In this issue, we were fortunate to have interviewed Dr. Michael Bowman, a tireless advocate for respiratory health and mentor for other caregivers, for over 20 years, to provide insights on some of the challenges surrounding children and asthma.
Routine use of albuterol before exercise is often used for adult exercise-induced bronchospasm. However, it may not be the best approach for a child with asthma as there may often be additional subtle signs of poor asthma control.
Children with asthma have a variety of symptoms. Wheezing is often associated with the condition. But when the child suffers a coughing fit, chest tightness or is observed having problems playing during recess, there can be greater uncertainty for the care provider and the family. It may be called “bronchitis” or something else. Clearly, there are many reasons―including asthma―why a child may have exercise intolerance. The challenge for everyone, the child, the parent, the provider, the school nurse and Physical Education (PE) teacher, is to figure out why a child is not able to exercise and then what to do about it. It has been said that the very best way to find a child not yet recognized as having asthma is to ask a PE teacher who he or she perceives as being “lazy.”
Activity can frequently trigger symptoms of asthma in children. If that is a cough or wheeze, adults can hear it. However, if it is merely chest tightness or dyspnea, it is likely to go unrecognized. The child may not recognize the uncomfortable sensation as being abnormal, and may not mention it to their parents or teachers. When asking the parent of a newly-diagnosed child with asthma how they do with exercise, the answer is often “fine”. However, if asked what the child does for activity, the parent may say “she likes to play with dolls” or “he spends a lot of time playing video games”. The problem can be magnified in children who are overweight, where vigorous activity is often the best solution. Care providers should not accept a stance from a parent that their child “has asthma and, therefore, needs an excuse from recess or physical education class.”