xpost - Exercise Induced bronchiospasms

[OneStepAtATime]

My DS (9) who has allergies but no real breathing issues to indicate asthma has started wheezing during karate instruction.  He did not do this before, but is doing it now, and pretty consistently.  4-5 things happened about the same time so I don't know how many of these are a factor or all of them or something else...

 

1.  He had a respiratory infection (the first one in a couple of years) right before Christmas and was sick for over two weeks.

2,  He was on hiatus from karate for several weeks over the holidays while they remodeled so he wasn't getting the same amount of exercise that he had been.

3.  The building has now been remodeled and smells differently and probably still has some particles floating about that would not normally be there (the building is about 15 years old).

4.  He moved up a belt and is doing more intense workouts now.

5.  He has seasonal allergies and this season we have all been sneezing a bit and coughing some.

 

In his last class the wheezing was so bad that they pulled him out, gave him oxygen from an oxygen tank and had him sit the rest of the class.  When he is home and doing his workouts he does not seem to have wheezing issues, though.  When I took him to the doctor today, after a cursory examination, she determined he probably has "exercise induced bronchiospasms".  She is putting him on an inhaler to be used before any heavy exercising.  I like our ped and what she said made sense, but she has misdiagnosed in the past or completely missed things altogether  so now I thought I would throw it out to the Hive in general and cross post it here to see what others thought.  We don't have many other options for peds that I would even consider going to, so getting a second opinion would not necessarily be a useful option.  I was just wondering if this sounded reasonable and if this means he may be on an inhaler forever...?

[geodob]

I would raise a serious question about the 'particles floating in the remodeled building'?

Also the different 'smells'?

Especially as when he does the workouts at home, he doesn't seem to have wheeze issues.

 

 

[Heathermomster]

Maybe get a 2nd medical opinion. Did the ped make the diagnosis? I'm wondering because when DS younger, he saw a pediatric pulmologist for his asthma.

[OneStepAtATime]

I would raise a serious question about the 'particles floating in the remodeled building'?

Also the different 'smells'?

Especially as when he does the workouts at home, he doesn't seem to have wheeze issues.

This actually is concerning me more than it seems to bother anyone else (including DH).

 

Maybe get a 2nd medical opinion. Did the ped make the diagnosis? I'm wondering because when DS younger, he saw a pediatric pulmologist for his asthma.

Yes, our ped did the diagnosis.  People just don't head to specialists much with children down here.  Therefore when you do go to a specialist, many have not dealt much with children and their diagnosis isn't always terribly accurate for kids.  I will ask around for someone that has experience specifically with children.  DH thinks DS is just being a bit overly dramatic when he starts to breath heavy and the instructor is over reacting.  I don't know.  I will be sitting through the entire class when he goes back, but he isn't going back until next week.  Still pondering this.  DS loves his karate instructors and the younger one especially has really helped turn around a lot of DSs coordination issues for whole body movements so if it IS the location remodel that could be an easy fix, but a painful and disappointing one...

[8filltheheart]

I have a dd with exercise induced asthma. She doesn't always need the inhaler, but when she does, she does. #4, intense workouts, is the main trigger for her.

[OneStepAtATime]

I have a dd with exercise induced asthma. She doesn't always need the inhaler, but when she does, she does. #4, intense workouts, is the main trigger for her.

Can you tell ahead of time when she is starting to struggle?  How does it start?  Does your child start with very mild symptoms?  

 

I am wondering if DS was having issues before and they just weren't pronounced enough to be noticed by the instructor.  Since he practices and does P.E. in shorter stints here at home, maybe he wasn't having this issue in a pronounced way during home exercising and we weren't in the karate class enough to notice...While parents can be in the class, the instructors prefer that they watch through the glass so as not to distract the students.  I think the remodel definitely contributed significantly to what is happening, but I am wondering if there was an issue before...

 

DS isn't always easy to read.  For instance, he had pneumonia as a 2 year old (nearly 3) and said nothing, did not seem to be in difficulties at all, but at church he was running across the playground one day trying to catch up to his older sister and got winded.  After a couple of hours he was still winded and mentioned it was not easy to catch his breath.  Within an hour of that statement his breathing deteriorated further and we took him to an emergency clinic since it was after hours.  His lungs were filling with fluid and he had probably been sick for days but really showed no signs...

[8filltheheart]

With my dd, the instructors push probably at a pt where at home she follows her body's natural indicators that it is time to back off a little.

 

She now takes 1 or 2 puffs before she even starts the intense workouts. It is what our dr advised. It has been the right decision for her. I can only think of 2 times where she progressed into an attack with this approach and both times she'd something respiratory going on anyway.

 

(Fwiw, her attacks happened before in completely different environments. Figure skating (competitively and intense practice) and in kickboxing. We definitely could not say it was the environment. But in both cases she had coaches that pushed her to her limit.

[OneStepAtATime]

With my dd, the instructors push probably at a pt where at home she follows her body's natural indicators that it is time to back off a little.

