There is evidence that the fitter you are, the better your asthmatic control is, although if you start out unfit, the process of becoming fit can be quite uncomfortable.

Asthma is becoming more common worldwide, and no-one is quite sure why. It may simply be that the disease is recognised more easily now and so is being diagnosed more often. Or it may be that increasing air pollution or changes in world flora are offering more irritants to those with irritable airways, leading to asthma.

Most asthmatics have certain trigger factors which they can recognise easily, such as smoke, anxiety, and animal fur. Some have exercise induced asthma, either as their only type of asthma, or as one of their trigger factors. It usually requires fairly vigorous aerobic activity to trigger the classical wheezy chest of an asthmatic in exercise-induced asthma.

How should an asthmatic exercise?

Asthma is not an uncommon illness among world class athletes. How does someone with asthma even start to exercise if they are breathless and wheezy to start out with?

The first thing to do is to make sure that your asthma is as well controlled as possible. Unfortunately too many people, and that includes doctors, believe that an asthmatic must necessarily have a certain amount of discomfort, even if treated. Except in very severe cases, this is not true.

Current treatment guidelines state categorically that, unless someone only suffers symptoms very occasionally, they should be on regular inhaled steroids. This means daily ? whatever the state of your chest. Even if you are feeling fine, you use your inhaled steroids!

There are many to chose from, all at varying prices, and so what your doctor prescribes will probably depend on whether or not you have medical aid. There are now good generic products which allow asthma to be properly treated without it costing a fortune. Children should also use inhaled steroids. Long-term studies have shown that there are no deleterious effects on growth with their use.

The long acting bronchodilators such as Serevent? (salmeterol), although very expensive, are being more widely used as well. They allow control through the whole 24 hour period with only twice daily dosing.

The newer leukotriene antagonists such as monteleukast are not yet available in South Africa, but seem to be effective, although they must still be used along with inhaled steroids.

Starting an exercise programme

So, now you have managed to get the correct treatment for your asthma, and you are feeling a lot better. How should you approach getting fit?

If you have not exercised regularly, then the answer is the same as for any relatively unfit person ? slowly. You must take the time to warm up properly before exercising. If you have a longish period of low-intensity exercise, this will prepare you for higher intensity exercise.

Exercise towards the lower end of your target heart rate, or if you are not using a heart rate monitor, then make sure you are still feeling comfortable.

If all you are doing is trying to improve your fitness then stick to low-intensity exercise such as walking or slow, long-distance swimming. Build up slowly, increasing distance and speed over a period of weeks. If you are getting fitter, then you should find that your chest feels more comfortable at all times, and that exercise does not lead to wheezing and breathlessness.

If you want to get into something more vigorous such as running and cycling, then you must still start slowly, or you will be so uncomfortable that you will put yourself off. Running is actually the worst type of exercise for an asthmatic, since, even for people with normal lung function, the early stages can be positively unpleasant!

Take it slowly. Set yourself a realistic training target (visit our Running section), and when you feel the need to walk, do so. Even non-asthmatics wheeze when they start running, so don't be put off.

Cycling is a good sport for asthmatics since it does not have the weight bearing that you have with running, so it causes less discomfort in the early stages of getting fit. It is still excellent aerobic exercise, and as such will improve your fitness sufficiently to improve your asthma control. It is perfectly possible to cycle long distances as an asthmatic ? I cycle the Cape Argus Pick 'n Pay Cycle Tour every year and enjoy it.

If you are just starting out and are not training for a specific cycling event, then stick to steady cycling along fairly flat routes. Leave the hills until you feel comfortable on the flat at a reasonable speed. When you first tackle hills you will feel wheezy and breathless, but that is probably due to lack of fitness, rather than acute asthma! Take it slowly, and stop at intervals to get your breath back. Keep at it. Hill training will improve your strength generally and will be of the most benefit to your lungs long-term.

If your asthma is definitely exercise-induced, then take two puffs of salbutamol before you start. Those on long-acting bronchodilators may not need to do this, but carry a salbutamol inhaler with you in case you need it.

If, after some time in an exercise programme you are still not noticing an improvement in your asthma, then see your doctor again. You may not be on the correct treatment.

Being asthmatic does not mean that you are restricted to an inactive lifestyle. On the contrary, you are condemning yourself to a more uncomfortable life, with less control of your illness, if you don't do any exercise at all. Find an exercise which you enjoy, do it regularly, and enjoy the benefits of improved health.