared the prevalence of respiratory symptoms with responses to methacholine challenge and EVH in 45 swimmers, 45 winter sport athletes, and 30 controls. Two methacholine challenge cutoffs for AHR were analyzed: <or= 4 mg/mL (the sport agencies' criteria for AHR) and <or= 16 mg/mL. Sixty percent of swimmers, 29% of winter sport athletes, and 17% of controls had evidence of EIB or AHR (with the <or= 4 mg/mL criteria). Among athletes with a methacholine provocative concentration inducing a 20% decrease in the FEV(1) between 4 and 16 mg/mL, 43% of swimmers and 100% of winter sport athletes were symptomatic (P < .05). Prevalence of positive EVH tests were 39% in swimmers, 24% in winter sport athletes, and 13% in controls when the highest FEV(1) value measured at each time point post-EVH was used to identify maximal response for calculation of airway response, although these prevalences were higher if we used the lowest value. This study suggests that AHR/EIB is frequent in swimmers, whereas the frequently reported respiratory symptoms in winter sport athletes are often not related to AHR/EIB. Furthermore, the choice of methods for assessing methacholine challenge and EVH responses influences the prevalences of AHR and EIB. TRIAL REGISTRATION clinicaltrials.gov; Identifier NCT 00686491 and NCT 00686452.
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Affiliation(s)
- Valérie Bougault
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
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Philpott J, Houghton K, Luke A. Les recommandations en matière d'activité physique pour les enfants ayant une maladie chronique précise : l'arthrite juvénile idiopathique, l'hémophilie, l'asthme ou la fibrose kystique. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Weisel CP, Richardson SD, Nemery B, Aggazzotti G, Baraldi E, Blatchley ER, Blount BC, Carlsen KH, Eggleston PA, Frimmel FH, Goodman M, Gordon G, Grinshpun SA, Heederik D, Kogevinas M, LaKind JS, Nieuwenhuijsen MJ, Piper FC, Sattar SA. Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations. ENVIRONMENTAL HEALTH PERSPECTIVES 2009; 117:500-7. [PMID: 19440486 PMCID: PMC2679591 DOI: 10.1289/ehp.11513] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 09/30/2008] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children's exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue. DATA SOURCES A workshop was held in Leuven, Belgium, 21-23 August 2007, to evaluate the literature and to develop a research agenda to better understand children's exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs. SYNTHESIS Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection. CONCLUSIONS Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.
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Affiliation(s)
- Clifford P Weisel
- Environmental and Occupational Health Sciences Institute, Robert Wood Johnson Medical School/University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey 08854, USA.
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Weisgerber M, Webber K, Meurer J, Danduran M, Berger S, Flores G. Moderate and vigorous exercise programs in children with asthma: safety, parental satisfaction, and asthma outcomes. Pediatr Pulmonol 2008; 43:1175-82. [PMID: 19003892 DOI: 10.1002/ppul.20895] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous research suggests that physical activity programs may improve fitness and reduce symptoms in children with asthma, but few studies have included severe asthmatics and focused on safety and parental satisfaction with the programs. OBJECTIVE To examine safety, parental satisfaction, and pre- to post-intervention changes in symptoms and quality of life (QOL) in a pilot study of the impact of vigorous physical activity (swimming) and moderate-intensity activity (golf) on inner-city children with asthma. DESIGN/METHODS Children with asthma (7-14 years old) residing in Milwaukee's highest asthma prevalence zip codes were randomized to a 9-week swimming or golf program. Pre- and post-intervention data were obtained on safety, parental satisfaction, asthma symptoms, quality of life, and urgent asthma physician visits. RESULTS Twenty-eight children in the swimming group and 17 in the golf group completed the program. Combined group analysis (N = 45) revealed that only six symptom exacerbations occurred during 1,125 person-sessions of swimming and golf (all resolved with bronchodilator therapy), 92% of parents were very or extremely satisfied with the program, and post-exercise decreases were observed in asthma symptom severity scores (9.3-7.3, P < 0.001), improved parental QOL (4.9-5.4, P < 0.001), and reduced urgent physician visits for asthma (1.3-0.2 visits per person, P = 0.04). The study lacked sufficient power to perform intergroup comparisons. CONCLUSIONS Findings from this pilot study indicate that vigorous (swimming) and moderate-intensity (golf) physical activity programs are well-tolerated, safe, and achieve high parental satisfaction. Participants and parents reported reduced childhood asthma symptoms and physician office visits and improved parental QOL. These findings suggest a potentially beneficial role for moderate to vigorous physical activity in childhood asthma.
