Scenario 3 A Run In The Park - Practice Exercises: Asthma

Content provided by the Faculty of the Harvard Medical School

Scenario 3: A run in the park

Just yesterday you had commented to a friend how well your asthma seemed to be doing lately. You were taking your controller medication in the form of a tablet every day and rarely needed to use your quick-relief bronchodilator. People at work no longer recognized you by your ever-present cough. Even your sleeping had become more restful, no longer interrupted by coughing and a sense of chest tightness.

Today, at the insistence of family and friends, you agree to participate in a local Fourth of July walk/run family race. It is a hot and muggy summer day, and your breathing does not feel its best even when you are sitting quietly. When your turn comes, you go at it hard for 15 minutes, until your legs feel like rubber. Your breathing becomes labored and you start to cough repetitively. You find the nearest bench and plop onto it, feeling like a wet dishrag.

You search deep in all your pockets for your quick-relief bronchodilator. When your asthma was under poor control, you could not have imagined going anywhere without it. You always carried one with you and kept one in your car, one at your office, and one by the bedside table at night. Now, to your dismay, you find that you have forgotten to bring it with you. Fortunately, you feel your strength coming back to your arms and legs and your breathing has begun to slow. What do you do next?

Management options

Exercise has the potential to trigger symptoms in virtually everyone with asthma. Physical activity causes you to breathe heavily, which means that you bring extra amounts of air down into your lungs and into your bronchial tubes. If the air inhaled during exercise is cold and dry, or filled with air pollutants, fumes, or other irritating substances, the muscles surrounding the bronchial tubes may contract and the airways narrow.

The good news, however, is that an attack of asthma brought on by exercise is generally short-lived. The bronchial muscles usually begin to relax over a period of minutes and your breathing tends to return to normal in about 30 to 60 minutes. Exercise also causes much less inflammation and swelling of the bronchial tubes than allergic triggers, such as cat dander or dust mites. Unless you are allergic to pollen and ran your race on a day with a high pollen count, there is a good chance that your breathing will continue to improve as you sit quietly and relax.

Staying calm is a good strategy for any asthma attack. Breathe slowly and deeply, and with each breath give adequate time for breathing out. Try counting three beats out for every one beat spent breathing in.

If your breathing remains difficult despite resting, another option is to borrow a quick-relief bronchodilator inhaler from a friend or family member. Asthma is common and there is a good chance that you will find someone nearby willing to help. At the same time, it is a good rule never to use an unfamiliar medication. If you have any doubt that the offered medication is appropriate and safe for you, it is best to decline its use. If you find yourself gradually getting better, you would do best to wait until you return home and retrieve your own medicine.

In the future, try to remember to bring your medication and don't participate in a race on a day when your breathing doesn't feel fully comfortable. Another option is to make time for a brief warm-up period before exercising and a brief cool-down period afterwards.

If you exercise during the winter, it is helpful to avoid breathing cold air while you exercise. You may decide to exercise indoors, or you can try wearing a thick scarf over your nose and mouth. With the scarf, you can trap some of the warm, moist air that you exhale and lessen your intake of cold, dry air. A cold-weather face mask is sold for the same purpose.

Last updated:	September 27, 2007