Exercise: both trigger and treatment for asthma

Dirk Bovell (center standing) heads Boston Children’s Hospital Boston Asthma Swim Program at DotHouse Health.

You might think that people with asthma have a legitimate exemption from exercise. No gym class, no fitness center, no barbells to hoist. After all, as many as 90 percent of all people who have asthma will experience symptoms during exercise, according to the Asthma and Allergy Foundation of America. For some, exercise may even be the most common cause of asthma symptoms.

Yet, asthma has not sidelined several well-known athletes. Jackie Joyner-Kersee won six Olympic medals for track. Former Pittsburgh Steeler and Super Bowl champion, Jerome Bettis, was diagnosed with asthma at the age of 15. Greg Louganis, regarded as one of the best male divers in history, won five Olympic medals.

During exercise the body demands more oxygen. In response you breathe more deeply and faster — and usually through the mouth. That’s what causes the problem. Normal breathing is through the nose, which moisturizes, cleans and warms the air before it reaches the throat and lungs. Mouth breathing on the other hand increases the intake of dry, cooler air, which triggers the airways to narrow, thus obstructing air flow.

This condition is often called exercise-induced asthma, but is more accurately termed exercise-induced bronchoconstriction, according to the Mayo Clinic. Exercise induces the narrowing of airways, but is not a root cause of asthma. Symptoms of coughing, wheezing, shortness of breath and tightness in the chest may begin several minutes into exercise and can continue another 30 minutes or more after stopping exercise.

In spite of these potential problems, exercise does not get a stay. Health professionals recommend it for overall good health and to improve the function of the heart and lungs. Studies have shown that exacerbations or flare-ups are less in people with asthma who are more active. A recent study published in BMJ Open Respiratory Research found that adult study participants who engaged in the most amount of exercise — roughly 30 minutes most days of the week — were almost 2.5 times more likely to have their asthma under control compared to those who did not exercise at all.

Certain physical activities are more likely to trigger symptoms. Cold-weather sports like ice hockey and skiing are examples. In addition, sports that require constant activity, such as soccer and long-distance running, are more prone to trigger an attack.

On the other hand, activities, such as baseball and gymnastics, which are demanding only in spurts, tend to cause fewer problems. Walking, hiking and biking are good sports activities for those with asthma, according to the American Academy of Allergy Asthma & Immunology.

Regardless of the activity chosen, there are measures one can take to prevent a flare-up. Stay hydrated; warm up before exercising and cool down afterwards; wear a face mask or scarf when exercising in cool, dry weather; breathe through the noise instead of the mouth. Most important is to take medications before exercise if recommended by your doctor.

Swimming

Swimming is actually one of the best exercises recommended for those with asthma. The wetness and warmth of the water can prevent the cascade of events leading to an attack.

You don’t have to explain that to Dirk Bovell. He has asthma and learned to swim in elementary school. Although he admits that football was his first love, the weather was too cold for him, and caused him to resort to his asthma pump. Swimming, however, increased his lung capacity, he explained.

As a youth he said he was discouraged from sports because of his asthma. It’s a good thing he didn’t listen. The water is Bovell’s domain. He is a certified lifeguard, a lifeguard instructor and an American Red Cross instructor. He is the aquatic coordinator and head swim coach at DotHouse Health in Dorchester. But on Saturdays, his second calling comes into play.

Bovell is the program manager of the Boston Asthma Swim Program for Boston Children’s Hospital. Each session lasts for 10 weeks and can accommodate 15 kids between the ages of 8 and 12. The program has two parts. First is the classroom. Bovell teaches the students and their parents about asthma, its medications and triggers — all to help them understand the disease better.

Then comes the fun part — finally getting into the pool. For some, however, initially it’s not that much fun. “They might have had a bad experience,” he explained, and are fearful of the water. “Emotion is a trigger. The brain can take you to the yellow zone,” he said, referring to a period of increased symptoms. The yellow zone is a warning that, without a remedy, the situation can become an emergency.

Several of the participants use rescue inhalers before the class to prevent an attack. If they need help with their inhaler, Bovell can assist. He has had personal experience.

The program has many successes. The kids learn to control their asthma; they overcome their fear and learn to swim. No one has ever suffered an attack while in the water. Some of the students excel in swimming to the point that they join the DotHouse Health Stingrays, a USA registered swim team in the New England Swimming LSC. Each Local Swimming Committee is a member of USA Swimming, which is charged with selecting the United States Olympic Swim team. Who knows? There might be another Greg Louganis in the making.

The program’s success has one downside, though. “Now the problem is getting the kids out of the water,” Bovell said.