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Affiliation(s)
- Michael Weisgerber
- Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Airway responsiveness and inflammation in adolescent elite swimmers. J Allergy Clin Immunol 2008; 122:322-7, 327.e1. [PMID: 18554704 DOI: 10.1016/j.jaci.2008.04.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 04/04/2008] [Accepted: 04/22/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Whereas increased airway hyperresponsiveness (AHR) and airway inflammation are well documented in adult elite athletes, it remains uncertain whether the same airway changes are present in adolescents involved in elite sport. OBJECTIVE To investigate airway responsiveness and airway inflammation in adolescent elite swimmers. METHODS We performed a cross-sectional study on adolescent elite swimmers (n = 33) and 2 control groups: unselected adolescents (n = 35) and adolescents with asthma (n = 32). The following tests were performed: questionnaire, exhaled nitric oxide (FeNO), spirometry, induced sputum, methacholine challenge, eucapnic voluntary hyperpnea (EVH) test, and exhaled breath condensate pH. RESULTS There were no differences in FeNO, exhaled breath condensate pH, cellular composition in sputum, or prevalence of AHR to either EVH or methacholine among the 3 groups. When looking at airway responsiveness as a continuous variable, the swimmers were more responsive to EVH than unselected subjects, but less responsive to methacholine compared with subjects with asthma. We found no differences in the prevalence of respiratory symptoms between the swimmers and the unselected adolescents. There was no difference in FeNO, cellular composition of sputum, airway reactivity, or prevalence of having AHR to methacholine and/or EVH between swimmers with and without respiratory symptoms. CONCLUSION Adolescent elite swimmers do not have significant signs of airway damage after only a few years of intense training and competition. This leads us to believe that elite swimmers do not have particularly susceptible airways when they take up competitive swimming when young, but that they develop respiratory symptoms, airway inflammation, and AHR during their swimming careers.
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Welsh L, Kemp JG, Roberts RGD. Effects of physical conditioning on children and adolescents with asthma. Sports Med 2005; 35:127-41. [PMID: 15707377 DOI: 10.2165/00007256-200535020-00003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
More than 40 years ago, the effects of exertional dyspnoea and the associated fear of an asthma attack usually lead to an avoidance of physical activity amongst asthmatic children. This issue still exists today, particularly in children with severe asthma. This article presents a comprehensive review of published information concerning the effects of training programmes on children and adolescents with asthma. The primary focus of these investigations was to examine the effects of physical conditioning on aerobic fitness, the severity and incidence of exercise-induced asthma (EIA) and asthma symptoms. The large majority of training studies of asthmatic children and adolescents demonstrate significant increases in aerobic fitness post-training or the achievement of normal levels of aerobic fitness. While there are a few reports of a reduced severity in EIA symptoms post-training, the majority of studies demonstrate no change in the occurrence or degree of EIA. However, a number of these studies have reported some reductions in hospitalisations, wheeze frequency, school absenteeism, doctor consultations and medication usage. It is, therefore, recommended that children and adolescents with asthma should participate in regular physical activity. This may improve asthma management and associated general health benefits, whilst minimising inactivity-related health risks.
