Asthma and Exercise – Anyone for Golf ?

Exercise Is Important For Health Maintenance

Asthma is a common disease with a prevalence of up to 10% of some populations. Exercise limitation may be documented with symptomatic disease but at the same time, exercise is important for health maintenance. A study in Chest 2003 showed that about 30% of participants with current asthma, 24% with former asthma patients and 27% who never had asthma were considered to be inactive. Participants with asthma were less likely to engage in running, basketball, golf and weightlifting, but were more likely to use an exercise bicycle than were participants without asthma. The authors concluded that like most US adults, the majority of those with asthma were not meeting the current recommendations for physical activity.

Inflammatory Disease & Symptoms

The National Institutes of Health (NIH) Asthma guidelines 1997 expert panel report define asthma as a ‘chronic inflammatory disease of the airways in which many cells play a role, in particular mast cells, eosinophils and T-lymphocytes. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night and/or in the early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partially reversible either spontaneously or with treatment. This inflammation also causes an associated increase in airways hyper responsiveness to a variety of stimuli.’

Airway Allergy Symptoms

The treatment of asthma is dictated by disease severity and numerous guidelines exist with recommendations on stepwise treatment; stepping up or higher-level treatment for more severe disease with increased associated exercise limitation. The more recent GINA 2006 Asthma Guidelines (December 2008 update) classify asthma severity by level of control.

Controlled & Exacerbation

Controlled is achieving freedom from exacerbations and night awakenings and having minimal daytime symptoms and requiring minimal need for reliever each week. One exacerbation in a year means patients are at best partly controlled but patients can have minor symptoms and use rescue on up to 100 days per year and can still be considered as controlled. Thus exacerbations are seen as being of greater importance. This explains a bolder line separating symptoms and exacerbations in the above table.

GINA Identifies Four Components of Asthma Care

1. Develop patient doctor partnership.
2. Identify and reduce exposure to risk factor.
3. Assess, treat and monitor asthma.
4. Manage exacerbations.

Exercise-Induced Asthma

A variety of asthma syndromes are recognised and include exercise-induced asthma, nocturnal asthma, aspirin-induced asthma, occupational, cough variant and fatal / near fatal asthma. In exercise-induced asthma, patients are frequently inhibited from participating in physical activities because of the degree of pulmonary limitation on exertion during exercise.

Golf Courses, Thunderstorms and Asthma

The golf course can be a relatively exposed environment prone to the elements and weather conditions including thunderstorms. A link between asthma and thunderstorms has been reported in England and Australia. Thunderstorm asthma also happens in Canada, according to a study in Chest (2003; 123: 745-50). The number of patients with asthma visiting one emergency department in Ontario went up (in line with atmospheric concentrations of fungal spores) by 15% during the 151 thunderstorms between 1993 and 1997.

Other Triggers To Allergic Asthma

Other triggers for an asthma attack may also be found on the golf course environment. Tree, grass and weed pollens and certain environmental moulds may trigger allergic reactions in susceptible individuals. Atopic asthma is akin to allergic asthma and has much in common with allergic rhinitis which manifests as hay fever on the golf course. During the spring, tree pollens such as birch are common triggers, others may be sensitive to grasses and weeds, pollen counts of which are highest during late summer in the evenings. In desert environments, Alternaria is a mould to which sensitised individuals may react.

Articles written by Dr. Edwin Poon

Image credit: www.schladming-dachstein.at/.../golf/