From the Allergic Living magazine archives.
FORGET the stereotype of the wheezy, wimpy kid puffing on an inhaler. Young athletes prove that you can be a winner in sports – even with asthma.
Since being diagnosed with asthma when he was 4 years old, Brett Favaro has suffered pneumonia and bronchitis, asthma attacks, and been to numerous doctors. Now 22, he still has a nebulizer, a machine that delivers asthma medication in a fine mist through a facemask, in his bedroom.
But if you’re picturing a skinny kid, wheezing on the sidelines, you’ve got the wrong guy. Favaro was a competitive swimmer for 13 years, culminating with a stint as captain of the varsity swim team at Simon Fraser University in Vancouver. He’s also competed in cross-country running, taken tae kwon do lessons, and played basketball. Plus, he’s an avid weightlifter. Favaro says that with the support of his doctor, “I was able to do everything that everyone else did. I just had to be more mindful of my ability to breathe than other people.”
Growing up, Favaro achieved what experts say is possible for all asthmatic kids. “If they have good control, they can be competitive to any level,” says Dr. Brian Lyttle, a pediatric respirologist in London, Ontario. Good control usually means taking a corticosteroid (such as Flovent or Pulmicort) every day to reduce inflammation, minimizing exposure to triggers  such as cigarette smoke and allergens, and having a fast-acting reliever puffer on hand in case of an asthma attack.
While exercise is important for everyone, it plays a special role for people who have asthma. “The better shape you’re in, the better your lungs function,” says Dr. Michael Clarfield, a sports medicine specialist and former team physician for the Toronto Maple Leafs. “When you’re getting diminished function from your asthma, the more function you had to start with, the better off you will be.”
Dr. Alan Kaplan, a doctor in Richmond Hill, Ontario who chairs the Family Physician Airways Group of Canada, looks at it this way: “Exercising will teach your muscles to learn to work with what you’ve got. So even if you do have lung impairment, it’s still important to exercise and to teach your muscles to be able to exercise even at lower oxygen levels.”
It’s not that asthmatic kids should ignore their symptoms  and push themselves into respiratory distress; rather, with the right combination of medications, and in a supportive environment with minimal triggers, all kids with the disease should be able to reach their athletic goals.
Katherine Smith, 14, a Canadian whose family lives in Phoenix, has certainly not let asthma deter her athletic pursuits. A bout with pneumonia at age 1 left her with diminished lung function, and she also has bad seasonal allergies . When she was about 9 years old, her parents noticed she had difficulty breathing when she ran or played sports at school. “If she had to do anything that required any endurance, all of a sudden she was gasping for air,” says her dad, Doug Smith.
With the right medications and a good attitude, Katherine has thrived. She pitches for a competitive softball team that placed ninth out of 70 teams at last year’s U.S. national championships. “She treats the asthma meds as something ‘I’ve just got to do to prepare,’ ” says Smith, “like going to conditioning class, or to her trainer.”
But not every kid with asthma is a Brett or a Katherine. There is growing evidence that some young people with asthma shy away – not just from team sports – but from physical activity period. Researchers at John Hopkins Medicine conducted a telephone survey of 243 parents in 2004 and discovered that 20 per cent of asthmatic children were not getting enough exercise.
The lack of activity stemmed partly from misguided beliefs: 25 per cent of parents surveyed with an asthmatic child were afraid their child would get sick if he or she exercised. The kids’ attitudes toward exercising also played a role: 25 per cent of the parents responded that their child gets “upset with strenuous activity”.
A study published in the Journal of Asthma in March 2008 compared overweight status in adolescents with and without asthma; the study authors found that receiving an asthma diagnosis in early childhood may increase the likelihood of becoming overweight. Kaplan relates that he has been approached by parents asking him to write a note dismissing their child from gym class. “There are people who use asthma as an excuse not to exercise.”
For parents who don’t know a lot about the disease, hearing that their child has asthma can be alarming. There’s often a lack of understanding of both the disease and the level of control that should be attainable. When Jordan Stewart of Thornhill, Ontario, was diagnosed at age 3, his mother Tula Stewart was terrified. “My heart just dropped,” she says. “I was devastated. You hear stories of people dying from it; that was probably my biggest fear.”
