Pathophysiology week 5a

Soccer Cough

As an adult, the benefit of of exercise is you feel good, you look good, and your out look in life is better. If you are a child, all you just want is to play and the benefits wrapped up in having fun. In the following scenario, young Jeremy believes he is not meant to play soccer because he is “not any good”; only to find out this may not be the case.
Jeremy is a 11 y.o. male who has been playing soccer for two years. He wanted to quit soccer last year because according to Jeremy “I am just not any good.” His parents, however, have encouraged him to try playing one more year. His parents are noticing that Jeremy is very tired after soccer and he often falls asleep doing his homework.
While watching soccer practice one day, Jeremy’s mother notices that Jeremy seems to be short of breath and is coughing a lot. He has trouble keeping up with the other boys on the field. She does not think this is normal and makes a doctor’s appointment for Jeremy. The doctor listens to Jeremy’s chest and hears some wheezing. He also does some breathing tests and takes a chest x-ray. The findings are as follows.
The doctor diagnoses Jeremy with exercise-induced asthma (EIA) and sends Jeremy home with a beta2-agonist bronchodilator in an inhaler as well as information on how to control his asthma.
Asthma in itself is an reversible bronchial obstruction affecting the breathing passages of the lungs ( bronchi and bronchioles). Asthma causes inflammation and excessive air way sensitivity to
different triggers such as an inhaled antigen/ mold (extrinsic) or temperature change, exercise,and drugs ( intrinsic) In all asthmatic cases the response is the same. The bronchi and bronchiols respond to the stimuli in each episode with inflammation of the mucosa with edema, contraction of the smooth muscle (broncho spasm), and increase secretion of thick mucus, causing a narrowing of the bronchus (bronchcoconstriction). Each individual has their own triggers. Gould, B. E., p351, 2011)
Exercise-induced asthma (EIA) can occur with people who already have asthma or an independent asthma attack can occur only with exercise in people who have no history of asthma. Accordingly to Asthma and Allergy foundation of America (AAFA), 80-90 % of people who already have asthma will experience EIA with vigorous activity. The trigger in EIA is temperature and humidity. With vigorous activity people need increase oxygen and compensate by mouth breathing with inhalation. This causes cooler and dryer air intake in the lungs. Mouth breathing can also increase the pollutes taken into the lungs. The dry cooler air, decrease humidity, and pollutes can trigger bronchospasm. Common symptoms include coughing, wheezing, chest tightness, and shortness of breath; however coughing may be the only symptom. Symptoms can begin during exercise and become worst 5 -10 minutes after one stops exercising. Resolution of symptoms usually occur 20 -20 minutes after the exercise has stopped, with a few experiencing symptom as late as 4 -12 hours after stopping exercise. (, 2012)
Diagnosis can be made with a thorough history and breathing measurements with a spirometer before, during and after exercise. An oximeter may also be placed on the individual’s finger to monitor oxygen stats before, during and after activity. Peak flow of a person exhale before, during and after exercise can help the physician determine any narrowing of the respiratory airways. A chest x-ray may be done to rule out any other problems. (aafa, 2012)
With proper individual treatment and management, all who experience EIA can continue their exercise regardless of the activity. The magic word is ‘preparation’ and taking steps to prevent symptoms while monitoring the respiratory status before, during, and after exercise. Taking medications before exercise usually prevents EIA. Warm ups prior to activity also helps and for some prevent need for repeated medications The goal is always to prevent an asthma attack, carry on normal activities, maintain normal or near normal lung functions and have as few side effects from medications. (emedicinehealth, 2012)(aafa, 2012)
Medication used for EIA are usually short and long acting beta 2-agonist bronchodilators inhalers. The short acting beta 2- agonist ( also called rescue medication) are used for quick relief of symptoms. One example is albuterol (proventil) 1-2 puffs every 4-6 hours/day ( total of 12 puffs/day) for an adult; for EIA, adult dosage is 2 puffs 5- 30 minutes prior to exercise. The long acting beta 2-agonist helps control symptom of asthma by relaxing thr bronchial tubes or airway s of the lungs. An example of long acting beta 2-agonist is Salmeterol (Serevent) MDI: 2 puffs twice a day (do not exceed) for adult and children 4 years of age and up. For EIA 1 puff at least 30 minutes prior to exercise. (globallrph, 2011)
Like Watty Piper’s “The Little Engine That Could”, Jeremy has a bright future in soccer if he wishes to continue.

Anonymous. (2012). Epstein-Barr Virus Antibodies
Retrieved January 20, 2012, from AAFA website
Anonymous. (2012). Exercise induced asthma
Retrieved January 20, 2012, from emedicinehealth website
Anonymous. (2012). Asthma
Retrieved January 24, 2012, from globalrph website

Gould, B. E.. (2011) Chapter 14
(pp. 351), Path physiology for the Health Professions, 4th Edition. Saunders Learning, printed in United States.

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