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PEDIATRICS: CHILDHOOD ASTHMA AND PHYSICAL ACTIVITY

The following points are made by D.M. Lang et al (Pediatrics 2004 113:e341):

1) Asthma is a chronic inflammatory disease of the airways associated with significant medical and social morbidity.(1–3) The National Asthma Education and Prevention Program and the American Academy of Pediatrics include normal activity in their stated goals of asthma therapy.(1,4) With appropriate control, children with asthma can lead normal lives, including participation in physical activity. Physical activity is an important part of both a healthy lifestyle and a child’s daily routine.(5) Development of good health and fitness habits in childhood is associated with physical fitness as an adult.

2) Participation in physical activity is an important part of a child’s normal psychosocial development and self-image. Children should not be excluded from physical activity without a compelling medical contraindication. Physical activity is especially important in children with asthma. Activities such as running and swimming are associated with improved fitness and decreased severity of asthma symptoms. Regular exercise and level of physical conditioning are major determinants of exercise tolerance in children with controlled asthma. Recent studies indicate a comorbidity of asthma and obesity in urban children; however, the direction of the association is uncertain. Regardless of the cause and effect, physical activity is an important contributor to fitness in children with asthma.

3) The physical activity level of children with asthma varies in different studies. In the US, an analysis of the 1988 National Health Interview Survey found that 30% of children with asthma had some parent-reported limitation in physical activity. This analysis of a large data set linked asthma with reported limitations but did not quantify activity or investigate asthma-related predictors of activity. Outside of the US, a survey of school children in New Zealand found that children with asthma were more active than their peers and had favorable attitudes toward physical activity. A survey of students in Norway found no difference in the frequency of activity between children with and without asthma. The authors of the New Zealand study hypothesized an association with a current publicity campaign about the benefits of exercise for people with asthma. Other reports have found that children may have difficulty with specific activities but that asthma did not prevent their overall participation in sports or physical education. In addition to the influences of activity in all children, children with asthma may be influenced by symptoms of bronchospasm, attitudes toward activity, and maternal beliefs about the safety of exercise in children with asthma.

4) The authors report a study to compare the activity of inner-city children with asthma to their peers and to evaluate the factors associated with the activity level of children with asthma. The authors hypothesized that children with asthma are less active than their peers and that a combination of biomedical and psychosocial factors influence their activity level.

5) The authors conclude: Disease severity and parental health beliefs contribute to the lower activity level of children with asthma. Pediatricians should evaluate exercise level as an indicator of disease control and address exercise and its benefits with patients and caregivers to help achieve the goal of normal physical activity in children with asthma.

References (abridged):

1. National Asthma Education and Prevention Program. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. Pub no 97-4051. Bethesda, MD: Department of Health and Human Services, National Institutes of Health; 1997

2. Newacheck PW, Halfon N. Prevalence, impact, and trends in childhood disability due to asthma. Arch Pediatr Adolesc Med. 2000;154:287–293

3. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002;110:315–322

4. American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Metered-dose inhalers for young athletes with exercise-induced asthma. Pediatrics. 1994;94:129–130

5. Sallis JF, McKenzie TL, Alcaraz JE. Habitual physical activity and health-related physical fitness in fourth-grade children. Am J Dis Child. 1993;147:890–896

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