Asthma and Physical Education
For children with asthma, physical education classes can sometimes be intimidating. What if they can't run very far? Will the other kids laugh at them when they take their medication? Will their teacher scold or belittle them because they are not participating? The list can go on. But a number of actions can be taken to make sure the child with asthma gets to participate as much as possible in her physical education classes and other recreational school activities.
To help avoid problems in school associated with physical education, parents should make sure that a copy of the child's asthma management plan is available to physical education teachers and coaches, with their roles clearly identified in helping to manage your child's asthma.
Asthma Management Plan
Supporting your child's efforts to follow her asthma management plan is an important step to keep her participating in physical education activities at her school. Your child needs sensitivity and understanding from both her teachers and other students in dealing with her asthma. If your child is teased about her asthma, she may avoid using her medication when she needs it or may skip her physical education class. Or if she is told to “tough it out” in a physical education class, she may risk health problems or just give up entirely.
If peer pressure is a problem, parents can suggest that the school use an asthma awareness curriculum (developed by the National Heart, Lung, and Blood Institute) that teaches children from kindergarten to sixth grade about asthma and how they can offer support to children rather than barriers.
Working with Teachers and Coaches
At school or perhaps on a sports team, your child could encounter questions from teachers or coaches when he declines to participate in an exercise or sport because of asthma symptoms. While it is important that teachers and coaches respect the child's report of his own condition, it also is important that you keep lines of communication open with them.
If your child is asking on a regular basis to be excused from physical education class or recess, a real physical problem may be present that needs to be addressed. Or maybe your child could use additional assistance and support from his teacher or coach that would let him become a more active participant.
Teachers and coaches can play important roles by talking with your child and learning his concerns about asthma and exercise. They should be able to reassure him they understand his condition and have a shared understanding about the conditions that require activity modifications or medications. They should respect his limits.
To improve the experience of your child with asthma, find out if his teachers and coaches are doing the following:
Including adequate warm-up and cool-down periods with the activity.
Consulting with either you or your child's asthma management plan on the type, length, and frequency of any limitation.
Observing for asthma symptoms (such as wheezing, coughing, or chest tightness).
Encouraging the child to monitor his peak flow if he uses a peak flow meter.
Monitoring the surrounding environment — and consider a temporary change of location — for potential allergens and irritants, such as a recently mowed field or pollen; poor air quality; extreme weather conditions; or possible interior conditions that could promote asthma symptoms, such as a refinished gym floor.
Making exercise modifications when needed (such as permitting a child to walk or walk/run if running is scheduled).
Keeping a child involved if temporarily unable to participate. (For instance, asking a student to be a scorekeeper, timer, or equipment handler until he returns for full participation.)
Teachers and coaches should recognize symptoms of exercise-induced asthma, and be ready to take action if it occurs. You should make sure that your child's asthma plan and the school's emergency plan are easily accessible so that they know what to do and take appropriate action if your child shows the following symptoms while exercising: coughing, wheezing, pain or chest tightness that may last several minutes to an hour or more. They should know that these symptoms are very different from breathlessness and deep, rapid breathing usually seen after an aerobic exercise that quickly returns to normal in children without asthma symptoms.
Once the child stops the activity that is causing symptoms, the asthma management plan should be followed. Assistance should be provided with medication, if necessary.
Teachers and coaches should observe if an emergency is occurring and if it's necessary to call for medical help. The symptoms indicating an emergency are: The child is hunched over with shoulders lifted — struggling to breathe; the child has difficulty completing a sentence and takes breaths between words; and the child's lips or fingernails turn blue.
Also keep in mind how environmental factors on the school playing fields might trigger — and even worsen — your child's exercise-induced asthma symptoms. For instance, insecticides, pesticides, fertilizers, and herbicides used to maintain playing fields might cause symptoms to appear. Paints and other decorative materials that enhance the appearance of playing fields could trigger symptoms as well.
Access to Medication
Many children with asthma require two different medications:one that they can use for daily control and prevention, and the other to treat and relieve symptoms. Generally, the longer-acting bronchodilator sprays can last up to twelve hours — precluding the use of the shorter-acting sprays.
However, short-term inhaled medication still could be needed by your child — sometimes about fifteen minutes before physical education class or recess. In this instance, if accessing the medication is difficult during the school day or is inconvenient or embarrassing, your child may get discouraged and fail to use the inhaler as needed. Then, her asthma could get worse and her exercise and physical activities could be unnecessarily restricted.
Most states now have passed legislation that does permit children to carry their daily inhalers with them at all times at appropriate ages. (See Chapter 11.)
Monitoring Peak Flow
Aside from watching for symptoms, your child can use a peak flow meter to monitor for signs of exercise-induced asthma. The peak flow meter is a hand-held device that measures how fast air is blown out of the lungs: The peak flow number will drop when your child's lungs are congested. A sharp drop in the peak flow number may signal that extra medicine or a brief rest during exercise is needed.
A peak flow meter can be an objective way to make decisions about participation in sports or physical education class. Sometimes, teachers or coaches may not fully understand the impact of asthma on an athlete: Some may prohibit an athlete from participating while others may push for them to keep up with their peers. A peak flow meter can help take away some the confusion.