Certain sports and some forms of exercise are more likely than others to cause problems for people with asthma
'THE ONLY way that I can describe it is that it's like having a weightlifter's belt tightened around your chest. You are constantly gasping for air but the tank is always half full."
This vivid description of the impact of asthma comes from 39-year-old Gareth Dixon who has had the condition since he was a child.
Dixon played soccer with Home Farm when he was a teenager and recalls incidences where he would be standing on the sidelines literally struggling to breathe. "Back then asthma wasn't really treated with the respect it deserved - it was a case of grabbing the inhaler and puffing away whenever you felt symptoms coming on. It has become a lot more manageable over the years since."
Just how manageable the condition has become is evidenced by the fact that the Dubliner last year completed the world's oldest marathon event, the Boston Marathon, in a very respectable time of 4:23:25.
"The asthma wasn't a concern in the lead-up to the marathon. What concerned me were the usual things any runner is thinking about before a long-distance run - whether the legs, knees and hips will stand up to it. The asthma wasn't a factor."
A combination of consistent preventative treatment ("two puffs of the inhaler morning and evening", he says) and a high level of fitness were the key to this successful sporting endeavour.
"We trained five days a week for five months and I found that the fitter I became the better my symptoms got. The asthma became less of a hindrance to me. So I think that sport and fitness definitely help in managing the condition."
Because exercise is often one of the triggers for an asthma attack, many asthmatics are understandably wary of partaking in sport for fear of exacerbating their condition.
Last year the Asthma Society of Ireland ran a campaign called "Reach Your Peak with Asthma" which highlighted that not only should people with asthma not feel excluded from exercise, but that being fit helps alleviate the condition.
"Asthmatics shouldn't be afraid of partaking in sports," says Dr Philip Carolan, chairman of the Gaelic Games Doctors Association and Dean of the Faculty of Sport at the Royal College of Surgeons. "Because of the body's reaction to airway restriction, they may fatigue quicker than the normal population, but with proper management there is no reason why asthmatics shouldn't be able to compete at the highest level."
More than 470,000 people in the Republic suffer from asthma which puts us at number four in the world asthma league. While often considered a childhood illness, asthma can affect older people, according to Frances Guiney, a respiratory nursing specialist with the Asthma Society of Ireland.
"I am surprised at the number of middle-aged men we have calling us to say they have symptoms for the first time.
"It could be due to a new course of medication that they are taking or due to their work environment. It could even be triggered by a viral infection. We also get a lot of calls from people who had it in childhood and then went in to remission only for it to return in their 30s."
Asthma is a chronic condition that affects the airways which carry air in and out of the lungs. In an asthmatic, the airways are narrowed by inflammation of the bronchial tubes and tightening of the muscles which surround them. Asthmatics also typically suffer from an over-production of mucus, which also blocks the airways.
The net result is that the airflow to the lungs is restricted which leads to the classic asthma symptoms of wheezing, breathlessness, chest tightness and coughing.
Because the bronchial airways of asthmatics are also extremely sensitive, they are quick to respond if anything irritates them. In extreme cases, the tubes can suddenly squeeze tight, making it difficult for air to pass through - this is an asthma attack. Although triggers vary from person to person, they can include cold air, dust, cigarette smoke and exercise.
Exercise-induced asthma (EIA) is a form of asthma where airway narrowing is brought on by vigorous exercise. The symptoms of EIA - wheeze, breathlessness, cough or chest tightness - may start during exercise but usually worsen in the five to 10 minutes after the exercise ceases.
It is generally believed that with EIA the airways are sensitive to sudden changes in temperature and humidity, particularly cold, dry air. The problem is compounded by the fact that during exercise we tend to breathe through the mouth which means that cold, dry air is delivered directly to the lower airways without passing through the nose where it would be warmed and moistened first.
Certain sports and forms of exercise are more likely than others to cause problems for asthmatics. Vigorous sports such as rugby, football, hurling, long-distance running and competitive cycling, particularly when performed in cold air, top the list of "high-risk" activities.
More gentle forms of exercise such as yoga and golf are lower risk as are "stop-and-go" sports such as martial arts and volleyball. It is important to emphasise, however, that by following their medication plan and avoiding triggers, many asthmatics can fully participate (and indeed excel) in so-called high-risk sports.
"I think it very much depends on the individual," says Guiney. "A lot of people say that swimming is a good one for asthmatics because it is a warm and moist environment but we get quite a number of calls from asthmatics complaining about swimming and we believe it might be because of the chlorine content in the water. Dry, cold air is problematic for asthma so sports such as skiing or ice-skating could cause problems."
The Asthma Society of Ireland advises asthmatics to take sensible precautions when taking part in sports. "First and foremost, compliance with your therapy regime is the most important precaution that you can take," says Guiney.
"It is also important to do a proper warm-up before you start exercising and a warm-down when you finish. We would also advise people to drink lots of water which can help to keep the airways moist.
"If you are allergic to pollen and you are aware that the pollen count is high, it's important to choose the right time of the day to do your exercise. And obviously if you are under the weather or have a cold or chest infection, you should wait until you are better."
Even though asthma treatment is now predominantly focused on prevention, asthmatics should still bring their reliever inhaler with them when partaking in sport, according to Carolan.
"We would always advise that they have the inhaler in the kit-bag, regardless of how well controlled their condition is. It is no harm to take two puffs prior to a game and if they feel symptoms coming on, then they should re-use the inhaler to settle the symptoms."
Perhaps not surprisingly given the recent controversy surrounding Kerry footballer Aidan O'Mahony's positive drug test, Carolan also advises GAA players to ensure that their condition is documented with their GP.
As we know, men are notoriously reluctant to own up to a perceived "weakness" of any kind - do men with asthma feel stigmatised in the macho world of sport? "I think that the reactions are different," says Guiney. "I think some asthmatics just put up with the condition and are grateful that they can participate in sport at all.
"Others go into denial and that's where you see problems. They can be very down about the impact of asthma on their sporting ability and they don't know where to turn for help or advice," he says.
Carolan believes that asthmatics do face a stigma. "I think there is a stigma there, probably for younger kids rather than adults. Young kids do not want to be seen by their friends to be taking an inhaler. That's why it's so important that we have seen campaigns over the last few years where professional and amateur athletes have come out and said they have the condition."
Fit to breathe
• Be in control - take your asthma medications, especially preventer medications correctly and regularly.
• Have regular reviews with your doctor/nurse and have a personal written Asthma Action Plan.
• Make sure your coach/instructor/teacher knows that you have asthma.
• Always have your reliever (blue) inhaler easily accessible with you when exercising.
• If exercise triggers your asthma, take your reliever inhaler immediately before you warm up.
• Always warm up (15-20 mins) before exercise and warm down after exercise.
• Identify your asthma "triggers" and try to avoid them.
• Increase your fitness levels gradually.
• If you have asthma symptoms during exercise, stop, take your reliever inhaler and wait five minutes until breathing easily and symptom free before starting again.
• Carry your reliever inhaler and an Asthma Attack Card with you AT ALL TIMES.
Source - Asthma Society of Ireland
• For more information on asthma see www.asthmasociety.ie or call the Helpline on 1850 44 54 64 (Tue-Thu 10am to 1pm)