Asthma and Physical Education

Asthma is lung disease characterized by chronic inflammation and subsequent complications. Due to its continued prevalence and severity, it is a major public health concern. An estimated 25.7 million Americans have asthma, corresponding to 8.4% of the population (Slejko, et al., 2014). Asthma is one of the most common childhood diseases, disproportionately affecting urban minorities. Inner city and minority children are more likely to endure more frequent emergency room visits, hospitalizations, and even death from asthma. Additionally, asthma is a leading cause of school absenteeism in the United States, accounting for nearly 13 million missed school days per year. In some urban schools, asthma affects up to 20% of the student population (Jaramillo & Reznik, 2015). Students with chronic asthma demonstrate not only increased absences, but poorer performance on standardized academic tests (Liptzin, et al., 2016). During physical exertion, a condition known as exercise-induced bronchospasm or exercise-induced asthma (EIB) may occur in some children. Symptoms during or after engaging in exercise include cough, wheezing, decreased endurance, chest tightness, and sore throat. Other environmental factors such as air temperature, humidity and intensity of exercise it said to affect the onset of EIB. Students who display these symptoms are often excused from participating in PE (Stelmach, et al., 2016). Several scientific studies revealed children with asthma frequently have a reduced physical activity level and physical condition when compared with children without asthma. On the other hand, other studies could not establish these differences both affected physical condition and activity level. There are several correlated considerations affecting how asthmatic children participate in physical activity. These include the studentr's own belief that their asthma limits their ability to engage in physical activity, as well as misconceptions by both students and parents regarding the relationship between asthma and exercise. The reasons why children with asthma are less active than children without asthma are related to poor management, lack of parental knowledge, limited access to inhalers at school and overly protective parents (Hughes, Ramos, & Mwarumba, 2017). A study affirmed 37% of mothers reported exercise was dangerous for children with asthma, but there was no evidence of a link between the severity of the child's asthma and his or her level of physical activity. Data from Scotland have shown many parents, teachers and administrators felt very anxious about children with asthma being physically active, with physical activity as an apparent threat to asthma regulation (Jago, Searle, Henderson, & Turner, 2017). Increasing evidence indicates a studentr's physical fitness may contribute to the severity of asthma symptoms. The more physically fit students are, the fewer asthma symptoms they are likely to experience. Because of this, physical education classes play a key role in the treatment of asthmatic children. Though children with asthma have a lower health-related quality of life compared with healthy children, it is likely the quality of life in children with asthma could be improved by regular exercise (Wanrooij, Willeboordse, Dompeling, & van de Kant, 2014). Studies have found physical training in asthmatic children had positive results, with no worsening of asthma symptoms or any other adverse effects reported. Asthmatic students who participate in physical training showed striking gains in cardiopulmonary capacity and should be encouraged to participate in a regular exercise program, without fearing symptoms will worsen (Carson, et al., 2013). Studies of asthmatic children have indicated physical activity may even alter the immune response, resulting in a positive anti-inflammatory reaction. (Lochte, Nielsen, Petersen, & Platts-Mills, 2016). Children with asthma do not differ greatly in the overall level of physical activity from children without asthma, but they often participate less in moderate to intense exercise due to common misconceptions about the effects of exercise on their asthma. As a result, children with Asthma prefer mostly activities of mild and moderate intensity (Dimitrakaki, et al., 2013). Physical exercise is safe and is recommended in children with asthma. However, the intensity of the exercise is far more important than the type. PE teachers must monitor the exercise intensity for children with asthma in order to ensure symptoms are kept at bay and maximum health benefits are gained from exercise (Wanrooij, et al., 2014). A connection exists between obesity and asthma. Epidemiologic studies have consistently demonstrated obesity is closely linked to asthma, with obesity typically preceding asthma in children. A recent meta-analysis featuring six relevant studies indicated overweight children exhibited increased incidence of asthma (Chen, et al., 2014). Though exercise may provoke symptoms in children with asthma, treatment with medication such as bronchodilators should be used when needed before physical exercise to prevent exercise-induced asthma (EIB). Besides medication, there are alternative ways to limit EIB, such as breathing through the nose instead of the mouth, or exercising in a warm, humidified environment. Some children may benefit from warm-up exercises