AsthmaKATLIN TUCKET T

PEP 4370

SPRING 2015

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 don’t 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 & EvaluationAssessment 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 TreatmentThese medicines are used during asthma attacks to provide quick relief. They include:

Short- Acting β2 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.

ᵦ2 Agonists

Long- Term Medical TreatmentThese medicines are used only when needed to control asthma and prevent attacks. They include:

Long- acting β2 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 doesn’t take place then medication will be needed.

Some develop a second reaction which happens 3-4hrs after exercise has stopped.

Effects of Medication on ExerciseΒ2 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 TestingTesting 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. Take pre-exercise lung function measurements via spirometer of FEV1 and FVC. Repeat same measurements every 5 min for 40 min after exercise.

5. 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 Intensity, Frequency, & Duration Time to goal

Increase VO2 max Increase lactate & ventilatory

threshold Become less sensitive to

dyspnea Develop more efficient

breathing patterns Improvement in ADLs

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

2-3 months

Exercise Prescription- Strength Training (Free weights & isokinetic/isotonic machines)

Goals Frequency, Intensity, & Duration Time to goal

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

Low resistance, high reps 2-3 days/week

2-3 months

Exercise Prescription- Flexibility Goals Frequency, Intensity, & Duration Time to goal

Increase ROM 3 sessions/week 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.

Question’s??

ReferencesAmerican College of Sports Medicine. (2014). ACSM’s guidelines for exercise testing and prescription, 9th ed. Baltimore: Lippincott

Williams & Wilkens, 331-334.

American College of Sports Medicine. (2009). Asthma ACSM’s 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. ACSM’s 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.