The family doctor prescribed Jordan a puffer, but the asthma symptoms continued. At times of the year when Jordan had a cold, and during the spring and fall allergy seasons, he would cough and wheeze and become short of breath. At age 6, his parents enrolled him in soccer but that was short-lived.
As Stewart recalls, it just wasn’t worth the risk of having to rush him to the hospital. The Stewarts hadn’t yet learned enough about properly using medications to control Jordan’s asthma.
Next: Stereotypes about those with asthma
Kelly Saulnier’s daughter, Jenna, had been no stranger to the emergency room during asthma flare-ups that often turned into pneumonia. Because of the susceptibility to pneumonia, Jenna was on puffers from her first year of life.
But it wasn’t until she was 7 or 8 that she was officially diagnosed with exercise-induced asthma. (While her asthma is mostly set off by exercise, it can also be triggered by viral infections.) Upon hearing that diagnosis, Saulnier worried: would this leave her daughter on the sidelines of sports?
Parents’ fears are certainly not allayed by the stereotypes in popular culture. Asthmatics are just not portrayed as robust, healthy and as physically capable as others. For example, in the long-running sitcom “Malcolm in the Middle”, Malcolm’s friend from the gifted class, Stevie, is a wheelchair-bound asthmatic.
This kind of typecasting irritates Favaro: “Off the top of my head, I can think of Piggy [the smart, overweight asthmatic] from Lord of the Flies; I can think of the bad guy from the James Bond Casino Royale movie, and I can think of [Superman’s arch nemesis] Lex Luther from Smallville.” (The character had asthma as a child.)
“They’re never people that are high achievers, or the good guy. It’s the bad guy with his platinum inhaler; it’s always the fat kid; it’s always the kid who can’t do anything,” says Favaro, who’s completing an undergraduate degree in biology at Simon Fraser.
The depiction of the asthmatic as outcast is a genuine concern to young people. Ray Broadworth, an athletic 18-year-old from Woodstock, Ontario, plays lacrosse, hockey, football and badminton, and worked for years to bring his asthma under control. A year ago his doctor put him on Xolair, a medication given by injection for people with moderate to severe asthma triggered by allergens.
The drug has eliminated his need for his rescue inhaler, although he still carries it, just in case. Before he began the Xolair shots, he was on a daily corticosteroid, and often had to use his blue rescue puffer before and while playing lacrosse or hockey.
However, for fear of appearing less able to his coaches, he took a big risk: he resisted telling them he had asthma whenever possible. “If you’re an asthmatic, it’s a known that you can’t breathe as well – so I just kept it quiet,” he says. “Later in the year they saw me using my puffer, and they never thought much of it because I hadn’t shown weakness with it.”
The misconception that an asthmatic kid is ‘weak’ isn’t helped by the fact that, at times, young people are diagnosed with asthma when in reality they are simply out of shape. Kaplan says there is “some over-treatment of asthma” by family doctors, and notes a need for more lung function tests. “Sometimes young people who are short of breath are prescribed a puffer because it’s assumed that asthma is making them short of breath, when it could just be lack of fitness,” he says.
BUT for children who do have asthma, whether mild, moderate or severe, it’s helpful if they’re playing sports in an environment where coaches and organizers understand their condition and are supportive. Twelve-year old Connor Lee of Newmarket, Ontario, found out that he had exercise-induced asthma after a season of feeling breathless playing hockey.
“In hockey you’re pretty much told to go no matter what,” says his mother, Tracey Lee. “He couldn’t breathe, and they think he’s a wimp.” Connor switched to speed skating and started taking a short-acting bronchodilator 15 minutes before exercising, and every four hours during skate meets.
The medicine and the new sport have made a world of difference in this boy’s life. Even though Connor had to drop out of a meet right before the provincial finals because the cold air in an Ottawa arena had aggravated his asthma, organizers made an exception and he was allowed to skate at the provincials. He placed tenth. “He’s found something where people are really supportive,” says Lee.