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Affiliation(s)
- Liam Welsh
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Weisgerber MC, Guill M, Weisgerber JM, Butler H. Benefits of Swimming in Asthma: Effect of a Session of Swimming Lessons on Symptoms and PFTs with Review of the Literature. J Asthma 2003; 40:453-64. [PMID: 14529095 DOI: 10.1081/jas-120018706] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A study involving eight children with moderate persistent asthma was undertaken to determine whether standard swimming lessons improved symptoms and pulmonary function tests (PFTs) in asthmatic children. Five children ages 7-12 years old with moderate persistent asthma were randomized to a swimming lesson group (5- to 6-week session) and three to a control group. Both groups completed pre- and poststudy period PFTs and symptom questionnaires. Swimming lessons did not produce a significant change in asthma symptoms or PFTs. Review of previous literature found that swimming has been shown to have definite benefits in improving cardiorespiratory fitness in asthmatic children. Swimming has been shown to be less asthmogenic than other forms of exercise. Some studies have also shown improvement in asthma symptoms in children participating in exercise programs.
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Affiliation(s)
- M C Weisgerber
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Inbar O, Naiss S, Neuman E, Daskalovich J. The effect of body posture on exercise- and hyperventilation-induced asthma. Chest 1991; 100:1229-34. [PMID: 1935276 DOI: 10.1378/chest.100.5.1229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent studies have shown that swimming is of relatively low asthmogenicity, even under conditions of high respiratory heat (and/or water) loss (RHL). It has been suggested that the horizontal body position may contribute to swimming's low asthmogenicity. We studied the effects of upright and prone body postures on pulmonary function following exercise (EIA) and after nonexercise hyperventilation (HIA). Twelve asthmatic boys (aged 12 to 16 years) underwent two 8-min exercise sessions of shoulder flexion-extension and two 8-min isocapnic hyperventilation treatments, in a counterbalanced order, either while lying prone or standing upright. All tests were carried out in a climatic chamber at 10 +/- 1 degree C and 31 +/- 2 percent relative humidity. Minute ventilation (VE) was kept constant at a predetermined individual level during all treatments. No differences were observed in pulmonary functions between the prone and upright postures following either exercise (FEV1 = -20.5 +/- 18.7 percent vs -22.2 +/- 18.7 percent, respectively) or hyperventilation (FEV1 = -29.6 +/- 19.0 percent vs -29.7 +/- 20.2 percent). We conclude that body posture on land has no meaningful effect on the severity of bronchoconstriction in asthmatic children; however, in view of some conceivable physiologic benefits of the prone position in water, an interactive effect on swimming-induced asthma (SIA) of body posture and water immersion cannot be ruled out.
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Affiliation(s)
- O Inbar
- Department of Research and Sport Medicine, Wingate Institute Netania, Haifa, Israel
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Abstract
A long-term physical exercise program was established for a large number of children with bronchial asthma. Asthmatic children were first taught to swim on their backs to prevent breathing problems customary for beginners using other strokes. They concurrently participated in gymnasium exercises, and the program was later completed with outdoor running. Program effectiveness was evaluated by monitoring asthmatic symptoms, changes in medication, and changes in the activity and physical fitness of the children. Data collected from 121 children showed that during the first year in the program the number of days with asthmatic symptoms decreased in a large majority of the patients while medication was decreased. School absenteeism and hospitalization dropped markedly. Parental evaluation of the children indicated much improvement in 51.2%, improvement in 40.5%, unchanged condition in 7.4%, and deterioration of general health was only reported in one child (0.8%). The same extent of improvement continued during the second year. The Cooper test was applied for the first time to such an exercise program and indicated that the participating asthmatic children performed as well as a control group of nonasthmatic children, and the cardiovascular efficiency of the asthmatics was actually better.
