Reducing the possibility of an attack during exercise

March 25, 2014 by Asthma Care in Asthma and Exercise

Exercise-induced asthma (also known as EIA) occurs due to an increased  volume  of breathing  brought  about  by the demands  of physical effort. The  theory  generally  accepted among  researchers  is that  increased  ventilation  cools and dehydrates  the  airways. With increased ventilation,  airways are required  to condition  a greater  volume  of air and  this causes the dehydration  and cooling effect. According to Anderson, the greater  the volume of ventilation, the greater the  loss  of  water  and  cooling  of  the  airways and  so  the greater the severity of bronchoconstriction. Estimates   at  the   incidence   of  exercised  induced   bronchospasm  are anything  between  eighty per cent and ninety per cent.

Buteyko cites the loss of carbon dioxide as playing the primary role. If the volume of air being breathed  is greater than is required  by the metabolism,  the airways narrow and asthma  symptoms  occur. When  this  happens,  the  amount of  carbon  dioxide  being  breathed  out  is greater  than  the amount  the metabolism  is producing. This results in activation  of the  body’s defence  mechanism as it constricts  the airways to prevent the loss of carbon dioxide.

Buteyko’s theory carries a lot of weight because during physical activity ventilation  increases far more than it would at rest. However, when the control pause is sufficiently high, there  are no symptoms  during  exercise due to the muscles producing  plenty  of carbon  dioxide  to  counterbalance the increase  of breathing.  If EIA were caused  solely by airway dehydration,  then  surely symptoms  would occur regardless of the  CP or  degree  of exercise? Another  question  worth asking is: if airway cooling, or drying, is the  cause of EIA, then at what temperature or air moisture content could exer- cise be taken in order to prevent an attack? Would an attack occur if exercise were taken in a steam room, for example? Quite  possibly all theories  have a validating  argument but  it does  not  matter  which  theory  is correct.  The  most important thing  to  recognise  is that  overbreathing  causes bronchoconstriction.

How do you know if you are exercising correctly?

You are exercising correctly if you can achieve the following: nasal breathing,  an improved  control  pause  and  if you no longer require reliever medication  prior to exercise.

Nasal  breathing: It  is  of  the  utmost  importance   that  all breathing   is  done  only  through   the  nose,  and  especially when  the  CP is low. This comes  as quite  a shock to most people because mouth  breathing  is so predominant in every activity, including walking. When the change to nasal breath- ing  is first  made,  fitness  levels will tend  to dip below the normal  level. However with continued  nasal breathing  this will soon correct itself. Research conducted  with top athletes has  shown  that  fitness   levels  will  improve  substantially within  eight  weeks  if  nasal  breathing   is  maintained.  It is essential  in  reducing  exercise-induced  asthma  and  it is advisable for people  involved  in  sports  to train  at a more relaxed pace until they become accustomed  to nasal breath- ing. Once the new regime becomes like second nature more intensive training can be undertaken.

Regardless of what type of exercise is being undertaken, if the need to breathe  in through  the mouth  arises then the training  is too  intense. For chronically  ill people, this  can occur after just a few steps. For people who are physically fit this may not occur until after a few miles of jogging. As soon as the  need  to  breathe  in  through  the  mouth  arises, it is important to stop and relax, wait for a few minutes  to catch a breath and only then proceed with the exercise once again. For this reason, walking in a park where there are plenty of seats is a good  idea. This affords the  opportunity  to sit down on a bench and relax for a few moments whenever the need  to breathe  through  the  mouth  occurs. In a matter  of just a few weeks it should  be  possible  to  walk the  entire distance without having to sit down and the route should be a lot easier to complete than previously.

It is often pointed  out that nasal breathing  can become quite  pronounced and  audible  during  even  mild  exercise. The body’s requirement for air increases  substantially  with any exercise. As a result the breathing  becomes  louder  and many people are conscious that other people can hear them breathing  while they are out walking. This is only a tempo- rary state and breathing  will reduce  as the levels of carbon dioxide increase.  Whatever  happens  it is important not  to revert to mouth breathing.

Reliever medication: Only take short-acting reliever medica- tion if it is really needed;  this is accepted medical practice. Never  take reliever medication  if it is not  needed  because it is easy to develop a subconscious  dependence on quick- acting  reliever medication.  Quite  often  an inhaler  is taken out of habit rather than need. At the same time, continue  to have the reliever close to hand just in case it is required mid- way through  training. It is proven that a tolerance to reliever medication  occurs over a period of time and this can result in more and more puffs being needed to reduce symptoms.

Asthma is a defence mechanism to prevent  the further loss of carbon  dioxide. When  the  airways constrict  this  is the body’s way of reducing hyperventilation.  If five puffs of reliever medication  are typically required  during  a football match, then the asthma  is totally out of control. It would be far safer to reduce  the intensity  and/or  duration  of exercise until such a large dose of medication  is no longer required.

Controlled breathing during sports: All this might  seem to indicate that people with asthma won’t be able to compete at the top level in their chosen sport but, in fact, nothing  could be further  from the truth. Everything that an individual can do with the aid of relievers can be done without the need for medication – as long as attention is paid to breathing.

It is relatively easy to combine controlled breathing  with sport,  with  the  exception  of  sports  that  require  intensive bursts such as sprinting. For example, playing football should not  present  a problem  if a gentle  and  gradual  warm-up  is performed  first.  Other  steps  to  aid  breathing  can  also be taken during the match. When the ball is elsewhere, breathe a little less than is required and when running  for the ball try to keep breathing  through  the  nose. If it gets to the  stage where the need  arises to breathe  through  the mouth,  calm the breathing and switch to nasal breathing  as soon as the ball has  been  passed.  If the  need  to  breathe through  the mouth   for  long  periods  occurs,  then it  is  better  to  stop playing football until such breathing  becomes easier and it is possible to play at the desired level. Continuing  to play while not breathing  properly will not help people with asthma. So while playing try to ensure  the  breathing  is not  too  deep and remember to observe the breathing  pattern  as much as possible.

Walking for half an hour every day is probably the best exercise for anyone who has not been taking regular exercise. Initially it may be best to walk alone rather  than  having to keep  pace  with  someone   else. Walking  alone  also  avoids talking which promotes mouth breathing and increases hyperventilation.    While   walking,   breathing    should    be reduced and again if at any time the need to deep breathe is experienced while walking or doing any exercise, then  slow down  and  relax. Resist  the  urge  to  breathe  through   the mouth  and, instead, stop and calm the breathing  and when ready start walking again.

Those people whose asthma is severe and who can only walk around twenty paces should start by just walking fifteen paces and  stopping.  Breathing  should  be reduced  and  it is important never to push the body beyond  the point  where breathing  cannot  be controlled;  to do so would be counter- productive  and  potentially  dangerous.   Don’t  be  too  con- cerned by needing to start at a very modest level; perseverance will  result  in  being  able  to  gradually  walk  further   and further.

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