The Australasian Society of Clinical Immunology and Allergy

Many patients with asthma run into trouble when they play sport. They may also be concerned about the use of asthma medications when pregnant or travelling.

Content Last updated 4 January 2001

Exercise asthma can be controlled

Many people with asthma will have symptoms provoked by vigorous exercise. The mechanisms appear to be reflex airway narrowing caused by drying of the airways. When thinking about exercise-induced symptoms, however, it is also important to consider whether asthma is well-controlled at other times. For example, a person needing their "reliever" medication more than twice per week or with peak flow readings less than expected may benefit from regular "preventer" medication. This helps spontaneous as well as exercise-induced asthma.

Plan ahead to reduce exercise-induced asthma

The following approaches often help to reduce symptoms that occur despite good asthma control the rest of the time:

1. Choose your exercise. For example, swimming is less likely to provoke attacks, because warm moist air is being inhaled. Cycling and running are more likely to provoke symptoms.
2. Doing warm-up exercises for at least 15-20 minutes before vigorous exercise.
3. Wearing a mask or balaclava to reduce heat and moisture loss, particularly in winter.
4. Using prescribed medicines, including:
   • Short acting "relievers" (e.g. salbutamol) and "preventer medications" (e.g. cromoglycate / Intal or nedocromil / Tilade) protect for 2 to 3 hours if taken just before exercise. You may need to take 2 to 4 puffs.
   • Longer-acting "symptom controllers" (e.g. salmeterol / Serevent, eformoterol/ Oxis/ Foradile) are active for up to 12 hours.
   • Leukotriene antagonists (Accolate, Singulair) are also effective if taken regularly.

Elite athletes can also suffer from asthma

Even elite athletes can suffer from asthma, but they control it by warm-up exercises or careful use of medication. Some asthma medications are approved for use in athletes participating in competitive sport, although many sporting bodies require a doctor's letter confirming that the athlete has asthma.

Some medicines must be declared

Other medications (such as inhaled steroid puffers and leukotriene antagonists) are also approved as long as their use is declared. Oral steroids must be declared and are not allowed within 6 weeks of competition. Eformoterol (Oxis, Foradile) is currently a banned substance.

Athletes competing at state or higher levels of competition should contact their national sporting organization to obtain additional information. The Australian Sports Drug Agency operates a toll free hotline to provide current information, Tel 1800 020 256.

Asthma must be controlled during pregnancy

Some increased shortness of breath during pregnancy is normal as the baby takes up space in the abdomen ("tummy"). Fortunately, asthma does not normally worsen during pregnancy. If it does, it is still important to treat the asthma. Uncontrolled asthma is a much greater risk to the baby than any theoretical risk of medication.

Asthma medicines are safe in pregnancy

There is little evidence that the medications used to treat asthma harm the developing baby in any way.

Flying with asthma

Pressurised aircraft have an oxygen pressure around 80 % of normal. This poses no problem to those with controlled asthma. As a rule of thumb, people able to walk 100 metres or climb one flight of stairs without getting puffed should experience no problems. Those experiencing shortness of breath at rest, however, should take medical advice beforehand.

Be prepared for the worst when travelling

There is no reason that people with asthma cannot travel. On the other hand, travellers are often exposed to new infections or high levels of allergen while away from home. This may worsen their asthma and increase the need for medication. It is therefore important to:

1. take sufficient medications, not only for your expected needs, but extra just in case you need to increase the dose if you get worse (including emergency medication such as prednisolone);
2. carry your medicines in your hand luggage in case your main bags are lost in transit;
3. check that your travel insurance will cover you for "pre-existent ailments".

To contact your local Asthma Foundation, telephone 1800 645 130.

Be positive about your asthma!

Control your asthma. Don't let it control you! With a bit of planning, people with asthma lead full and active lives.

It is important to note that information contained in this bulletin is not intended to replace professional medical advice. Any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

References

1. McDonald CF; Burdon JG. Asthma in pregnancy and lactation. A position paper for the Thoracic Society of Australia and New Zealand. Med J Aust 1996 Nov 4; 165(9): 485-8
2. Schatz M (ed). The pharmacotherapy of asthma during pregnancy: current recommendations and future research. J Allergy Clin Immunol 1999; 103: S329-376.
3. Anderson S, Holzer K. Exercise-induced asthma: Is it the right diagnosis in elite athletes? J Allergy Clin Immunol 2000; 106: 419-28.
4. Helenius I, Haahtela T. Allergy and asthma in elite summer sport athletes. J Allergy Clin Immunol 2000; 106: 444-52.
5. Zwar N. Health advice for travellers with chronic illness. Aust Prescriber 2000; 23: 107-9.