For more information about the diagnostic and treatment options for allergies, asthma, and sinus conditions, contact:
ALLERGY, ASTHMA & SINUS CENTER, PA
Gurdev (Dave) Judge, MD
Board-certified in Allergy, Asthma, & Immunology - Adults and Pediatrics
401 Keisler Drive, Suite 201
Cary, NC 27518
Telephone: (919) 859-5966
NORTH RALEIGH OFFICE
10931 Raven Ridge Rd, #111
Raleigh, NC 27614
Telephone: (919) 870-6440
WAKE FOREST OFFICE
1906 S. Main Street
Wake Forest, NC 27587
Telephone: (919) 562-7195
Movement and Asthma:
Living an Active, Normal Life
“Children of course have very small airways, so that makes treating the child with exercise-induced asthma or bronchospasm especially challenging and rewarding at the same time,” says Dr. Gurdev (Dave) Judge of the Allergy, Asthma & Sinus Center in Cary, with offices in North Raleigh and Wake Forest. He is a board-certified pediatrician as well as an allergist-immunologist.
|Dr. Judge and this active young patient discuss appropriate forms of exercise.|
“The pure definition of EIB—exercise-induced bronchospasm—is that the patient has normal results on a lung function test when at rest, but functional ability decreases markedly with exercise—usually within the first few minutes of exer-cise. Perhaps 80 percent of patients who have asthma are also susceptible to EIB, but the diagnosis is more challenging for those youngsters who test normally when at rest.”
Dr. Judge notes that EIB is often difficult to diagnose, for example, in small children. “How can you tell the condition of a two-year-old who is running through the house, crying or laughing, and suddenly starts coughing? They can have EIB even when they’re not sick—but it’s difficult to diagnose.
“And in older children, from six to eight, we sometimes find they have lung function loss without a cough at all. But they feel a heaviness and tightness in their chest. They may run well for the first five minutes of a soccer game, and then they slow down. There is no coughing, no wheezing—but in fact they are experiencing a reduction in lung function.”
Health&Healing: Do certain sports work better for children with asthma?
Dr. Judge: We encourage children as well as adults with asthma to exercise, and we especially recommend swimming because it tends to maintain body temperature while you’re in the water. Exercising in hot, humid weather and in cold, dry air can be triggers for EIB for some people. Our goal for each of our asthma patients is to help them live an active, normal life. Exercise is good for all of us, which is certainly true for those with asthma, as well.
We never suggest that someone ease off from exercising because they have asthma. Just the opposite. Our goal is to control the condition, rather than allowing the condition to control the patient. Perhaps the patient needs to take medication before exercising. Working together, we can find the very best ways to manage this disease to greatly lessen its impact on health and lifestyle.
One of the men I see loves to run. He travels all over the country to participate in 10k and 20k events. He first came here after a morning 5k run when he experienced a relatively mild problem breathing. We did a lung function test, and his numbers were very poor—at 60 percent of normal lung function for a person of his age and gender. Still he was doing a 5k run with little problem, because he was in such excellent condition. We gave him medication, and his lung function number improved significantly. Now he finds that, with a little help from medication, he can fly through his 5k and 10k runs.
Not all of us are great athletes, in this kind of condition. But all of us have the capacity to get into good physical shape, including those of us who have asthma.
The point is, for children who have asthma, we urge parents to keep the lung function of these children as normal as possible, so that they can and will engage in good exercise programs. We are here to help them do that, with medication and support as needed.
H&H: In North Carolina, with its air pollution problems, and elsewhere in the country, the incidence of asthma seems to be rising rapidly.
Dr. Judge: Yes. Estimates are there are more than five million people walking around, feeling pretty uncomfortable at times, who have undiagnosed asthma. We need to keep reminding them that this is a condition that responds well and fairly easily to treatment. It’s not curable, but certainly it can be managed to permit people with asthma to lead a perfectly normal life.
Our simple lung function test reveals a great deal about the effectiveness of the respiratory system. A patient said to me recently, “I went to my primary care doctor and he could not hear any wheezing. She said my chest is perfectly clear.” But in fact, the stethoscope comes into the picture much later. Wheezing indicates an advanced problem. You may have a tight chest that indicates nothing at all by stethoscope, but a lung function test may reveal your function is at the 70 percent level. That level of function benefits greatly from treatment.
H&H: What is the connection between some foods and exercise-induced bronchospasm?
Dr. Judge: Exercise-induced anaphylaxis is an uncommon but frightening and potentially fatal allergic reaction that sometimes occurs with food ingestion before vigorous activity. I sometimes have patients who understand that they cannot exercise right after a meal. They have to wait as long as three hours to exercise safely, so that their food is out of their stomach. Exercising sooner induces an anaphylactic reaction—it’s the combination of food plus exercise that they cannot tolerate. So generally they exercise first thing in the morning.
I had another patient with this problem who was very careful about his food intake and exercise program. One day he went to Atlanta, and he had to catch a train. From where he had parked his car, he knew he had to walk briskly to make his connection. This was right after lunch time. He did not consider that he was exercising. He was just walking at a quick pace. And he quickly convulsed into an anaphylaxis asthma attack. Anaphylaxis is the word we use for serious and rapid allergic reactions usually involving more than one part of the body which, if severe enough, can kill. So this patient is now even more sensitive about his own personal relationship to the combination of food and even mildly vigorous physical activity.