Expert: Kevin Smith - 2/18/2010

Question
My son was taken to the Emergency Department last evening where he was diagnosed with "Inflammation of the Lungs".  No medical terminology was given me by his father, who took him, so I know nothing more than that.  It began with tightness in his chest, pain in his chest which became increasingly more uncomfortable as the minutes ticked on, shortness of breath & pain in his left arm.  All of this is to preface this; his PE Coach at school - he is 18, in the 12th grade - said that she would like for him to be tested for Sports Related Asthma.  Could this "Sports Related Asthma" be what caused the lung inflammation in the first place, or am I probably looking at something more along the lines of Pleurisy, which seems to be the more common diagnosis?  An addendum to all of this is that, as a small boy (ages 18 months to 5 years old) he was repeatedly misdiagnosed with Bronchiolitis by his Physician & it was not until we relocated to Alabama - Decatur - that he was diagnosed as having seasonal allergies.  Once diagnosed such, he was given medications that worked proficiently & immediately on his symptoms, where the medications for the previous diagnosis had not.  Now, knowing all of this; that he has seasonal allergies, that his coach wants him to be tested for Sports Related Asthma - this is because of a semi-collapse, during PE one day, which resulted in him coughing up blood from the sheer force of the cough - AND the fact that he's now been diagnosed by an ER Attending with Inflammation of the Lungs, can it be presumed that the lung inflammation is probably caused by the sports related asthma, or is this totally unrelated?  The main point of the question is can Sports Related Asthma CAUSE Lung Inflammation, slowly, over a period of time if left unchecked & undiagnosed & the lungs are continually stressed in the ways, that say, something like Track Practice would stress them?

Thank you for your time.  I look forward to your response.

Regards,

Mrs. Melba Turner-Jones

Answer
Hello Melba,

To get straight to your primary question, yes, SRA ( Sports Related Asthma ) can and will be associated with inflammation of the lungs. I say that is can be related because the actual cause can be debatable, but the two are usually related to each other if both present in a person. As to what is causing what, it can be very difficult to 'nail-down' which is the symptom and which is the cause.

'Inflammation of the lungs' is a bit of a catch-all phrase in my opinion Essentially, it simply means that the interior of the lungs, the tubes that carry the gases back and forth, are inflamed to the point where air passage is being restricted. Think of it as one of those long, skinny balloons that clowns use, blown up, then you squeeze around the middle of it - the interior space is reduced. It is often used by ER's before there is a more detailed diagnosis of a patient. The thing about it, as a diagnosis, is that the treatments for it are all very similar, so it works for the ER. SRA is a more specific diagnosis that essentially means a type of asthma that is triggered by exertion - often sports are what people notice it in most, and thus, the name. Has your son ever shown signs of asthmatic problems in other situations - heavy physical work for example?

Your other question was centered around if, left unchecked, are the lungs continually stressed by things such at track practice. Unfortunately, the answer to that is 'yes and no'. Asthmatics usually have to walk a fairly 'fine line' between inducing their asthma due to physical exercise vs. not getting enough exercise by being afraid to trigger an attack. Almost every individual will have different tolerances to their level of exercise. Usually the only way to establish those tolerances is, unfortunately, by trial and error. A useful exercise for your son is to keep a journal for awhile of what activities he's doing when he feels any symptoms. For instance, say he is at track practice three times a week. For a given week, he may feel no symptoms at all for two practices, but on the third, he feels some tightness in his chest. What a journal of that will do will begin to paint a picture of what might be setting him off - weather, other activities, season, temperature, even diet can all contribute to this, and, if the symptoms are bad enough, asthmatics learn what their triggers are. It is important, though, for him to try to keep in good physical shape otherwise, so just not doing the activities can be counter-productive if he is not feeling symptoms or they are not enough to bother him.

Probably the most productive advice I can offer you is to see your family dr. together as a team. Go over the time he spent in ER and continue to work on a diagnosis. If the symptoms become more advanced, he may require a rescue inhaler such as Ventolin to carry with him ( if he doesn't already have one ) or daily medication that helps to strengthen the airways and prevent attacks. Many drs. may suggest two shots of the rescue inhaler BEFORE exercise in order to keep the airways open. That will depend on your son's discomfort due to symptoms mostly.

Good luck and get back to me if you have any more questions!