before intense physical exercise to further prevent EIB (Wanrooij, et al., 2014). Appropriate asthma management in schools is an important step to ensure children with asthma keep their condition under control. With nurses not always available on school grounds, it is important to have classroom teachers well informed and well trained to manage any potential asthma emergencies (Dimitrakaki, et al., 2013). In order to improve teachers' asthma knowledge and confidence in managing an asthma attack, on going training, especially at the beginning of each school year, may be required. With proper training, teachers could be key contributors in the management of an asthma emergency, especially in schools with limited availability of nurses. An increased knowledge in teachers regarding asthma symptoms, as well as added confidence in managing an asthma attack would result in fewer missed days of school and improved asthma care for students (Jaramillo & Reznik, 2015). Studies indicate, with few exceptions such as those with severe asthma or severe conditions, and as long as their condition is correctly managed; there is no reason why a child with asthma could not be as active as a child without asthma (Jago, et al., 2017). Many physical education teachers do not necessarily know how to correctly use an inhaler, nor do they understand enough about asthma to modify an exercise program or adjust their teaching to accommodate students with asthma (Hughes, et al., 2017). The main methods of managing asthma symptoms involve sitting out during an activity, drinking water, and visiting the nurse. Students often lack awareness or observance to action plans to prevent or control asthma. Students report limited access to medication during school, as well as feelings of embarrassment or shame when having to use medication in front of others. For many students with asthma, the use of medications was associated with unwanted attention (Walker, & Reznik, 2014). School districts are required to provide teachers with pertinent medical information about their students, but the information is not always easily accessible, so it is sensible for teachers to ask for this information themselves from parents at the beginning of each school year. Because of possible life-threatening consequences, all physical educators should have current certification in First Aid and CPR (Jaramillo & Reznik, 2015). Fewer than half of U.S. public schools have full-time nurses, with school nurses covering an average of 2.2 schools each. Consequently, teachers or other school personnel may be required to manage medical emergencies until trained medical help arrives. In physical education, the risk of injury or triggering health emergencies, such as an asthma attack, is higher than in the classroom. Because of this, PE teachers must become cognizant of issues unique to specific disabilities, as ignorance may have tragic consequences (Hughes, et al., 2017). Fear of an asthma attack is one of the main obstacles keeping children and adolescents with asthma from exercising. Consequently, many youngsters with asthma withdraw from exercise as a coping strategy. Despite this, 81% of adolescents with asthma reported exercise to be their most enjoyable activity. Mixed activities, as well as team games appear to achieve the best results, perhaps because of how the fitness aspects of a game are camouflaged by the social and cooperative elements of the game, appearing less intimidating to students with asthma (Winn et al., 2017). It is important for PE teachers to treat asthmatic students as normal, encouraging them to exercise and have fun despite the perceived limitations children with asthma may place on themselves. Programs focusing on active play, cooperative games, or a sports education or teaching games for understanding model have a higher likelihood of succeeding among students with asthma due to how all students are treated fairly and are encouraged to work together with others (Westergren, et al., 2016). In conclusion, the writer found that despite misconceptions surrounding the relationship between asthma and exercise, students with asthma could benefit greatly from participating in regular physical activity in the form of physical education class. Contrary to popular belief, students with asthma, except for the most severe cases, do not need to sit out of PE, but merely need to be monitored, with the exercise intensity perhaps adjusted. PE teachers, however, must understand the need for students with asthma to feel normal. As asthmatic students participate in a variety of activities as part of PE, they will become more confident in their ability to maintain a certain level of exertion, as well as get acquainted with their comfort level and better understand how their body reacts to exercise. PE teachers must make every effort to educate themselves about asthma, as well as be CPR certified, considering they may be called upon in the event of an emergency such as an asthma attack Though students with asthma may initially feel like they should not participate in PE, physical educators should take an active role in helping students with asthma understand the benefits of physical exercise while allowing them to fully experience PE without limitations, but rather small modifications in the intensity of certain activities.

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