Recently, a mother of a 12 year old asthmatic boy, visited my clinic. She was very intelligent and was obviously well read. Our conversation was long, but I am reproducing some parts of it from my memory.

Mother: Doctor, my son wheezes when he goes out to play football. Running clearly aggravates his problem. I should stop him from playing, right ?
Me: NO !! Wrong. Don’t stop him from playing. Control his asthma so that he may play like any normal child. It is very much possible. Exercise is good for health. We should not let asthma come in the way of exercise.

Mother: But Doctor, I have read somewhere that exercise is a trigger of asthma and the general rule for asthmatics is to avoid their triggers.
Me: In general that is correct. Triggers should be avoided; with only one exception. And that is exercise. Many asthmatics, when their asthma is not well controlled, have trouble when they exercise. The reason could be exposure from outdoor pollens, particularly pollens of grass, dust exposure, pollution or the fact that breathing in cold air irritates the inflamed air tubes and they react by constricting. But the solution does not lie in trying to avoid exercise. It lies in controlling the inflammation of their air tubes completely, so that exercise and the associated triggers are now not capable of provoking them.

Mother: Then what should I be doing so that my son can can play normally.
Me: Firstly, keep has asthma under good control by taking the preventer inhalers regularly. If the inflammation in the air tubes is kept under control by these inhalers, then triggers cannot set off an asthma attack. Secondly, know the triggers of your son’s exercise induced attacks – they could be any of the earlier mentioned allergens and take special care. For instance, if he is allergic to grass pollens then indoor sports or swimming could be good for him. On the other hand if he is allergic to chlorine of the swimming pool then he has to avoid swimming. Thirdly, remember that asthmatics tolerate sports with spurts of activity better than those which require sustained exertion ( like long distance running ). Fourthly, remember to ask him to slowly warm up before sports and cool down after sports activity. And lastly, some long acting bronchodilator inhalers (like salmeterol) can be taken about an hour before sports and this can prevent bronco-spasm.

Mother: I have always stopped my son from going out to play. He always feels bad that he cannot play like other kids. But I always thought that it was best for him.
Me: Obviously, you had his best interest in mind. Many a times mothers of asthmatic children impose unnecessary restrictions on their child, hoping that it would reduce the asthma. I see a similar thing happening in case of diet. Don’t eat this, don’t eat that etc !! ##

Mother: Doctor, do you really think that my son can play football like other kids. He really loves football !
Me: Most certainly ! But first be regular with the inhaled preventers. Also, since he has not played much before, he is quite out of shape. Start slowly. Let him get back into shape. Let him slowly build stamina. Then, he will be able to play like any other kid. Don’t be afraid. Let him go. Cut the umbilical cord. Did you know that many sport champions and Olympic athletes have asthma and it does not prevent them from winning gold medals.

So the broad message is clear – asthma triggers are everywhere. While it is desirable to avoid them, it would only be possible to a certain extent. It is equally important to take preventer inhalers to control the over-sensitivity of the air tubes, so that these triggers cannot initiate mischief.