Connor’s younger sister Tia has also taken up speed skating, and placed eighth at the provincials. She has multiple food allergies and asthma, and her mother says being involved in a sport has worked miracles for the girl’s self-esteem. “She would be very clingy before,” says Lee. “The child who started in September  to now – she’s a totally different child.”
A key to helping a young asthma sufferer feel comfortable exercising is for the child and his or her family to become educated about asthma and how it can be managed. As Kelly Saulnier and Jenna learned about the disease, her mother realized that “the more she did participate in activities, and push her limits a bit, the better it was for her and for her lungs.”
Jenna has attended Camp Treasure Chest, a week-long camp run by The Lung Association of Nova Scotia. The camp’s trained counselors and medical staff teach the kids how to manage their asthma. She also participated in the association’s Learn to Run program, and worked her way up to running 1.5 kilometres.
The course “really inspired her” says her mom, and she is now part of a running club at school, where she and her peers were training for a 4.5-km youth run in May that was part of the Blue Nose International Marathon in Halifax. “Education goes a long way,” notes Saulnier.
Jordan Stewart and his mom now also have a much better handle on his condition. About two years ago, he began seeing a respirologist who fine-tuned his medication to reduce the mucus build up in his airways. Now, Jordan excels at swimming and recently completed his bronze cross, which required being in the pool for 2 1⁄2 hours every Sunday.
He is eagerly awaiting his 16th birthday, so he can start his lifeguard certification. (“I can make money,” he notes.) In the meantime, he and his friends are often at the pool during public swim, and his mom is hoping he’ll join a competitive team.
It’s important to remember that there are some additional medical considerations for a child with asthma who’s involved in sports. “It’s not our belief that [kids with asthma] should be limited in any way,” says respirologist Lyttle. But this usually means they do need medication on a regular basis.
“It’s just finding the medication that works best for that child,” he says. Daily corticosteroids will reduce inflammation in the airways, making them less likely to react when the child is exposed to an asthma trigger, such as pollen, pollution, cold air, or even exercise itself. “If we aggressively manage the asthma, you should be able to manage a single exposure to pollen. It shouldn’t actually make you that sick,” explains Kaplan.
Asthmatics can further reduce the likelihood of having symptoms during physical activity by taking one of the approved medications for use before exercise, such as short-acting beta agonists, sodium cromoglycate or montelukast (Singulair).
“Get your asthma under control,” says Kaplan. “If you still need something for the exercise, then use a medication before the exercise that allows you to do it efficiently,” says Kaplan. A light warm up before exercising or going into a cold rink could also help.
If the asthma is triggered by pollen, avoiding exercise during peak pollen times further reduces the risk of an attack. For example, “in the spring and the early summer, you want to exercise in places which are not heavily forested, or the grass is not freshly cut,” says sports medicine expert Clarfield.
However, experts agree that asthmatics should take a break from rigorous outdoor sports during the poor air quality days of summer. “If the air quality is bad, I don’t know that anyone needs to run around out in that,” says Lyttle.
And while it may be hard for those who are real competitors, it’s important for asthmatics to remember that if they’re having asthma symptoms, they should use their rescue inhaler and slow down, says Kaplan. “If the symptoms abate, then carry on. If not, then a break is certainly in order, as well as a visit to your physician or asthma educator.”
There will be challenges when participating in sports with asthma. “The biggest problem for me,” recalls Favaro, “was my ability to be able to compete in different pools. The ventilation was often not the greatest, and the condition of the air was often a big determinant of how I would do at the practice or at the swim meet.”
Still, he says he never wanted to let his asthma keep him from achieving his goals. “If asthma was the reason that I had to sit out for half a practice, I would just say, ‘OK, that’s my physical limitation at the moment. But I’m not going to let that hold me back from trying again.’ Lots of things can hold you back. You can injure yourself or you can be unable to complete a set. But I never wanted to say, ‘my asthma is not letting me do this’. If for some reason I can’t complete what I’m trying to do, I try and do it again next time.”
As proof that asthma is not a deterrent to athletic success, there is a long list of Olympians with asthma. Although it may take some work to understand a child’s asthma triggers and to fine-tune medications, whether the child aims to become an Olympian or simply wants to do something as fundamental to being human as exercise, asthma is not an excuse.
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