 

She now takes 1 or 2 puffs before she even starts the intense workouts. It is what our dr advised. It has been the right decision for her. I can only think of 2 times where she progressed into an attack with this approach and both times she'd something respiratory going on anyway.

 

(Fwiw, her attacks happened before in completely different environments. Figure skating (competitively and intense practice) and in kickboxing. We definitely could not say it was the environment. But in both cases she had coaches that pushed her to her limit.

Thanks for explaining your experience.  Appreciate it.  :)

[Incognito]

I had problems with this some as a child (and do occassionally now as an adult when I am coming down with something - so it doesn't seem like I am sick but my body is already fighting).

 

It is hard to say if it would be environmental or not.  I would suppose that if you treat it as the doctor has suggested, and the treatment doesn't work, it is likely environmental factors.

 

I was never given oxygen at any event or place -I wonder a bit about that- was he turning blue?  What did he feel and sound like?  If stopping the exercise and resting didn't solve the problem, it makes me wonder about the exercise having really been the problem in the first place.

 

Can you run your son around the block a few times and see what happens?  How does he sound?  How does he feel?  Increased phlegm?  Tightness?  How deep of breaths can he take before and after doing it?  If it is the karate locale and not the exercise, exercising him somewhere else might help you discern if it really is just the exercise that is causing the issue.

 

 

 

[OneStepAtATime]

I had problems with this some as a child (and do occassionally now as an adult when I am coming down with something - so it doesn't seem like I am sick but my body is already fighting).

 

It is hard to say if it would be environmental or not.  I would suppose that if you treat it as the doctor has suggested, and the treatment doesn't work, it is likely environmental factors.

 

I was never given oxygen at any event or place -I wonder a bit about that- was he turning blue?  What did he feel and sound like?  If stopping the exercise and resting didn't solve the problem, it makes me wonder about the exercise having really been the problem in the first place.

 

Can you run your son around the block a few times and see what happens?  How does he sound?  How does he feel?  Increased phlegm?  Tightness?  How deep of breaths can he take before and after doing it?  If it is the karate locale and not the exercise, exercising him somewhere else might help you discern if it really is just the exercise that is causing the issue.

Good points.  We did have him do some more vigorous exercises at home to see if we could trigger the same response, but we did not have him do really intense aerobics for an extended period of time.  I did talk to the main instructor again today and things are a bit clearer.  His son was doing the instruction and when DS started wheezing it was during some really intense, extended aerobic warm ups, not during the normal karate practice.  He had DS go sit, but walking to go sit the wheezing sounded like it was getting worse.  He didn't actually give him a chance to sit down and see if that helped.  Since they have the oxygen on hand for the main instructor's wife (the younger instructor's mother), he had him breath in the oxygen a couple of times to try and help.  Apparently DS HAS been "wheezing" during the intense aerobic workouts lately but usually does pretty well once they switch to normal karate routines.  I think the younger instructor overreacted with the oxygen, but I wasn't there.  Maybe he was in more distress than DS believes he was.  Even if the instructor did overreact, if DS is "wheezing" during aerobic workouts, there is obviously something at issue.  Asthma runs in DH's side of the family and even a couple of members of my family use inhalers periodically.  We will start with the inhaler this week and see if it addresses the issues, but I will also have DS do some intense, extended aerobic work here at home to see if the wheezing happens away from the other location.  Thanks for the input.

[geodob]

As it only seems to occur with intense aerobic exercises?

Perhaps you could do a simple test with him?

It just involves asking him to take a few deep breathes, and observing where he breathes into?

The basic thing to look for, is whether he breathes into his belly and extends his abdomen ?

Or if he breathes into his shoulders, and his shoulders raise as he breathes in?

 

The crucial issue, is if he is a 'shoulder breather', and his shoulders rise.

The problem with shoulder breathing, is that only a small volume of air can taken into the upper chest.

Which becomes a major problem with intense activity, where rapid breathing is only way to try and cope.

Though rapid breathing is also associated with anxiety, and can trigger it.

 

So maybe you could try this, and observe whether he is a shoulder or belly breather?

Where shoulder breathing can be corrected, just by practicing belly breathing and developing it as a normal way of breathing.

 

[OneStepAtATime]

As it only seems to occur with intense aerobic exercises?

Perhaps you could do a simple test with him?

It just involves asking him to take a few deep breathes, and observing where he breathes into?

The basic thing to look for, is whether he breathes into his belly and extends his abdomen ?

Or if he breathes into his shoulders, and his shoulders raise as he breathes in?

 

The crucial issue, is if he is a 'shoulder breather', and his shoulders rise.

The problem with shoulder breathing, is that only a small volume of air can taken into the upper chest.

Which becomes a major problem with intense activity, where rapid breathing is only way to try and cope.

Though rapid breathing is also associated with anxiety, and can trigger it.

 

So maybe you could try this, and observe whether he is a shoulder or belly breather?

Where shoulder breathing can be corrected, just by practicing belly breathing and developing it as a normal way of breathing.

Thanks geodob.  I will test that.