Expert: Marc Rubin, RPh Asthma Educator - 7/29/2008

Question
my nine year old son has always had terrible allergy issues. Recently(in the last year) he has started to have difficulty breathing when exercising,he is very physically fit he plays soccer,basketball and indoor soccer.I took him to the doctor she believes that it is asthma brought on by physical activity. She prescribed ProAir HFA. He is suppose to take two puffs fifteen minutes before activity. He started soccer practice yesterday and used the medicine as prescribed he helped for the first hour but he had difficulty breathing after that. I am wondering at that point is it ok for him to use the inhaler again? I have called his doctor but it is taking forever for her to get back with me,she is probably very busy. I am just wondering how often it is ok to use the inhaler,I am also wondering if maybe he just needs a different medication. Any thoughts you might have would be helpful. Thanks

Answer
Hi Leah,

Of those individuals which have EIB (Exercise Induced Brochospasm), 90% are undiagnosed asthmatics.

With your sons history of terrible allergies, I would definitely make an appointment with an allergist. To find a board certified specialist, go to http://www.AAAAI.org   I'll assume that you have insurance coverage, so check with the physicians office to make sure that they take your card.

Back to therapy...

Yes, ProAir would be appropriate as a pre-treatment to take ~ 15 minutes prior to exercise, and may be repeated if an attack occurs. BUT..you need to be sure it is bronchospasm, and not just being winded. Visually, if you observe the shoulders rising and falling with each breath, it is bronchospasm. The BEST way to check is using a peak flow meter, a device that reflects airway resistance, and presents the information like a stoplight (Green: 80-100% function>OK to play, Yellow: 50-79% function> use rescue and rest until back to green zone, RED: 49% of less fucntion: get immediate assistance!) Once his personal best is determined, he should hold off participating when not in the GREEN zone.

Once you've been to an allergist for a proper evaluation, the specialist will determine whether there is a need for daily controller therapy. I'd expect this will be the case for your son. By getting his condition under control, not only will he feel better all the time, but his performance will increase too!

Finally, proper preparation is required. He should begin fluid loading ~ 1 hour prior to activity, and continue fluid intake throughout the activity. Also, he needs to start warming up 10-15 minutes before working out, and cooling down after the workout.

You're lucky right now, AAAAI (American Academy of Allergy, Asthma and Immunology) has a program on EIB. Follow this link to the site:

http://www.aaaai.org/patients.stm

Good luck, and please get back to me after a visit with the specialist. Let their office know that he has been having significant problems lately, and hopefully they'll get him in from a cancellation.

Sincerely,

Marc