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Abstract
Physical exercise is not hazardous to asthmatics. Some asthmatics may benefit from physical training, and almost all asthmatics can perform any kind of physical exercise. Free running was earlier thought to induce more asthma than swimming, for example; however, when ventilation is identical during running and swimming, the exercise-induced asthma will also be the same. Hyperventilation alone is as good as physical exercise to induce exercise-induced asthma. If the physical exercise provokes an asthmatic attack, this is most often easily reversed by inhaled beta 2-agonists. Pretreatment of exercise-induced asthma is most efficient by inhaled beta 2-agonist; orally dosed beta 2-agonist is not as efficient as inhaled beta 2-agonist in the pretreatment of exercise-induced asthma. Inhaled sodium cromoglycate diminishes exercise-induced asthma, and the effect seems to be better in children than in adults. Inhaled steroids have no immediate effect on exercise-induced asthma, but long term treatment with steroids diminishes exercise-induced asthma. The pathogenesis of exercise-induced asthma remains obscure. If the water content is low in the inhaled air, e.g. in cold air, the changes in ventilatory capacity following exercise. will be greater than when the exercise is performed while inhaling hot air with high humidity. Almost all asthmatics present changes in the ventilatory capacity following exercise. Seasonal changes in exercise-induced asthma are only present in asthmatics with seasonal allergies, e.g. pollen allergy. No diurnal variation is found in exercise-induced asthma. Asthmatics can do any form of physical exercise. Almost all asthmatics can prevent major changes in ventilatory capacity by pretreatment of exercise-induced asthma or be treated for exercise-induced asthma during the physical activity so that they will not suffer from asthma while performing physical exercise. Asthmatics who have been successfully treated for exercise-induced asthma can do physical exercise at the same level as non-asthmatics. Asthmatic children in particular should be encouraged to perform any sport they like, as the physiological and psychological effects may be beneficial to them. It is concluded that almost all asthmatics have exercise-induced asthma, and that physical training may be beneficial. Exercise-induced asthma is best treated and pretreated by inhalation of beta 2-agonists.
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Bundgaard A, Ingemann-Hansen T, Halkjaer-Kristensen J. Physical training in bronchial asthma. INTERNATIONAL REHABILITATION MEDICINE 1984; 6:179-82. [PMID: 6396266 DOI: 10.3109/03790798409165959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Physical exercise is advocated as an important form of preventative medicine and in the treatment of various cardiovascular diseases. This review looks at whether a similar approach may be of value in chronic obstructive lung disease (COLD). Few studies have been properly controlled and outcome measures are not well defined. However, it is clear that exercise is safe and increases work capacity and sense of well being.
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Bar-Yishay E, Gur I, Inbar O, Neuman I, Dlin RA, Godfrey S. Differences between swimming and running as stimuli for exercise-induced asthma. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1982; 48:387-97. [PMID: 7200881 DOI: 10.1007/bf00430229] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Thirteen children each exercised for 6 min by running on a treadmill and by tethered swimming, breathing air at room temperature and either 8% or 99% relative humidity continuously. Ventilation, gas exchange and heart rate were closely matched in all four tests in each child, with a mean oxygen consumption of 32.3 +/- 1.7 ml x min-1 x kg-1. The post-exercise fall in FEV1 expressed as a percentage of the baseline FEV1 (delta FEV1) was significantly greater after running compared with swimming breathing either humid or dry air. The delta FEV1 was also related to respiratory heat loss (RHL) calculated from measurements of inspired and expired gas temperature and humidity. At a standardised RHL, the difference between running and swimming was highly significant [delta FEV1 (%) +/- SE = 39 +/- 5 and 28 +/- 4 respectively, p less than 0.01]. These experiments suggest that the type of exercise influences the severity of exercise-induced asthma even under conditions of the same metabolic stress and respiratory heat loss.
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Abstract
In brief: Recent studies suggest that avoiding exercise is unwarranted and detrimental for asthmatics. Although exercise provokes bronchospasm in most asthmatics, the severity of exercise-induced asthma can be reduced by several factors: control of exercise duration; less intense, intermittent exercise; warm-ups; warmer, humid inspired air; aerobic fitness; and drugs. Regular vigorous activity increases fitness, enhances tolerance to attacks, and provides more social and psychological independence. The recent development of protective medications has made such activity possible for many asthmatics. Preexercise cromolyn sodium and beta adrenergic agonists are recommended for blocking or reversing attacks.
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